Pankreasın Benign Neoplazileri
Özet
Pankreasın benign neoplazileri inflamatuar (psödokist), neoplastik ve mikroskopik olmak üzere üç ana grupta sınıflandırılmaktadır. En sık karşılaşılan kitleler inflamatuar gruptaki psödokistler olup, genellikle akut pankreatit veya travma sonrası gelişirler. Neoplastik grup ise seröz kistadenom, müsinöz kistadenom ve intraduktal papiller müsinöz neoplazm (IPMN) gibi kistik yapılar ile pankreatik nöroendokrin tümörler (PNET) ve solid psödopapiller tümörler gibi solid yapılardan oluşur. Seröz kistadenomlar genellikle iyi huylu seyrederken; müsinöz kistadenomlar premalign özellik taşır ve cerrahi rezeksiyon gerektirir. IPMN'ler ise ana veya yan pankreas kanallarında papiller uzantılar oluşturarak malignite riski barındırırlar. Fonksiyonel PNET'ler arasında insülinoma, gastrinoma, glukagonoma, VIPoma ve somatostatinoma yer almaktadır. Mikroskopik grupta incelenen pankreas intraepitelyal neoplazileri (PanIN) ise invazif duktal karsinomun prekürsörüdür ve özellikle PanIN-3 en yüksek riskli lezyon olarak öne çıkar. Bu lezyonların doğru tanısı ve ayrımı için bilgisayarlı tomografi, manyetik rezonans ve endoskopik ultrasonografi gibi görüntüleme yöntemlerinden yararlanılmaktadır.
Benign neoplasms of the pancreas are classified into three main categories: inflammatory (pseudocyst), neoplastic, and microscopic. Pseudocysts, representing the inflammatory group, are the most common pancreatic masses, typically developing after acute pancreatitis or trauma. The neoplastic category is divided into cystic lesions—including serous cystadenoma, mucinous cystadenoma, and intraductal papillary mucinous neoplasm (IPMN)—and solid lesions, such as pancreatic neuroendocrine tumors (PNET) and solid pseudopapillary tumors. While serous cystadenomas generally follow a benign course, mucinous cystadenomas are premalignant and warrant surgical resection. IPMNs form papillary projections within the pancreatic ducts and carry a distinct risk of malignancy. Functional PNETs include insulinomas, gastrinomas, glucagonomas, VIPomas, and somatostatinomas. Lastly, the microscopic group comprises pancreatic intraepithelial neoplasia (PanIN), which serves as a precursor to invasive ductal carcinoma, with PanIN-3 carrying the highest risk for developing adenocarcinoma. Accurate differential diagnosis of these lesions relies heavily on imaging modalities such as computed tomography, magnetic resonance imaging, and endoscopic ultrasonography.
Referanslar
Kandemir, S. (2019). Pankreasın Cerrahi Anatomisi. Osman Abbasoğlu (Ed) , Karaciğer Safra Yolları ve Pankreas Cerrahisi içinde (s. 213-218). Ankara: Dünya Tıp Kitabevi
Shamamian P. Pancreatic pseudocysts. In: Cameron J, ed. Current surgical therapy. 8th ed. Philadelphia: Elsevier Mosby; 2004. p.480- 5.
K. Lewandrowski, A. Warshaw, C. Compton, Macrocystic serous cystadenoma of the pancreas: a morphologic variant differing from microcystic adenoma, Hum. Pathol. 23 (8) (1992 Aug) 871e875.
G. Kloppel, E. Solcia, D.S. Longnecker, et al. World Health Organization International Histological Classification of Tumors, Histological Typing of Tumors of the Exocrine Pancreas, second ed., Springer-Verlag, Berlin, Germany, 1996
I Sluvkin, GR Hafez, JE Niederhuber et al. Combined serous microcystic adenoma and well-differentiated endocrine pancreatic neoplasm. Arch Pathol Lab Med 2
Tanaka M, Fernandez-del Castillo C, Adsay V, et al. International consensus guidelines 2012 for the management of IPMN and MCN of the pancreas. Pancreatology 2012;12(3):183-197. doi: 10.1016/j.pan.2012.04.004
Reddy S, Wolfgang CL. Benign pancreatic tumors. Surg Clin North Am 2007;87(6):1359- 78.
Burk KS, Knipp D, Sahani DV. Cystic Pancreatic Tumors. Magn Reson Imaging Clin N Am 2018; 26: 405- 20.
Huo L, Feng F, Liao Q, et al. Intraductal papillary mucinous neoplasm of the pancreas with high malignant potential on FDG PET/MRI. Clin Nucl Med 2016; 41: 989-90.
Panzuto F, Nasoni S, Falconi M, et al. Prognostic factors and survival in endocrine tumor patients: comparison between gastrointestinal and pancreatic localization. Endocr Relat Cancer. 2005 Dec;12 (4):1083–1092
Tucker ON, Crotty PL, Conlon KC. The management of insulinoma. Br J Surg 2006;93: 264-75
Oberg K, Eriksson B. Endocrine tumours of the pancreas. Best Pract Res Clin Gastroenterol 2005;19:753-81.
Perry RR, Vinik AI. Clinical review 72: diagnosis and management of functioning islet cell tumors. J Clin Endocrinol Metab 1995;80: 2273-8
House MG, Yeo CJ, Schulick RD. Periampullary pancreatic somatostatinoma. Ann Surg Oncol. 2002;9:869-74
Chatelain D, Vibert E, Yzet T, et al. Groove pancreatitis and pancreatic heterotopia in the minor duodenal papilla. Pancreas 2005;30(4):e92- 5.
Hruban RH, Wilentz RE, Kern SE. Genetic progression in the pancreatic ducts. Am J Pathol 2000;156:1821-5.
Hruban RH, Adsay NV, Bores-Saavedra J, et al. Pancreatic intraepithelial neoplasia: a new nomenclature and classification system for pancreatic duct lesions. Am J Surg Pathol 2001;25:579-86.
