Lymphoepithelial cyst of the pancreas associated with elevated CA 19-9 levels

Yamaguchi, Takahiro; Kagawa, Ryuzaburo; Takeda, Ryoji; Sakata, Shingo; Yamamoto, Masafumi; Nishizaki, Daisuke

doi:10.1007/s00534-007-1314-6

Cited by 35 publications

(21 citation statements)

References 6 publications

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“…Although our study was initiated because of this interesting observation (elevated CEA levels in lymphoepithelial cysts), this phenomenon has been reported, primarily in case reports in the literature. [4][5][6][7][8][9] However, the source of the elevated CEA has not been previously systematically studied. It is interesting to note that CEA can be elevated in the cyst fluid of lymphoepithelial cysts of the head and neck, 19,20 but this finding does not pose the same diagnostic challenge as it does in pancreatic cysts.…”

Section: Discussionmentioning

confidence: 99%

“…Several case reports have noted elevated levels of both CEA and CA19-9 in lymphoepithelial cysts. [4][5][6][7][8][9] This is an important diagnostic pitfall in lymphoepithelial cysts that needs to be further addressed, as patients who have any suspicion of harboring a neoplastic cyst often have the cyst resected. In this study, we reviewed a series of nine lymphoepithelial cysts that were resected at our institution.…”

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confidence: 99%

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Pancreatic lymphoepithelial cysts express CEA and can contain mucous cells: potential pitfalls in the preoperative diagnosis

et al. 2010

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Pancreatic lymphoepithelial cysts are rare benign cysts that cannot be reliably differentiated from neoplastic mucinous cysts preoperatively. Although elevated cyst fluid carcinoembryonic antigen (CEA) levels support a diagnosis of a mucinous cyst, the finding of increased CEA levels in lymphoepithelial cysts prompted this study. Nine resected lymphoepithelial cysts were examined for expression of CEA, carbohydrate antigen (CA) 19-9, CK7, p63, PAS-D and a panel of mucins. The pathology data were correlated with clinical information, including serum, cyst fluid and imaging studies. By computed tomography scan, although most lymphoepithelial cysts appeared cystic, 23% were described as masses. The endoscopic ultrasound findings were variable, but the lymphoepithelial cysts tended to be hypoechoic cystic lesions or masses. On cytology, 44% of the cysts had squamous cells, 67% had glandular cells and 56% had atypical cells. The cysts were resected because of size Z3 cm (89%), symptoms (44%) and/or elevated cyst fluid CEA levels (33%). The cyst fluid CEA levels in the three cysts tested were 4450 ng/ml. Histopathologically, all cysts were lined by mature, stratified squamous-type cells and produced keratin. Mucous cells were present in 78% of the cysts. The immunohistochemical profile of the squamous lining was CK7 þ , p63 þ , MUC1 þ , MUC4 þ , MUC2À, MUC5ACÀ and MUC6À. Even though lymphoepithelial cysts are lined by squamous-type epithelium, all our resected lymphoepithelial cysts expressed CEA and/or CA19-9, many contained mucous cells, and three exhibited markedly elevated cyst fluid CEA levels. Although cyst fluid CEA levels 4200 ng/ml support the diagnosis of mucinous neoplasms, this study emphasizes the need for clinicians and pathologists to recognize that lymphoepithelial cysts can mimic neoplastic mucinous cysts clinically, radiographically and on cyst fluid CEA analysis.

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Section: Discussionmentioning

confidence: 99%

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confidence: 99%

Pancreatic lymphoepithelial cysts express CEA and can contain mucous cells: potential pitfalls in the preoperative diagnosis

et al. 2010

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“…Only few cases presented with elevated serum levels of CA 19-9 [17,26,32]. This is an interesting finding considering that squamous metaplasia in pancreatic ductal epithelium is often immunohistochemically negative for these markers.…”

Section: Differential Diagnosismentioning

confidence: 94%

Lymphoepithelial Cyst of the Pancreas: A Rare Case Report and Review of Literature

et al. 2010

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Lymphoepithelial cysts are rare pancreatic lesions of undetermined pathogenesis. The literature on this entity is limited to case reports or small series. We describe a case of 66 year male, incidentally diagnosed as lymphoepithelial cyst of pancreas that was managed by enucleation. This is the first case report of lymphoepithelial cyst from India. An extensive Medline search was carried out for lymphoepithelial cyst of pancreas. Till date less than 100 cases were identified in available literature. All these cases (including our case) were analyzed. This entity has uniform and distinctive clinicopathological features. About half of the reported cases were asymptomatic with most of the lesions diagnosed incidentally. Majority of patients presents with non-specific symptoms making preoperative diagnosis difficult. Lymphoepithelial cyst of the pancreas is a rare benign lesion, which is difficult to diagnose preoperatively. High index of suspicion and preoperative fine needle aspiration cytology may help in making diagnosis and avoiding surgery in asymptomatic patients.

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“…Although elevations of serum CA 19-9 [11] , cyst fluid CA 19-9 [12] and persistence of elevated CA 19-9 postresection [13] have been described in lymphoepithelial cysts, none of our patients had such abnormal levels. Thus, we believe that this marker has no utility in the clinical assessment of these cystic lesions [14] .…”

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confidence: 56%

Lymphoepithelial cysts and cystic lymphangiomas: Under-recognized benign cystic lesions of the pancreas

Konstantinidis

Kambadakone

Catalano

et al. 2014

WJGS

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Contrast enhanced computed tomography demonstrated that the cysts had thin walls, without calcifications, pancreatic duct dilation or pancreatic parenchyma invasion. Endoscopic ultrasound with fine needle aspiration (EUS/FNA) confirmed the diagnosis of a lymphoepithelial cyst in 3 patients, one of whom was spared an operation and continues to do well after 6 years. Eleven patients had a resection: 3 pancreaticoduodenectomies, 7 distal pancreatectomies, and 1 enucleation. The median size of the cysts was 3 cm (range 2-20 cm). At a median follow-up of 57 mo no recurrences or other pancreas-related conditions occurred. CONCLUSION:Lymphoepithelial cysts and cystic lymphangiomas of the pancreas can be diagnosed with a combination of contrast-enhanced computed tomography scans and EUS/FNA. If the lesion is asymptomatic, an operation might be avoided. Key words: Lymphoepithelial cysts; Cystic lymphangiomas; Pancreas; Asymptomatic cysts; Benign cystic lesions of the pancreas Core tip: Lymphoepithelial cysts and cystic lymphangiomas of the pancreas represent rare, benign cystic lesions. The experience with their diagnosis and treatment is limited mostly to case reports. This report describes our experience with twelve lymphoepithelial cysts and cystic lymhangiomas of the pancreas, analyzing their clinicopathologic characteristics, the role of contrast enhanced computed tomography and endoscopic ultrasound with fine needle aspiration for their diagnosis with an emphasis on non-surgical management when a correct diagnosis can be established in an asymptomatic patient. METHODS:Retrospective review of clinicopathologic and imaging characteristics of patients diagnosed with lymphoepithelial cysts and cystic lymphangiomas of the pancreas at Massachusetts General Hospital. RESULTS: Twelve patients were identified between

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Lymphoepithelial cyst of the pancreas associated with elevated CA 19-9 levels

Cited by 35 publications

References 6 publications

Pancreatic lymphoepithelial cysts express CEA and can contain mucous cells: potential pitfalls in the preoperative diagnosis

Pancreatic lymphoepithelial cysts express CEA and can contain mucous cells: potential pitfalls in the preoperative diagnosis

Lymphoepithelial Cyst of the Pancreas: A Rare Case Report and Review of Literature

Lymphoepithelial cysts and cystic lymphangiomas: Under-recognized benign cystic lesions of the pancreas

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