Zusammenfassung
Zystische Läsionen des Pankreas sind häufig und werden zunehmend als Zufallsbefunde
bildgebender Diagnostik entdeckt. Im Gegensatz zu anderen parenchymatösen Organen
sind dysontogenetische Pankreaszysten sehr selten. Unter den Zufallsbefunden dominieren
zystische Neoplasien unterschiedlichen Malignitätsrisikos, bei symptomatischen zystischen
Pankreasläsionen handelt es sich dagegen überwiegend um akute oder chronische Pseudozysten.
Die Endosonografie spielt neben anamnestisch-klinischen Kriterien in der differenzialdiagnostischen
und prognostischen Charakterisierung eine herausragende Rolle. In einer Sitzung sind
morphologische Beurteilung, Darstellung der Vaskularisation und Feinnadelaspiration
von Zysteninhalt, Zystenwandung und soliden Anteilen möglich. Dennoch können Differenzialdiagnose
und Entscheidungsfindung über das weitere Vorgehen im Einzelfall erhebliche Probleme
aufwerfen, die in dieser Übersicht diskutiert werden. Es wird ein evidenzbasierter
diagnostischer Algorithmus für zystische Pankreasläsionen vorgestellt.
Abstract
Pancreatic cystic lesions are common. They are increasingly detected as a finding
of radiological imaging. In contrast to other parenchymal organs in the pancreas dysontogenetic
cysts are extremely rare. The majority of incidental cystic lesions are neoplasms
which own different risks of malignancy. In symptomatic patients the most frequent
cystic pancreatic lesions are acute and chronic pseudocysts. In addition to clinical
criteria endoscopic ultrasound has an outstanding role in the differential diagnosis
and prognostic characterization of pancreatic cystic lesions. In one examination it
is possible to perform morphological description, perfusion imaging, and fine-needle
aspiration of cyst content, cyst wall and solid components. Nevertheless, in several
cases differential diagnosis and management decisions may prove difficult. This review
will discuss problems in and approaches to endosonographic diagnosis of cystic pancreatic
lesions. An evidence-based algorithm for diagnosis of pancreatic cystic lesions is
introduced.
Schlüsselwörter
Endosonografie - abdominelle Sonografie - kontrastverstärkte Sonografie - EUS - EUS-FNA
- zystische Pankreasläsion - seröse zystische Neoplasie - Zystadenom - muzinöse zystische
Neoplasie - intraduktale papillär-muzinöse Neoplasie
Key words
endoscopic ultrasound - transabdominal ultrasound - contrast-enhanced ultrasound -
EUS - EUS-FNA - cystic pancreatic lesion - serous cystic neoplasm - mucinous cystic
neoplasm - intraductal papillary mucinous neoplasm
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Dr. med. Christian Jenssen
Klinik für Innere Medizin · Krankenhaus Märkisch Oderland
Prötzeler Chaussee 5
15331 Strausberg
Telefon: +49 / 33 41 / 52 08 22
Fax: +49 / 3 34 56 / 4 03 02
eMail: c.jenssen@khmol.de
