Zusammenfassung
Die Vorläuferläsionen der pankreatobiliären Karzinome sind entweder zystisch oder flach. Zu den zystischen Vorläufern des Pankreaskarzinoms gehören die muzinös zystische Neoplasie und die intraduktal papillär muzinöse Neoplasie (IPMN). Das Gegenstück im Gallengang stellt die intraduktal papilläre Neoplasie (IPN) dar. In den zystischen Vorläuferläsionen ist eine Adenom-Karzinom-Sequenz erkennbar, welche meistens auf dem Boden 4 histogenetisch unterschiedlicher Zelltypen entsteht: pankreatobiliär, onkozytär, intestinal und gastrisch. Diese Subtypen der IPMN/IPN sind morphologisch und immunhistochemisch gut charakterisiert und haben eine klinische Relevanz durch ihre unterschiedliche Prognose: Der gastrische Subtyp hat die beste Prognose, gefolgt vom intestinalen und onkozytären Typ, die schlechteste Prognose weist der pankreatobiliäre Typ auf. Die pankreatische intraepitheliale Neoplasie (PanIN) und die biliäre intraepitheliale Neoplasie (BilIN) repräsentieren die flachen Vorläuferläsionen. Die PanIN sind morphologisch und molekularbiologisch gut charakterisiert. PanIN mit lobulozentrischer Atrophie wurde vor Kurzem als eine weitere potenzielle Vorläuferläsion des Pankreaskarzinoms beschrieben. Die BilIN sind morphologisch gut definiert, allerdings sind die zugrunde liegenden molekularen Veränderungen nur wenig erforscht.
Abstract
Precursor lesions of pancreatobiliary cancer can be divided into cystic and flat lesions. Mucinous cystic neoplasm and intraductal papillary mucinous neoplasm (IPMN) comprise the cystic precursors in the pancreas, while intraductal papillary neoplasm (IPN) represents their counterpart in the bile duct system. There is an adenoma-carcinoma sequence in the cystic precursors arising from four different types of epithelia: pancreatobiliary, oncocytic, intestinal and gastric. These subtypes of IPMN/IPN are morphologically and immunohistochemically well characterised and show clinical and prognostic relevance: the gastric subtype is associated with the best prognosis, followed by the oncocytic and intestinal subtypes, while the pancreatobiliary subtype is characterized by adverse clinical behaviour. Pancreatic intraepithelial neoplasia (PanIN) and biliary intraepithelial neoplasia (BilIN) represent the flat precursors. PanIN are morphologically and biologically well defined. PanIN with lobulocentric atrophy has recently been described as a putative precursor of pancreatic cancer. Despite well defined morphological features in BilIN, the molecular alterations seen during early tumor progression in the biliary tract are poorly understood.
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Sipos, B., Henopp, T. Vorläuferläsionen pankreatobiliärer Karzinome. Pathologe 32 (Suppl 2), 224 (2011). https://doi.org/10.1007/s00292-011-1513-4
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DOI: https://doi.org/10.1007/s00292-011-1513-4
Schlüsselwörter
- Vorläuferläsion
- Pankreaskarzinom, duktales
- Gallengangskarzinom
- Intraepitheliale Neoplasie
- Neoplasien, zystische, muzinöse und seröse