Renz B W, Ilmer M, D'Haese J G, Werner J
Klinik für Allgemein, Viszeral- und Transplantationschirurgie, Klinikum der Universität München, Standort Großhadern, Marchioninistr. 15, 81377, München, Deutschland.
Chirurg. 2020 Sep;91(9):736-742. doi: 10.1007/s00104-020-01217-4.
Cystic tumors of the pancreas (PCN) have increasingly gained importance in the clinical routine as they are frequently diagnosed as an incidental finding due to the continuous improvement in cross-sectional imaging. A differentiation is made between non-neoplastic and neoplastic cysts, whereby the latter has a tendency to malignant transformation to a varying extent. Therefore, they can be considered as precursor lesions of pancreatic cancer (PDAC). In addition to a detailed patient history and examination, imaging modalities, such as computed tomography (CT), magnetic resonance imaging (MRI) and endoscopic ultrasound (EUS) with fine needle aspiration (FNA) are used for the differential diagnosis. The indications for surgical resection of these lesions are based on the current European guidelines from 2018; however, the content is not evidence-based but relies on knowledge and recommendations from experts. According to these consensus recommendations asymptomatic serous cystic neoplasms (SCN) are serous lesions with a low tendency for malignant transformation and can be monitored. In contrast resection is warranted for all mucinous cystic neoplasms (MCN) >4 cm and all solid pseudopapillary neoplasms (SPN). Intraductal papillary mucinous neoplasms (IPMN), which are differentiated into main duct (MD-IPMN) and branch duct type (BD-IPMN) IPMN based on the position in the pancreatic duct system, should be resected as MD-IPMN and mixed type (MT)-IPMN. The risk of malignant transformation in BD-IPMN is variable and depends on risk factors, which are defined clinically and by imaging morphology. The treatment management is therefore carried out on an individual basis following risk estimation. In order to quantify the quality of indications in PCN and thereby also contributing to optimized medical care, prospective long-term studies are urgently needed.
胰腺囊性肿瘤（PCN）在临床实践中越来越受到重视，因为随着横断面成像技术的不断改进，它们经常被偶然发现。非肿瘤性囊肿和肿瘤性囊肿有所不同，后者有不同程度的恶变倾向。因此，它们可被视为胰腺癌（PDAC）的前驱病变。除了详细的病史和检查外，成像方式，如计算机断层扫描（CT）、磁共振成像（MRI）以及内镜超声（EUS）结合细针穿刺活检（FNA），都用于鉴别诊断。这些病变的手术切除指征基于2018年的现行欧洲指南；然而，其内容并非基于证据，而是依赖专家的知识和建议。根据这些共识建议，无症状的浆液性囊性肿瘤（SCN）是恶变倾向较低的浆液性病变，可以进行监测。相比之下，所有直径>4厘米的黏液性囊性肿瘤（MCN）和所有实性假乳头状肿瘤（SPN）都需要进行切除。导管内乳头状黏液性肿瘤（IPMN）根据其在胰腺导管系统中的位置分为主胰管型（MD-IPMN）和分支胰管型（BD-IPMN），MD-IPMN和混合型（MT）-IPMN应进行切除。BD-IPMN的恶变风险各不相同，取决于临床和成像形态学所定义的风险因素。因此，治疗管理需在风险评估后个体化进行。为了量化PCN的指征质量，从而也有助于优化医疗护理，迫切需要进行前瞻性长期研究。
