Lymphoepithelial cysts of the pancreas: CT and sonographic findings

Kim, Y. H.; Auh, Yong Ho; Kim, K. W.; Lee, M. G.; Kim, K. S.; Park, S. Y.

doi:10.1007/s002619900318

Cited by 35 publications

(12 citation statements)

References 10 publications

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“…This finding is similar to those reported in previous reports (6,8,9). Radiologists should be aware of this contradictory finding, in order to narrow the differential diagnosis when a cystic lesion of the pancreas is present.…”

Section: Discussionsupporting

confidence: 79%

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Lymphoepithelial Cyst of the Pancreas: A Case Report

Joo

Kim

et al. 2005

J Korean Radiol Soc

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Lymphoepithelial cyst (LEC) is a rare, benign disease. The radiographic differentiation of LECs from other cystic lesions of the pancreas with malignant potential is challenging. We describe the radiographic features of LEC in the hope that the knowledge of the distinctive radiography of this entity may minimize unnecessary surgery. Case ReportA 45-year-old man was referred to our hospital for the evaluation of a cystic mass in the head of the pancreas that was incidentally detected in an ultrasonography (US) examination performed at a local clinic. The patient had undergone subtotal gastrectomy 20 years earlier due to a perforated ulcer. He had no abdominal discomfort, tenderness or palpable masses. Laboratory testing revealed an elevated serum carbohydrate antigen (CA19 9) level of 55.5 U/mL (normal level < 37 U/mL).A contrast-enhanced abdominal computed tomography (CT) scan demonstrated a 5 cm multilobulated, multilocular cystic mass with septations at the superior aspect of the body of the pancreas. The attenuation value of the internal content was approximately 22 Hounsfield units. (Figs. 1A and 1B). Endoscopic retrograde cholangio-pancreatography (ERCP) showed no abnormality or communication between the pancreatic duct and the mass.Laparotomy revealed a well-defined, grayish, multilobular solid-like mass located at the head of the pancreas. Intraoperative sonography depicted a well-defined lobulated mass with moderate echogenicity mimicking a solid lesion (Fig. 2). The mass was completely enucleated.On gross examination, the cyst was found to be covered by a thin capsule and to measure 6 cm in diameter. On examination of the cut section, it was found to be multilobulated and multilocular without a solid portion (Fig. 3). The cyst's contents were caseous in appearance and gray-yellow to tan in color. Upon microscopic examination, the cyst was found to be lined by a keratinized stratified squamous epithelial layer with abundant mature lymphocytes present in the cyst wall. These findings were histologically consistent with a lymphoepithelial cyst. The patient's postoperative We present a case of lymphoepithelial cyst of the pancreas. The cyst showed moderate echogenicity, mimicking a solid lesion on ultrasonography (US), and had a cystic appearance on computed tomography (CT). This ambivalent finding may be a distinctive feature of lymphoepithelial cysts of the pancreas.

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Section: Discussionsupporting

confidence: 79%

“…The attenuation values of the internal contents sometimes exhibit negative Hounsfield units, implying the presence of lipid contents (6,8). It has been suggested that a combination of a cystic appearance on CT and a nonhomogeneous echogenicity on sonography can provide a clue to the correct diagnosis (6,8,9).…”

Section: Discussionmentioning

confidence: 99%

Lymphoepithelial Cyst of the Pancreas: A Case Report

Joo

Kim

et al. 2005

J Korean Radiol Soc

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“…Thus, we believe that this marker has no utility in the clinical assessment of these cystic lesions [14] . Consistent with published reports [15] , CECT scans in our patients demonstrated cysts with thin walls, without evidence of calcificystic lesions. Seventy-one percent of cysts in a recent report from our institution were serendipitous imaging findings [4] .…”

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confidence: 93%

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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“…Of the reported cases, 80% involved patients aged over 40 years. 7,8 Some patients are asymptomatic, and the lesions are found incidentally during abdominal US or CT. Other patients have an isolated symptom such as abdominal pain, or a combination of symptoms including nausea, vomiting, diarrhea, fever, weight loss, and fatigue. Sako et al 9 reported that LECs causing symptoms are greater than 3 cm in diameter, whereas those that cause no symptoms are less than 6 cm in diameter.…”

Section: Discussionmentioning

confidence: 99%

Lymphoepithelial Cyst of the Pancreas: Report of a Case

et al. 2007

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A lymphoepithelial cyst (LEC) is an extremely rare benign lesion of the pancreas. During a medical check-up, a 77-year-old man without any symptoms was found to have a cyst in the body of the pancreas. His serum carbohydrate antigen 19-9 level was slightly elevated. Computed tomography showed a multilocular, low-attenuating cyst on the superior surface of the pancreatic body. Thus, we performed distal pancreatectomy with splenectomy. Histological examination revealed that the cyst wall was lined with squamous epithelium and surrounded by abundant mature lymphoid tissue. Keratinous substances were present in the cyst. An LEC of the pancreas is associated with a good prognosis and, although unusual, it should be considered in the differential diagnosis of pancreatic cystic lesions. Minimal resection of the cyst should be performed whenever possible, and extensive surgery avoided. For patients with a high surgical risk, fine-needle aspiration biopsy may be considered.

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Lymphoepithelial cysts of the pancreas: CT and sonographic findings

Cited by 35 publications

References 10 publications

Lymphoepithelial Cyst of the Pancreas: A Case Report

Lymphoepithelial Cyst of the Pancreas: A Case Report

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

Lymphoepithelial Cyst of the Pancreas: Report of a Case

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