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Duktales Adenokarzinom und ungewöhnliche Differenzialdiagnosen

Ductal adenocarcinoma and unusual differential diagnosis

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An Erratum to this article was published on 23 May 2016

Zusammenfassung

Das duktale Adenokarzinom ist der weitaus häufigste solide Tumor des Pankreas. Die Prognose ist sehr schlecht, insbesondere bei fortgeschrittenen, nicht mehr lokal begrenzten Tumoren. Bei meist unspezifischen geringen Beschwerden kommt der Bildgebung eine entscheidende Rolle zu. Durch die weite Verbreitung bildgebender Verfahren werden jedoch gleichzeitig vermehrt inzidentelle Befunde im Pankreas entdeckt, die einer weiteren Abklärung bedürfen. Das duktale Pankreaskarzinom kann von einer Vielzahl anderer Läsionen vorgetäuscht werden, hierzu zählen anatomische Varianten, peripankreatische Strukturen oder Tumoren, seltenere primäre solide oder auch zystische Raumforderungen des Pankreas, Metastasen anderer Primärtumoren oder verschiedene Varianten von Pankreatitiden. Neben diesen Entitäten sind zudem mehrere Vorläuferläsionen des duktalen Pankreaskarzinoms differenzierbar. Eine Differenzierung dieser Erkrankungen von echten Pankreaskarzinomen ist insofern wichtig, als dass eine frühe, korrekte Diagnosestellung für die Prognose wichtig ist und gleichzeitig die – ggf. vermeidbare – Therapie sehr einschneidend ist.

Prinzipiell können alle bildgebenden Verfahren verwendet werden. Neben der meist am Anfang der Untersuchungskaskade stehenden Oberbauchsonographie sind dies v. a. die CT mit hervorragender Übersichtlichkeit und guter Ortsauflösung, die MRT mit guter Weichteildifferenzierung und der Möglichkeit der Magnetresonanzcholangiopankreatikographie (MRCP), die Endosonographie mit hervorragender Ortsauflösung, ggf. in Kombination mit einer endoskopisch retrograden Cholangiopankreatikographie (ERCP) oder der Möglichkeit einer Biopsie, und auch die Positronenemissionstomographie(PET)-CT als molekulare Bildgebung. Die unterschiedlichen Verfahren bieten dabei jeweils Vor- und Nachteile und sollten je nach konkreter Fragestellung miteinander kombiniert werden.

Abstract

Ductal pancreatic adenocarcinoma is by far the most common solid tumor of the pancreas. It has a very poor prognosis, especially in the more advanced stages which are no longer locally confined. Due to mostly unspecific symptoms, imaging is key in the diagnostic process. Because of the widespread use of imaging techniques, incidental findings are to a greater extent discovered in the pancreas, which subsequently entail further work-up. Ductal pancreatic adenocarcinoma can be mimicked by a large number of different lesions, such as anatomical variants, peripancreatic structures and tumors, rarer primary solid pancreatic tumors, cystic tumors, metastases or different variants of pancreatitis. Additionally, a number of precursor lesions can be differentiated. The correct classification is thus important as an early diagnosis of ductal pancreatic adenocarcinoma is relevant for the prognosis and because the possibly avoidable treatment is very invasive. All major imaging techniques are principally suitable for pancreatic imaging. In addition to sonography of the abdomen, usually the baseline diagnostic tool, computed tomography (CT) with its superior spatial resolution, magnetic resonance imaging (MRI) with its good soft tissue differentiation capabilities, possibly in combination with MR cholangiopancreatography (MRCP), endosonography with its extraordinary spatial resolution, conceivably with additional endoscopic retrograde CP or the option of direct biopsy and finally positron emission tomography CT (PET-CT) as a molecular imaging tool are all particularly useful modalities. The various techniques all have its advantages and disadvantages; depending on the individual situation they may need to be combined.

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  1. Zentrum für Radiologie HELIOS Universitätsklinikum Wuppertal, Universität Witten/Herdecke, Heusnerstr. 40, 42283, Wuppertal, Deutschland

    P. Haage,  C. A. Schwartz &  C. Scharwächter

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Correspondence to P. Haage.

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C. Scharwächter, C.A. Schwartz und P. Haage geben an, dass kein Interessenkonflikt besteht.

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Haage, P., Schwartz, C.A. & Scharwächter, C. Duktales Adenokarzinom und ungewöhnliche Differenzialdiagnosen. Radiologe 56, 325–337 (2016). https://doi.org/10.1007/s00117-016-0090-1

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