Massive Größenprogredienz und maligne Transformation einer muzinös-zystischen Neoplasie des Pankreas in der Schwangerschaft – ein Fallbericht

Zusammenfassung

Hintergrund Muzinös-zystische Neoplasien (MCN) machen 10% aller zystischen Pankreasläsionen aus. Sie kommen fast ausschließlich bei weiblichen Patienten vor und weisen ein ovar-ähnliches Stroma sowie häufig Östrogen- und Progesteronrezeptoren auf. Während einer Schwangerschaft können sie massiv an Größe zunehmen und maligne entarten.

Fallbericht Wir berichten von einer 29-jährigen Patientin, bei der vor einigen Jahren eine 35mm große Zyste im Pankreasschwanz aufgefallen und als Pseudozyste eingestuft worden war. Im Rahmen einer Schwangerschaft kam es zu einer massiven Größenzunahme der Zyste, die sich letztendlich als muzinös-zystische Neoplasie mit fokaler maligner Transformation herausstellte.

Schlussfolgerung Zystische Neoplasien des Pankreas bedürfen eines differenzierten Managements, um einerseits eine Übertherapie, andererseits eine maligne Transformation im Intervall zu vermeiden. Patientinnen im gebärfähigen Alter mit V.a. MCN bzw. ätiologisch nicht sicher einzuordnenden zystischen Pankreasläsionen sollten über das (seltene) Phänomen des Progresses von MCN in der Schwangerschaft aufgeklärt und im Rahmen einer Schwangerschaft engmaschig überwacht werden.

Abstract

Background Mucinous-cystic neoplasms (MCN) account for 10% of all pancreatic cystic lesions. They are found almost exclusively in females. MCN have an ovarian-like stroma and often estrogen and progesterone receptors. During pregnancy, they can massively increase in size and transform into malignancy.

Case report We report on a 29-year-old woman in whom a 35mm cyst in the pancreatic tail had been diagnosed several years ago. After workup the lesions had been classified as a pseudocyst. During pregnancy, the cyst massively increased in size and finally was resected. Histology showed a mucinous-cystic neoplasia with focal malignant transformation.

Conclusion Cystic neoplasms of the pancreas require a differentiated management. While overtreatment should be avoided, malignant transformation always merits consideration – in particular if the cystic lesion is located in the pancreatic tail. Women with suspected MCN or cystic pancreatic lesions of uncertain etiology should be informed about the (rare) risk of a malignant transformation of an MCN and should be closely monitored during pregnancy.

Schlüsselwörter

zystische Pankreasläsion - pankreatische muzinös zystische Neoplasie - maligne Transformation - Schwangerschaft

Keywords

Cystic pancreatic lesion - pancreatic mucinous cystic neoplasia - malignant progression - pregnancy

Publication History

Received: 03 October 2023

Article published online:
04 October 2024

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