Intraduktale papillär-muzinöse Neoplasien (IPMN) des Pankreas – Standards und neue Aspekte

Zusammenfassung

Die intraduktalen papillär-muzinösen Neoplasien (IPMN) des Pankreas gehören zur heterogenen Gruppe der zystischen Pankreasläsionen und werden mit zunehmender Häufigkeit diagnostiziert. Die Diagnosesicherung und Abklärung der Differenzialdiagnosen (Pseudozysten, serös-zystische Neoplasien [SCN], muzinös-zystische Neoplasien [MCN], intraduktale papillär-muzinöse Neoplasien [IPMN] und solid-pseudopapilläre Neoplasien [SPN]) sind häufig nicht einfach. IPMN werden als Vorläuferläsionen für die Entstehung eines Pankreaskarzinoms angesehen, wobei sich je nach morphologischem (Hauptgang- oder Nebengang-IPMN) bzw. histologischem Typ (intestinal, pankreatobiliär, onkozytisch, gastrisch) ein unterschiedliches malignes Potenzial ergibt. Die frühzeitige Diagnose und die Wahl des geeigneten Therapieverfahrens sind entscheidend für die Heilung. Konsens besteht über die Indikation zur Resektion aller Hauptgang-IPMN, da die Rate an malignen Befunden sehr hoch ist. Eine Befundkontrolle und Beobachtung ist nur für kleine Nebengang-IPMN ohne Anzeichen für Malignität zu empfehlen. Das zunehmende Verständnis der Histopathologie und Tumorbiologie von IPMN hat zu einer Novellierung der 2006 von der International Association of Pancreatology (IAP) aufgestellten Leitlinie geführt. Empfehlungen bez. der Beobachtung oder Nachsorge von Nebengang-IPMN können anhand der aktuellen Datenlage nicht eindeutig gegeben werden.

Abstract

Intraductal papillary mucinous neoplasms (IPMN) of the pancreas belong to the heterogeneous group of cystic pancreatic lesions and have been diagnosed more frequently in recent years. Diagnosis and differentiation from other cystic lesions (pseudocysts, serous-cystic neoplasias [SCN], mucinous-cystic neoplasias [MCN], intraductal papillary-mucinous neoplasias [IPMN] and solid pseudopapillary neoplasias [SPN]) is often challenging. IPMN of the pancreas are considered as precursor lesions for the development of invasive pancreatic cancer. However, depending on the morphological (MD-IPMN, BD-IPMN) and histological subtype (intestinal, pancreatobiliary, oncocytic or gastric) the malignant potential of IPMNs varies significantly. Hence, early diagnosis and selection of the appropriate therapeutic strategy is necessary for optimal outcome and cure. There is a strong consensus for the resection of all MD-IPMN. Small BD-IPMN without signs of malignancy can be followed by observation. The increasing understanding of the histopathology and tumour biology of IPMN has led to an amendment of the 2006 International Association of Pancreatology (IAP) guidelines for the treatment of cystic pancreatic tumours. In consideration of recent data, recommendations for observation and/or follow-up of IPMN cannot be given definitely.

Schlüsselwörter

IPMN - Pankreaskarzinom - Pankreaschirurgie - zystischer Pankreastumor - Prognose

Key words

IPMN - pancreatic cancer - pancreatic surgery - cystic pancreatic tumour - prognosis

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