Zystische pankreastumoren: Klassifikation und malignes potenzial

Cystic tumors of the pancreas are rare but increasingly recognized entities with higher resectability rates and better survival chances than classical ductal adenocarcinoma. A preoperative stratification in low- and high-risk tumors is possible according to the main clinico-pathological parameters (patient age and gender, localisation of the tumor, communication with the duct system, and relative frequency). The postoperative morphological and immunohistochemical classificationis relevant for the patient's prognosis and follow-up. Five entities, namely pseudocysts, intraductal papillary-mucinous neoplasms (IPMN), mucinous-cystic neoplasms (MCN), serous cystic neoplasms (SCN), and solid-pseudopapillary neoplasms (SPN), represent > 95% of all pancreatic cystic lesions. Among them, IPMN and MCN are the clinically most relevant since they display an adenoma-carcinoma-sequence that makes early diagnosis and surgical treatment at a non-malignant/non-invasive stage mandatory. IPMN can be further stratified in main- and branch-duct types, which bear a different prognosis and therefore require a different therapeutical approach. SPN and SCN, on the other hand, are almost invariably low-grade or benign tumors. In conclusion, a close cooperation between the pathologist and the clinician represents the basis for the exact classification and the most appropriate treatment of cystic tumors of the pancreas.