Zusammenfassung
Die neue WHO Klassifikation der Tumoren des Pankreas berücksichtigt abweichend von allen anderen voraufgegangenen Editionen nun sinnvollerweise die exokrinen und neuroendokrinen Tumoren in einem WHO-Band. Nach wie vor ist das duktale Adenokarzinom das häufigste und klinisch am meisten relevante Malignom. Seine Untergruppen und Varianten werden ausführlich dargestellt, ebenso wie gemischte Karzinome. Weitere Tumoren vom duktalen Phänotyp (muzinös zystische Neoplasie, MZN, und intraduktal papillär muzinöse Neoplasie, IPMN) werden konsequent als Neoplasie gelistet mit unterschiedlichem Dysplasiegrad bis hin zum invasiven Karzinom. Eine neue Subgruppe der IPNM, die intraduktale tubulopapilläre Neoplasie (ITPN) wird charakterisiert. Seröse und azinäre Tumoren werden als Neoplasien klassifiziert mit unterschiedlichem Dysplasiegrad. Die solid-pseudopapilläre Neoplasie gilt grundsätzlich als maligne Neubildung („low grade“), da sie prinzipiell metastasierungsfähig ist. Die neuroendokrinen Neoplasien werden unterschieden in neuroendokrine Tumoren (NET) G1 und G2 und neuroendokrine Karzinome (NEC) mit hohem malignem Potenzial. Syndromale NET sind gelistet nach ihrem Hormonexpressionsmuster. Auf die Probleme im Staging bei Anwendung des TNM-Systems bzw. der AJCC/UICC-Klassifikation (American Joint Committee on Cancer/Union Internationale Contre le Cancer), die gleichermaßen für endokrine und exokrine Tumoren gilt, wird hingewiesen.
Abstract
The new WHO classification of tumours of the pancreas logically includes both exocrine and neuroendocrine neoplasms in one volume, thus differing from all previous editions. Ductal adenocarcinoma is still the most frequent and clinically the most relevant malignant tumour. Its subtypes and variants are described in detail, as are mixed tumours. Other ductal tumours [mucinous cystic neoplasms (MCN) and intraductal papillary mucinous neoplasms (IPNM)] are classified as neoplasms with various grades of dysplasia up to invasive carcinoma. A new subtype of IPNM, intraductal tubulopapillary neoplasm (ITPN), has been characterized and newly added to the IPMN group. Serous and acinar tumours are classified as neoplasms with varying grades of dysplasia. Solid pseudopapillary neoplasm (SPN) is regarded as malignant (low grade) as a matter of principle because of its inherent potential to metastasize. Neuroendocrine neoplasms are characterized as G1 or G2 neuroendocrine tumours (NET) and neuroendocrine carcinomas (NEC, highly malignant). Syndromatic NETs are described and named according to their hormone expression pattern. The problems of staging when applying either the TNM or AJCC/UICC (American Joint Committee on Cancer/Union Internationale Contre le Cancer) classifications, which apply equally to endocrine and exocrine tumors, are discussed.
This is a preview of subscription content, log in via an institution to check access.
Literatur
Abraham SC, Klimstra DS, Wilentz RE et al (2002) Solid-pseudopapillary tumors of the pancreas are genetically distinct from pancreatic ductal adenocarcinomas and almost always harbor-catenin mutations. Am J Pathol 160:1361–1369
Brune K, Abe T, Canto M et al (2006) Multifocal neoplastic precursor lesions associated with lobular atrophy of the pancreas in patients having a strong family history of pancreatic cancer. Am J Surg Pathol 30:1067–1076
Canto MI, Goggins M, Hruban RH et al (2006) Screening for early pancreatic neoplasia in high-risk individuals: a prospective controlled study. Clin Gastroenterol Hepatol 4:766–781
Chari ST, Takahashi N, Levy MJ et al (2009) A diagnostic strategy to distinguish autoimmune pancreatitis from pancreatic cancer. Clin Gastroenterol Hepatol 7:1097–1103
DeLellis RA, Lloyd RV, Heitz PU et al (2004) Pathology and genetics of tumours of endocrine organs. WHO classification of tumours. IARC Press, Lyon
Klimstra DS, Modlin IM, Adsay NV et al (2010) Pathology reporting of neuroendocrine tumors: application of the Delphic consensus process to the development of a minimum pathology data set. Am J Surg Pathol 34:300–313
Klöppel G, Couvelard A, Perren A et al (2009) ENETS Consensus Guidelines for the Standards of Care in Neuroendocrine Tumors: towards a standardized approach to the diagnosis of gastroenteropancreatic neuroendocrine tumors and their prognostic stratification. Neuroendocrinology 90:162–166
Lowenfels AB, Maisonneuve P, DiMagno EP et al (1997) Hereditary pancreatitis and the risk of pancreatic cancer. J Natl Cancer Inst 89:442–446
Rindi G, Klöppel G, Couvelard A et al (2007) TNM staging of midgut and hindgut (neuro) endocrine tumors: a consensus proposal including a grading system. Virchows Arch 451:757–762
Scarpa A, Mantovani W, Capelli P et al (2010) Pancreatic endocrine tumors: improved TNM staging and histopathological grading permit a clinically efficient prognostic stratification of patients. Mod Pathol 23:824–833
Tanaka M, Chari S, Adsay V et al (2006) International consensus guidelines for management of intraductal papillary mucinous neoplasms and mucinous cystic neoplasms of the pancreas. Pancreatology 6:17–32
Van den Broeck A, Sergeant G, Ectors N et al (2009) Patterns of recurrence after curative resection of pancreatic ductal adenocarcinoma. Eur J Surg Oncol 35:600–604
Wisnoski NC, Townsend CM Jr, Nealon WH et al (2008) 672 patients with acinar cell carcinoma of the pancreas: a population-based comparison to pancreatic adenocarcinoma. Surgery 144:141–148
Zamboni G, Terris B, Scarpa A et al (2002) Acinar cell cystadenoma of the pancreas. A new entity? Am J Surg Pathol 26:698–704
Interessenkonflikt
Die korrespondierende Autorin gibt an, dass kein Interessenkonflikt besteht.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Lüttges, J. Was ist neu?. Pathologe 32 (Suppl 2), 332 (2011). https://doi.org/10.1007/s00292-011-1515-2
Published:
DOI: https://doi.org/10.1007/s00292-011-1515-2
Schlüsselwörter
- Pankreaskarzinom, duktales
- Pankreasneoplasie
- Neuroendokrine Tumoren
- Neuroendokrines Karzinom
- Vorläuferläsion