Squamoid Cyst of Pancreatic Ducts: A Distinct Type of Cystic Lesion in the Pancreas

Othman, Mohammad; Basturk, Olca; Groisman, Gabe; Krasinskas, Alyssa M.; Adsay, Volkan

doi:10.1097/01.pas.0000213349.42143.ec

Cited by 51 publications

(55 citation statements)

References 17 publications

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“…As MUC1 and MUC4 are expressed in the normal stratified epithelium, 32,35 pancreatic squamous metaplasia 36 and in squamoid cysts of the pancreas, 37 the presence of MUC1 and MUC4 in our study suggests that lymphoepithelial cysts may originate from the pancreatic duct with squamous metaplasia and cystic formation, or alternatively, from epithelial remnants in peripancreatic lymph nodes. 2 The scattered mucous cells could represent remnant ductal epithelial cells.…”

Section: Discussionmentioning

confidence: 83%

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: 83%

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

et al. 2010

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“…This is a recently recognized type of cystic lesion in the pancreas, 166 in which cystically dilated ducts are lined by a squamous/transitional epithelium ( Figure 15) without keratinization. The larger and clinically manifested examples reported were unilocular.…”

Section: Squamoid Cyst Of Pancreatic Ductsmentioning

confidence: 99%

Cystic lesions of the pancreas

Adsay

2007

Modern Pathology

191

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Although cystic tumors of the pancreas are relatively rare, they constitute an increasingly important category. Advances in imaging and interventional techniques and the sharp drop in the mortality rate of pancreatic surgery have rendered pancreatic biopsies and resections commonplace specimens. Consequently, in the past two decades, the nature of many cystic tumors in this organ has been better characterized. The names of some existing entities were revised; for example, what was known as papillary-cystic tumor is now regarded as solidpseudopapillary tumor. New entities, in particular, intraductal papillary mucinous neoplasm and its variants, such as oncocytic and intestinal subtypes were recognized. The importance of clinical and pathologic correlation in the evaluation of these lesions was appreciated, in particular, with regards to the multifocality of these lesions, their association with invasive carcinomas, and thus their 'preinvasive' nature. Consensus criteria for the distinction of these from the ordinary precursors of adenocarcinoma, the pancreatic intraepithelial neoplasia, were established. The definition of mucinous cystic neoplasms was refined; ovarian-like stroma has now become almost a requirement for the diagnosis of mucinous cystic neoplasia, and defined as such, the propensity of these tumors to occur in perimenopausal women became even more striking. The validity and clinical value of classifying the pancreatic cysts of mucinous type as adenoma, borderline, CIS and invasive have been established. Related to this, the importance of thorough sampling in accurate classification of these mucinous lesions was recognized. Greater accessibility of the pancreas afforded by improved invasive as well as noninvasive modalities has also increased the detection of otherwise clinically silent cystic tumors, which has led to the recognition of more innocuous entities such as acinar cell cystadenoma and squamoid cyst of pancreatic ducts. As the significance of the cystic lesions emerged, cystic forms of otherwise typically solid tumors were also better characterized. Thus, significant developments have taken place in the classification and our understanding of pancreatic cystic tumors in the past few years, and experience with these lesions is likely to grow exponentially in the coming years. Modern Pathology (2007) 20, S71-S93.

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“…1 These cases had elevated carcinoembryonic antigen (CEA) levels, which led clinicians to the most common preoperative misdiagnosis of mucinous cysts. 1 Microscopic features of material obtained via fine-needle aspiration (FNA) have not been described. Therefore, it is currently unclear if cytology can lead to a correct preoperative diagnosis, which would avoid unnecessary surgery, especially in an era when imaging is detecting increasing numbers of incidental benign pancreatic cysts.…”

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confidence: 99%

“…2014;138:270-273; doi: 10.5858/ arpa.2012-0667-CR) S quamoid cyst of pancreatic ducts (SCPD) is a recently described benign entity originally reported by Othman et al 1 as a series of 6 clinically manifested cases and 10 cases identified incidentally in resected specimens. A subsequent case was reported in a letter to the editor 2 years following this publication.…”

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confidence: 99%

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Squamoid Cyst of Pancreatic Ducts: A Case Series Describing Novel Immunohistochemistry, Cytology, and Quantitative Cyst Fluid Chemistry

Hanson

Salem

Mitchell

2014

Archives of Pathology &Amp; Laboratory Medicine

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Squamoid cyst of pancreatic ducts (SCPD) is a benign pancreatic cyst often misdiagnosed preoperatively as a mucinous cyst. The histopathologic features are well described but the cytology and quantitative fluid chemistry profiles from fine-needle aspiration have not been reported. This case series discusses the cytology and cyst fluid chemistry profiles in 2 SCPDs and describes morphologic and immunohistochemical features that have not been previously reported. Fine-needle aspiration of 2 SCPDs yielded acellular debris lacking mucin or exfoliated squamous cells. Two cysts had elevated fluid carcinoembryonic antigen (CEA) and amylase levels. Positive immunohistochemical staining included cytokeratin 5/6, pCEA, synaptophysin, and chromogranin (both focal). MUC2 and MUC5AC showed negativity in all cases, while PAX8 showed negative nuclear staining. An accurate preoperative diagnosis of SCPD is potentially difficult in the setting of elevated fluid CEA levels, and acellular cytology as a mucinous cyst cannot be confidently excluded.

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Squamoid Cyst of Pancreatic Ducts: A Distinct Type of Cystic Lesion in the Pancreas

Cited by 51 publications

References 17 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

Cystic lesions of the pancreas

Squamoid Cyst of Pancreatic Ducts: A Case Series Describing Novel Immunohistochemistry, Cytology, and Quantitative Cyst Fluid Chemistry

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