Zystische pankreastumoren: Diagnostik und therapie

Cystic pancreatic tumors encompass various different disease entities with distinct clinical, morphological, and prognostic characteristics. Due to an increasing awareness and improved imaging modalities, cystic lesions are increasingly diagnosed. Despite a wide spectrum of etiologies, 95% of cystic tumors are caused by 5 entities: pancreatic pseudocysts, intraductal papillary mucinous neoplasms (IPMN), mucinous cystic neoplasms (MCN), serous cystic neoplasms (SCN), and solid-papillary neoplasms (SPN). The differentiation of non-neoplastic and neoplastic cystic lesions and of serous and mucinous neoplastic lesions has great prognostic and therapeutic consequences. However, the differential diagnosis can be difficult and includes a careful patient history, abdominal imaging technologies plus pathological and chemical analysis. The most common neoplastic cysts are IPMN, which show mucin production, a dilated main pancreatic duct (main-duct IPMN) or ectasia of one of its side branches (branch-duct), and intraductal growth. Main-duct IPMNs are at a high risk of malignant transformation, while branch-duct IPMNs show a variable, yet more favorable prognosis. The risk of malignant transformation of branch-duct IPMNs depends on the histological subtype and risk factors such as size and mural nodules. Unspecific abdominal pain has no diagnostic value, while weight reduction, jaundice, and newly diagnosed diabetes are risk factors indicating malignant disease. Main-duct IPMNs and MCNs have the greatest risk of malignant transformation and should be resected, while SCNs have a very low risk of developing in cancer and can thus be followed.