[Intraductal neoplasms of the pancreas].
Intraduktale Pankreasneoplasien.
ITPN
PanIN
Pancreatic cancer
Pancreatic cyst
Precursor lesion
Journal
Der Pathologe
ISSN: 1432-1963
Titre abrégé: Pathologe
Pays: Germany
ID NLM: 8006541
Informations de publication
Date de publication:
Sep 2021
Sep 2021
Historique:
accepted:
30
06
2021
pubmed:
18
8
2021
medline:
1
9
2021
entrez:
17
8
2021
Statut:
ppublish
Résumé
The latest WHO classification of tumors of the digestive system (2019) has introduced new concepts for the stratification of intraductal neoplasms of the pancreas, mostly based on molecular genetics and malignant potential. Among them, pancreatic intraepithelial neoplasias (PanINs) and intraductal papillary mucinous neoplasms (IPMN) are both precursors of pancreatic ductal adenocarcinoma, whereas intraductal oncocytic papillary neoplasms (IOPN) and intraductal tubulopapillary neoplasms (ITPN) are usually associated with less aggressive subtypes of pancreatic cancer and therefore have a much better prognosis. Hence, it is of utmost importance to correctly classify these lesions and to distinguish them from each other as well as from other nonductal types of neoplasms, which can rarely display an intraductal growth, such as neuroendocrine tumors and acinar cell carcinomas. PanIN are microscopic lesions with limited clinical significance. In contrast, all other intraductal neoplasms can be identified as cystic processes and/or solid tumors by means of imaging, thereby setting an indication for a potential surgical resection. This review presents diagnostically relevant aspects of intraductal neoplasms of the pancreas, which are instrumental for the discussion within interdisciplinary tumor boards (resection vs. watch-and-wait strategies) as well as to determine the extent of resection intraoperatively. Die aktuelle WHO-Klassifikation für gastrointestinale Tumoren (2019) beinhaltet Neuerungen in der Einteilung von intraduktalen Pankreasneoplasien, die auf weiterführenden Erkenntnissen zum genetischen Profil der Tumoren und zum Malignitätspotenzial basieren. Zu dieser Gruppe zählen pankreatische intraepitheliale Neoplasien (PanIN) und intraduktale papillär-muzinöse Neoplasien (IPMN) als Vorläufer des duktalen Adenokarzinoms, wohingegen die intraduktalen onkozytär-papillären Neoplasien (IOPN) und die intraduktalen tubulopapillären Neoplasien (ITPN) mit weniger aggressiven Subtypen von Pankreaskarzinomen und besserer Prognose assoziiert sind. Daher ist es von größter Bedeutung, diese Läsionen korrekt zu klassifizieren und von anderen nichtduktalen Neoplasien zu differenzieren, wie beispielsweise von neuroendokrinen Tumoren und Azinuszellkarzinomen, welche selten auch ein intraduktales Wachstum aufweisen können. PanIN sind mikroskopische Läsionen mit begrenzter klinischer Signifikanz. Hingegen können alle anderen intraduktalen Neoplasien mittels Bildgebung als zystische Prozesse und/oder solide Tumoren identifiziert werden, wodurch die Indikation für eine mögliche chirurgische Resektion gegeben ist. In dieser Übersichtsarbeit werden die diagnostisch relevanten Aspekte intraduktaler Neoplasien des Pankreas vorgestellt. Diese sind für die Diskussion im Rahmen interdisziplinärer Tumorkonferenzen (Resektion versus watch & wait) sowie zur intraoperativen Entscheidung des Resektionsausmaßes von maßgeblicher Bedeutung.
Autres résumés
Type: Publisher
(ger)
Die aktuelle WHO-Klassifikation für gastrointestinale Tumoren (2019) beinhaltet Neuerungen in der Einteilung von intraduktalen Pankreasneoplasien, die auf weiterführenden Erkenntnissen zum genetischen Profil der Tumoren und zum Malignitätspotenzial basieren. Zu dieser Gruppe zählen pankreatische intraepitheliale Neoplasien (PanIN) und intraduktale papillär-muzinöse Neoplasien (IPMN) als Vorläufer des duktalen Adenokarzinoms, wohingegen die intraduktalen onkozytär-papillären Neoplasien (IOPN) und die intraduktalen tubulopapillären Neoplasien (ITPN) mit weniger aggressiven Subtypen von Pankreaskarzinomen und besserer Prognose assoziiert sind. Daher ist es von größter Bedeutung, diese Läsionen korrekt zu klassifizieren und von anderen nichtduktalen Neoplasien zu differenzieren, wie beispielsweise von neuroendokrinen Tumoren und Azinuszellkarzinomen, welche selten auch ein intraduktales Wachstum aufweisen können. PanIN sind mikroskopische Läsionen mit begrenzter klinischer Signifikanz. Hingegen können alle anderen intraduktalen Neoplasien mittels Bildgebung als zystische Prozesse und/oder solide Tumoren identifiziert werden, wodurch die Indikation für eine mögliche chirurgische Resektion gegeben ist. In dieser Übersichtsarbeit werden die diagnostisch relevanten Aspekte intraduktaler Neoplasien des Pankreas vorgestellt. Diese sind für die Diskussion im Rahmen interdisziplinärer Tumorkonferenzen (Resektion versus watch & wait) sowie zur intraoperativen Entscheidung des Resektionsausmaßes von maßgeblicher Bedeutung.
Identifiants
pubmed: 34402978
doi: 10.1007/s00292-021-00966-1
pii: 10.1007/s00292-021-00966-1
doi:
Types de publication
Journal Article
Review
Langues
ger
Sous-ensembles de citation
IM
Pagination
472-483Informations de copyright
© 2021. Springer Medizin Verlag GmbH, ein Teil von Springer Nature.
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