Differenzialdiagnose und radiologisches Management von zystischen Tumoren des Pankreas

Zusammenfassung

Zystische Pankreasläsionen werden oftmals als asymptomatischer Zufallsbefund und in deutlich zunehmender Häufigkeit entdeckt. In den letzten Jahren hat sich ein deutlich differenzierteres Verständnis dieser Tumoren entwickelt Das Spektrum der relevanten Läsionen umfasst insbesondere die intraduktal papilläre muzinöse Neoplasie (IPMN), die seröse zystische Neoplasie (SZN) und die muzinöse zystische Neoplasie (MZN). Diese Tumoren lassen sich mit sicheren Kenntnissen über den histologischen und bildmorphologischen Aufbau sowie Lokalisations-, Alters- und Geschlechtsverteilung gut differenzieren und von der häufigen Pankreaspseudozyste abgrenzen. Dies schließt auch ein grundlegendes Verständnis komplementärer endoskopischer Verfahren wie der Endosonografie mit der Möglichkeit der Aspiration des Zysteninhalts ein. Viele der zystischen Pankreastumoren zeigen das Potenzial zur malignen Transformation entlang einer Adenom-Karzinom-Sequenz und erfordern deshalb eine differenzierte Betrachtungsweise des radiologischen Managements dieser Läsionen. Die vorliegende Übersicht soll ein breites Verständnis pathologischer und bildmorphologischer Charakteristika von zystischen Pankreastumoren entwickeln und gibt Empfehlungen zum Vorgehen insbesondere bei inzidentell detektierten Läsionen.

Abstract

Cystic pancreatic lesions are often discovered incidentally as an asymptomatic finding, at a rate which is increasing considerably. In recent years the understanding of such tumors has become clearly differentiated. The spectrum of relevant lesions includes in particular the intraductal papillary mucinous neoplasm (IPMN), serous cystic neoplasm (SCN) and mucinous cystic neoplasm (MCN). With certain knowledge of their histological and radiomorphological structure as well as their distribution in terms of location, age and sex, such tumors are easy to differentiate and demarcate from common pancreatic pseudocysts. This also implies the fundamental understanding of complementary endoscopic procedures such as endosonography, which enables aspiration of the content of the cyst. A number of cystic pancreatic lesions have the potential to undergo malignant transformation along the adenoma-carcinoma sequence and therefore necessitate a differentiated approach to their radiological management. This review aims to develop a broad understanding of the pathological and radiomorphological characteristics of cystic pancreatic lesions and provides advice regarding procedures, particularly with respect to incidentally detected lesions.

Key words

abdomen - pancreas - CT - MR imaging

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