Radiographic features in lymphoepithelial cyst of the pancreas

Ueno, Shinji; Muranaka, Toshiya; Maekawa, Shinya; Masuda, Yuichi; Ro, T. K.; Saku, Motonori; Oshiumi, Y

doi:10.1007/bf00203514

Cited by 39 publications

(23 citation statements)

References 7 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: 90%

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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: 90%

“…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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“…The lesion often protrudes from the pancreatic parenchyma (31,39,41,46,50), and many cases appear to be peripancreatic rather than intrapancreatic. The mean size of LECs is 4.6 cm (range, 1.2-17 cm).…”

Section: Discussionmentioning

confidence: 99%

“…Radiologic tests may not be specific either. The main radiographic finding that may help distinguish LEC is that it is sharply demarcated from the pancreatic tissue (31,39,41,46,50). Some authors have found selective angiography to be particularly helpful in the diagnosis (45).…”

Section: Discussionmentioning

confidence: 99%

Lymphoepithelial Cysts of the Pancreas: a Report of 12 Cases and a Review of the Literature

et al. 2002

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Lymphoepithelial cyst (LEC) of the pancreas is a rare lesion of undetermined pathogenesis that had been documented almost exclusively in males. The literature on this entity is limited to reports of single or small numbers of cases. Here is presented a clinicopathologic analysis of 12 patients with LEC, 4 of whom were female. The mean age of the patients was 56 years. Four patients presented with abdominal pain and nausea, but in two patients, the cysts were detected incidentally. Only one patient had a history of chronic pancreatitis, and another had a family member with pancreatic cancer. In one patient, a clinical diagnosis of pseudocyst was rendered, and the remaining patients were clinically thought to have cystic neoplasms. None of the patients had any identifiable immunosuppression, HIV positivity, autoimmune disorder (such as Sjogren syndrome) or lymphoma. Seven cysts were located in the head of the pancreas, and 5 were in the tail. The mean size was 4.8 cm (range, 1.2-17 cm). Five LECs were multilocular, three were unilocular; in others, the number of loculi was not recorded. All were "macrocystic" lesions. Two patients had two separate lesions, both in the tail of the pancreas. Histologically, all cases were characterized by cysts, some containing keratin, and lined by mature stratified squamous epithelium surrounded by dense lymphoid tissue, often with prominent follicles. In some areas, the lining epithelium had more cuboidal, flattened, or transitional appearance. Mucinous goblet-like cells were seen in one case. Acute inflammation was not seen. Cystic lesions of the pancreas are relatively rare (1-3), but they constitute an important category with a challenging differential diagnosis at the clinical, radiological, and pathologic levels. In the past decade, wider application of radiographic techniques, coupled with the improvement in the surgical approach to this organ, has brought new attention to the cystic processes in the pancreas. As more cases of pancreatic cysts are being diagnosed and operated on, new clinicopathologic entities are being recognized (4 -6), and the old ones are becoming better characterized (7-10). Pseudocysts are the most common cystic lesions of the pancreas and usually occur as a complication of pancreatitis (11). True cysts, on the other hand, are most often neoplastic (1). The classification and understanding of these neoplastic pancreatic cysts have progressively improved in the last three decades. The serous and mucinous cystic neoplasms (SCN and MCN) described by Compagno and Oer-

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“…3,7 High CEA and CA19-9 concentrations repeatedly have been reported. 19,20 In 1 report, the authors speculated that these levels suggested that the cyst contents most likely were produced by cells derived from the exocrine pancreas. 20 These results demonstrate that, although high CEA concentrations are associated most often with mucinous neoplasms, the finding is not specific and may be misleading.…”

Section: Discussionmentioning

confidence: 99%

Fine-needle aspiration cytology of pancreatic lymphoepithelial cysts

Policarpio‐Nicolas

Shami

Kahaleh

et al. 2006

Cancer

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BACKGROUND. Lymphoepithelial cysts (LECs) of the pancreas are extremely rare, benign, nonneoplastic cysts that can mimic pseudocysts or cystic neoplasms clinically and radiographically. The cytologic features of LECs have been described only in a handful of case reports and may overlap with both benign and malignant pancreatic tumors. METHODS. The authors conducted a 5‐year, retrospective, computerized review of the cytopathology files of 2 institutions for all diagnoses of pancreatic LECs. Clinical, radiographic, cytologic, and chemical findings were reviewed. RESULTS. Four patients were identified. The study group consisted of 3 men and 1 woman who ranged in age from 33 years to 63 years. The masses were located throughout the pancreas. Tumor sizes ranged from 1.8 cm to 5.7 cm in greatest dimension. Smears from all patients revealed numerous anucleated squamous cells, rare benign nucleated cells, amorphous debris, and an absence of lymphocytes. Mildly atypical mucinous glandular and parakeratotic epithelium were identified in 2 patients, leading to diagnoses of atypical and suspicious for malignancy. Subsequent surgical follow‐up of 3 patients revealed pancreatic LECs. CONCLUSIONS. Pancreatic LECs are extremely rare, and certain cytologic pitfalls may hinder a correct prospective diagnosis. Familiarity with the lesion's clinical and cytologic features may help clinicians arrive at the appropriate prospective diagnosis and, thus, permit conservative management. Cancer (Cancer Cytopathol) 2006. © 2006 American Cancer Society.

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Radiographic features in lymphoepithelial cyst of the pancreas

Abstract: Two cases of pancreatic lymphoepithelial cyst are presented. Abdominal ultrasonography and endoscopic ultrasonography demonstrated cysts containing keratinized material, indicative of this diagnosis.

Cited by 39 publications

References 7 publications

Lymphoepithelial Cyst of the Pancreas: A Case Report

Lymphoepithelial Cyst of the Pancreas: A Case Report

Lymphoepithelial Cysts of the Pancreas: a Report of 12 Cases and a Review of the Literature

Fine-needle aspiration cytology of pancreatic lymphoepithelial cysts

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