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Zystische Raumforderungen des Pankreas

Differenzialdiagnostik und Therapie

Cystic lesions of the pancreas

Differential diagnostics and treatment

  • Schwerpunkt: Erkrankungen des Pankreas
  • Published:
Der Internist Aims and scope Submit manuscript

Zusammenfassung

Zystische Raumforderungen des Pankreas werden in den meisten Fällen als Zufallsbefund detektiert. Aufgrund des potenziellen Risikos einer malignen Transformation sind oft eine weiterführende Diagnostik und eine Überwachung der Patienten notwendig. Bevor die Patienten in ein Überwachungsprogramm aufgenommen werden, muss die klinische Gesamtsituation einschließlich des Alters, der Komorbiditäten und des Patientenwunschs nach ausführlicher Aufklärung berücksichtigt werden. Bisher gibt es keine zuverlässigen Biomarker, die das Risiko einer malignen Transformation sicher vorhersagen. Bei den bildgebenden Verfahren ist die Magnetresonanztomographie/Magnetresonanzcholangiopankreatikographie der Computertomographie hinsichtlich der Genauigkeit in der Darstellung von „besorgniserregenden“ Veränderungen überlegen. Der endoskopische Ultraschall wird komplementär eingesetzt und kann durch den Einsatz von Kontrastmittel bzw. durch eine diagnostische Punktion der zystischen Raumforderung zusätzliche Informationen liefern, die das therapeutische Vorgehen beeinflussen. Vor allem bei den häufigsten zystischen Neoplasien, den intraduktalen papillär-muzinösen Neoplasien (IPMN), existieren teilweise divergierende Empfehlungen und Strategien in Überwachung und Management. Unstrittig ist, dass IPMN vom Hauptgang- und gemischten Typ reseziert werden sollten. Zusätzlich bestehen relative Indikationen für eine operative Versorgung von IPMN bei Risikokonstellationen. Für alle zystischen Pankreasraumforderungen gilt, dass die Fälle in einer interdisziplinären Expertenrunde unter Beteiligung von Gastroenterologen, Viszeralchirurgen, Radiologen und Pathologen besprochen werden sollten, um die optimale patientenorientierte Therapiestrategie empfehlen zu können.

Abstract

Cystic space-occupying lesions of the pancreas represent incidental findings in most cases. As there is a potential risk of malignant transformation further evaluation of the lesions as well as a follow-up of these patients is usually recommended. Before this work-up is initiated the clinical situation of the patient as a whole and comorbidities, age and personal preferences have to be taken into account. So far there are no biomarkers that reliably predict the risk of malignant transformation. Imaging by magnetic resonance tomography (MRI) in combination with magnetic resonance cholangiopancreatography (MRCP) is more accurate than computed tomography to identify worrisome features. During follow-up, endoscopic ultrasound (EUS) can be used as complementary method to MRI/MRCP. Using contrast enhancement or endoscopic fine needle aspiration (EUS-FNA) may influence the therapeutic strategy in some patients. Whereas for some cystic pancreatic lesions consensus has been reached, varying recommendations exist for intraductal papillary mucinous neoplasms (IPMN). There is consensus that in main-duct as well as in mixed-type IPMN surgery is recommended. The management of branch-duct type IPMN, however, remains controversial. A multidisciplinary expert panel including gastroenterologists, visceral surgeons, radiologists and pathologists is essential to discuss all cases of patients with cystic pancreatic lesions and to guarantee an optimal, patient-centered treatment recommendation.

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Authors and Affiliations

  1. Klinik für Innere Medizin I, Universitätsklinikum Halle (Saale), Ernst-Grube-Str. 40, 06120, Halle (Saale), Deutschland

    J. Rosendahl & P. Michl

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  1. J. Rosendahl
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Correspondence to J. Rosendahl.

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Interessenkonflikt

J. Rosendahl und P. Michl geben an, dass kein Interessenkonflikt besteht.

Dieser Beitrag beinhaltet keine von den Autoren durchgeführten Studien an Menschen oder Tieren.

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M. Lerch, Greifswald

J. Mössner, Leipzig

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Rosendahl, J., Michl, P. Zystische Raumforderungen des Pankreas. Internist 60, 219–225 (2019). https://doi.org/10.1007/s00108-018-0547-6

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  • DOI: https://doi.org/10.1007/s00108-018-0547-6

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