Cystic tumors of the pancreas
Cystic tumors of the pancreas
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DOI：
10.1007/s00104-009-1861-2
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发表时间：
2010-08-01
期刊：
影响因子：
--
通讯作者：
Saeger, H. -D.
中科院分区：
文献类型：
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作者：
Gruetzmann, R.;Saeger, H. -D.
胰腺囊肿最常在慢性或急性胰腺炎症后发生。胰腺囊性肿瘤在临床实践中已被越来越多地认识到，90%由四种类型代表：浆液性微囊性（SCN）、粘液性囊性（MCN）、导管内乳头状粘液性（IPMN）和实性假乳头状（SPN）肿瘤。IPMN是现今最常见的形式，主导管和分支导管类型可通过形态学区分。该分类具有预后和治疗相关性。虽然主管IPMN恶性进展的风险高，因此建议切除，但分支导管IPMN具有低得多的恶性肿瘤风险。无症状或壁结节的小分支导管IPMN（< 2 cm）可通过定期监测进行管理。最近，它已经变得清楚，IPMN构成一个异质组至少有四个亚型。他们的分层揭示了IPMN的各种亚型具有不同的生物学特性，具有不同的预后意义，但在手术前通常不知道亚分类。此外，甚至炎性囊肿和肿瘤性囊肿之间的区分也可能具有挑战性。切除的明确适应症是局部并发症（黄疸或胃出口梗阻），大的和不断增加的肿瘤，症状或从乏特氏乳头分泌粘液。
Cysts of the pancreas most often develop after chronic or acute inflammation of the pancreas. Cystic neoplasia of the pancreas have been increasingly recognized in clinical practice and 90% are represented by four types: serous microcystic (SCN), mucinous cystic (MCN), intraductal papillary-mucinous (IPMN) and solid pseudopapillary (SPN) neoplasia. IPMN is the most common form nowadays and main duct and branch duct types can be differentiated by morphology. This classification is of prognostic and therapeutic relevance. While main duct IPMNs have a high risk of malignant progression and resection is therefore recommended, branch duct IPMNs have a much lower risk of harboring malignancy. Small branch duct IPMNs (< 2 cm) without symptoms or mural nodules can be managed by periodic surveillance. Recently, it has become clear that IPMN constitutes a heterogeneous group with at least four subtypes. Their stratification reveals that the various subtypes of IPMN have different biological properties with different prognostic implications, but the subclassification is usually not known prior to surgery. Moreover, even differentiation between inflammatory and neoplastic cysts can be challenging. Clear indications for resection are local complications (jaundice or gastric outlet obstruction), large and increasing tumurs, symptoms or secretion of mucinous fluid from the papilla of Vater.