Lympho-epithelial cyst of the pancreas: a difficult diagnosis. About two cases

We report two cases of lymphoepithelial cyst of the pancreas discovered incidentally on imaging in two men aged 50 and 61 years. One cyst contained hyperdense spots on CT-scan and in this case the biochemical analysis of the cyst fluid revealed high level of CEA. The unilocular cysts measured 4 and 5 cm on the surgical specimen. On microscopic examination, the cysts were lined by squamous keratinized epithelium positive for CEA, with rare mucin-secreting cells, lining on lymphoid tissue. The lymphoepithelial cyst is a rare dysembryoplastic benign lesion of the pancreas difficult to diagnose before surgery. The presence of keratin plugs on imaging is inconstant and the biochemical analysis of the cyst fluid can mislead to a diagnosis of mucinous cystic tumour. Cytological and histological analysis of fine needle aspiration material is of diagnostic interest and can avoid surgical resection when patients are symptom-free.     

Lymphoepithelial cyst of the pancreas: report of a case

The aim of this report is to describe the clinical and pathological features of a lympoepithelial cyst of the pancreas and to recommend fine-needle aspiration biopsy for the differential diagnosis of this lesion. A 55-year-old man was incidentally diagnosed as having a pancreatic tumor by abdominal ultrasonography. A hypoechoic cystic lesion was detected on the surface of the pancreatic body. A computed tomography revealed a cystic lesion surrounded by a smooth, flat wall. Magnetic resonance imaging revealed that the lesion was a low-intensity mass on the T1-image and a slightly high-intensity mass on the T2-image. The lesion was diagnosed as a benign cystic tumor, and enucleation of the tumor was scheduled. The fine needle aspiration biopsy was performed after laparotomy, and cytology of the contents was negative for malignant cells. The postoperative pathological diagnosis was a lymphoepithelial cyst of the pancreas. This cyst is an unusual but benign mass that requires minimal surgery.     

EUS diagnosis of cystic lesions of the pancreas

Summary Background. Cystic tumors of the pancreas are composed of benign, premalignant, malignant, and inflammatory lesions that are traditionally difficult to diagnose. Most of the tumors are initially detected on CT/US scanning, but often the morphological characteristics are insufficient for making a definitive diagnosis. Endoscopic ultrasound (EUS) may be an ideal tool for imaging of these lesions because it can provide highly detailed imaging without interference by bowel or air. Furthermore, EUS can direct fine needle aspiration of the lesions, providing cyst fluid for cytologic examination. The findings of cyst fluid cytology can be complemented by the use of cyst fluid tumor makers such as CEA. Using the morphologic appearance by endosonography, the results of cytology, and tumor marker analysis, EUS can often differentiate between benign, malignant, and inflammatory cystic lesions of the pancreas.     

Usefulness of in-phase and out-of-phase magnetic resonance imaging for the detection of pancreatic lymphoepithelial cyst

Lymphoepithelial cyst (LEC) of the pancreas is a rare benign lesion that may mimic cystic neoplasms. Diagnosis of pancreatic LEC has been depended on the elevation of serum carbohydrate antigen 19-9 (CA 19-9), biopsy of the cyst by endoscopic ultrasonography (EUS) and several abdominal imaging techniques including magnetic resonance imaging (MRI). However, it is very difficult to diagnose LEC of the pancreas preoperatively and excessive surgery has been done in spite of its benign nature. We herein report a case of pancreatic LEC which was preoperatively diagnosed by using in-phase and out-of-phase MRI and was successfully nucleated.     

Pancreatic cystic lesions: How endoscopic ultrasound morphology and endoscopic ultrasound fine needle aspiration help unlock the diagnostic puzzle

Cystic lesions of the pancreas are being diagnosed with increasing frequency,covering a vast spectrum from benign to malignant and invasive lesions.Numerous investigations can be done to discriminate between benign and non-evolutive lesions from those that require surgery.At the moment,there is no single test that will allow a correct diagnosis in all cases.Endoscopic ultrasound(EUS) morphology,cyst fluid analysis and cytohistology with EUS-guided fine needle aspiration can aid in this difficult diagnosis.     

Lymphoepithelial cyst of pancreas. Role of endoscopic ultrasound guided fine needle aspiration

Lymphoepithelial cysts of the pancreas are extremely rare, benign, nonneoplastic cysts that may simulate pseudocysts or cystic neoplasm of the pancreas. Endosonographic and cytologic features of pancreatic lymphoepithelial cysts are poorly characterized because of their rarity. However, appropriate prospective diagnosis of pancreatic lymphoepithelial cysts using endoscopic ultrasound-guided fined needle aspiration (EUS-FNA) cytology may permit conservative management because of their benign nature. We conducted a MEDLINE search using the MeSH terms "pancreas", "cyst" and identified 16 patients who were diagnosed with endosonography or computerized tomography (CT) guided fine needle aspiration. Usefulness and pitfalls of EUS- or CT-guided cyst fluid analysis in the pre-operative diagnosis of pancreatic lymphoepithelial cysts are discussed.     

Improved early diagnosis of cystadenocarcinoma of the pancreas

IntroductionT here are great differences between the therapy for cystadenocarcinomas and benign pancreatic lesions. Early diagnosis is propitious to selecting the appropriate therapy, and may directly influence the prognosis.[1-4] Differential diagnosis between cystadenocarcinoma and benign pancreatic lesion is difficult, because they lack typical clinical symptoms in early stage. In the commonly used examinations, the specificity of B-ultrasonography (B-US) and CT is very poor; they are di…     

Lymphoepithelial cyst of the pancreas

We experienced a rare case of lymphoepithelial cyst of pancreas. The patient was a 68-year-old man in whom a cystic lesion in the pancreas was detected when he was admitted for chronic renal failure. On ultrasonography, we detected a cystic lesion, 3 cm in diameter, with a septum, in head and body of the pancreas. On both computed tomography and magnetic resonance imaging, the cystic lesion did not show solid components. Endoscopic retrograde cholangiopancreatography showed no abnormality in the pancreatic duct and did not detect the cystic lesion. Although the lesion showed no evidence of malignancy on the images, we could not rule out malignancy, since high levels of carcinoembryonic antigen and carbohydrate antigen 19-9 were detected. We therefore performed a pancreatoduodenectomy. In the resected specimen, the lesion was a well-circumscribed and multilocular cyst that contained yellowish-white keratinous material and had no solid components. Histologically, the cyst wall was composed of mature keratinizing squamous epithelium and lymphoid tissue; it was diagnosed as a benign lymphoepithelial cyst of the pancreas.     

Lymphoepithelial cysts of the pancreas: The use of endoscopic ultrasound-guided fine-needle aspiration in diagnosis

Lymphoepithelial cysts (LECs) are rare non-neoplastic lesions that can appear as a complex cyst or a mass in the pancreas. Cytology from endoscopic ultrasound-guided fine-needle aspiration (EUS-FNA) can be helpful in making a diagnosis with the aim of avoiding unnecessary surgical resection. A case involving a 51-year-old woman with lower abdominal pain who was found to have a multiloculated cystic lesion at the junction of the pancreatic body and tail is described. Cytology from EUS-FNA was consistent with a pancreatic LEC. The lesion was managed conservatively and follow-up imaging of the cyst over the following two years was unchanged. The patient remains clinically well. Cytology from EUS-FNA can help distinguish LECs from cystic neoplasms, thus preventing radical surgical resection of this benign pancreatic cyst.     

The expanding role of endoscopic ultrasound in pancreatic disease

Since endoscopic ultrasound (EUS) was first developed in the 1980s, this technology has emerged as the principal modality for imaging the pancreas. When compared with other imaging techniques, EUS can more accurately image solid lesions of the pancreas and determine vascular involvement that might preclude surgery. Furthermore, EUS-guided fine needle aspiration allows safe and accurate sampling and histological diagnosis of these lesions. EUS also plays a large role in the evaluation of cystic lesions of the pancreas. EUS cyst morphology, as well as fluid analysis obtained by fine needle aspiration, can often be used to diagnose the etiology of these lesions, helping the clinician to more accurately assess the presence or potential for malignancy. EUS can also predict the probability of the presence of chronic pancreatitis, primarily on the basis of histological correlates. The focus of this review is to discuss the role of EUS in these and other commonly encountered pancreatic diseases.     

A serous oligocystic adenoma of the head of the pancreas successfully treated by dome resection and chemocautery: a new approach to serous oligocystic adenoma

Serous oligocystic adenoma (SOA) is an extremely rare benign tumor and ill-demarcated large cyst. We report a case of pancreatic SOA. During abdominal ultrasonography (US) for a routine health examination and computed tomography (CT), a 69-year-old woman was found to have a 9-cm unilocular cyst located in the head of her pancreas. After a 2-year follow up, the cyst was seen to increase in size. The results of US, CT, magnetic resonance imaging, endoscopic retrograde cholangiopancreatography (ERCP), and angiography led to suspicion of a benign or low grade malignancy cystadenoma of the pancreas adjacent to the peripheral organs. Fluid analysis and frozen section pathological studies revealed a serous oligocystic adenoma with no malignancy. Dome resection, chemocautery, and omental filling were performed, and the postoperative course was uneventful. SOAs are difficult to diagnose without surgery. When the cyst exists in the head of the pancreas, adjacent to the biliary tract, portal system, or visceral vessels, it is also difficult to perform complete resection without the threat of morbidity or mortality. We have developed a new approach to SOA diagnosis and treatment that involves minimally invasive procedures.     

A new case of congenital cyst of the pancreas

A new case of congenital cyst of the pancreas is reported. A 34-year-old woman was admitted with a painless, large, epigastric mass. Ultrasonography revealed an anechogenic retrogastric tumor. Computed tomography scan described a liquid cyst of the pancreas which was 15 cm in diameter. During surgery, a well-delimited translucent cyst was found and no local malignancy was observed. Extensive distal pancreatic resection with preservation of the spleen was performed and a thin part of cephalic pancreas was preserved. The liquid of the cyst did not contain any mucus. Microscopic study of the cyst wall described normal cuboidal cells and congenital cyst of the pancreas was diagnosed. Several diagnoses including hydatid cyst, pseudocyst and cystic tumors of the pancreas are discussed. Before surgery, lack of acute pancreatitis in recent medical history rules out pseudocyst and hydatid cyst. During the operation, if cystadenocarcinoma is easily ruled out, macrocystic serous cystadenoma is more difficult to exclude. Only histological examination of the cystic wall confirms the difference between cystadenoma and congenital cyst which remains an exceptional entity.     

Cystic tumors of the pancreas

The discovery of a cystic lesion in the pancreas implies a challenge for the physician. Approximately 10% are cystic tumors, benign to highly malignant, or true cysts, showing all stages of cellular differentiation, from benign to highly malignant tumors. Malignant cystic tumors are rare and comprise only about 1% of all pancreatic malignancies, they are potentially curable. Therefore, correct diagnosis and treatment of these lesions are of great importance. It is usually not possible to separate a pseudocyst from a benign cyst or a cystic tumor, but there are some signs and findings that could be helpful in the clinical decision. The diagnosis of a cystic pancreatic tumor requires different imaging techniques, including ultrasonography, computerized tomography, magnetic resonance imaging, and magnetic resonance cholangiopancreatography, but to distinguish a pseudocyst or a benign cyst from a potentially malignant lesion can be very difficult. The usefulness of blood tests and investigations of cyst fluid can be questionable. Today, surgical treatment of cystic pancreatic tumors can be performed with low morbidity. Therefore, we conclude that an active strategy with resection of cystic tumors of the pancreas should be recommended.     

Pancreatic epidermoid cyst.

Epidermoid cyst of intrapancreatic spleen is described but epidermoid cyst occurring in the pancreas itself is not documented. We report a 36-year-old man who presented with abdominal pain radiating to the back. On ultrasonography, a multilocular cyst was seen in the head of the pancreas. Fine-needle aspiration cytology suggested a diagnosis of epidermoid cyst, which was confirmed on histology of the resected specimen.     

Macrocystic form of serous pancreatic cystadenoma

OBJECTIVES: Macrocystic serous cystadenoma of the pancreas are benign lesions with sometimes difficult diagnostic issues. We aimed to describe clinicopathological and imaging features with cyst fluid analysis in a series of patients undergoing surgery for macrocystic serous cystadenoma. METHODS: Eight patients underwent pancreatic resection for a macrocystic lesion of the pancreas diagnosed on ultrasonography or CT. Endoscopic ultrasonography and preoperative fine-needle aspiration were performed in seven patients. Immunohistochemical analysis of the surgical specimen with antibodies to carcinoembryonic-antigen (CEA), carbohydrate antigen (CA) 19-9, estrogen receptor, and progesterone receptor antibodies was performed in all cases. RESULTS: Patients included seven women and one man, with a mean age of 48 yr. Lesions were incidentally discovered on ultrasonography in six patients and had a mean size of 3 cm (range, 1.5-5 cm). Endoscopic ultrasonography revealed millimetric cysts in three cases. In the seven aspirated cysts, cytological analysis was non-contributive, but biochemical analysis showed low content of CEA (< 5 ng/ml) and CA72.4 (< 40U/ml) in all but two. At histology, cysts were lined by clear cuboidal cells. They focally expressed CA19-9 but were negative for anti-CEA, antiestrogen receptor, and antiprogesterone receptor antibodies. Microscopic cysts in the wall of the lesions were demonstrated in five cases. CONCLUSIONS: Macrocystic serous cystadenoma is a particular variant of pancreatic serous cystadenoma. Endoscopic ultrasonography may be useful in detecting peripherally located millimetric cysts in unilocular lesions, and measurement of enzymes and tumor markers in cyst fluid may also contribute to the diagnosis showing low concentrations.     

Lymphoepithelial cyst of the pancreas

Summary Conclusion Lymphoepithelial cyst of the pancreas (LC) is a very rare benign lesion and preoperative diagnosis is difficult. Conservative surgery seems to be the appropriate therapy in symptomatic patients or when a precise preoperative diagnosis is not achieved. The benign behavior of all reported cases suggests that the asymptomatic patients with a certain morphological preoperative diagnosis might be clinically followed up. The histogenesis of LC remains to be elucidated. Background LC of the pancreas is a cyst that is histologically characterized by a fibrous tissue, a lymphoid component and a lining squamous epithelium. Methods Clinical and pathological findings of two personal cases are reported with review of the literature. Results A 56-yr-old man, complaining of epigastric pain, and a 47-yr-old man, with a history of alcohol abuse, were admitted to hospital. In both cases the lesion was detected with abdominal ultrasound but a certain diagnosis was obtained only after histological examination of the resected cysts.     

Thymic carcinoma developing in a multilocular thymic cyst

Thymic carcinoma developing in a pre-existing thymic cyst has rarely been reported in literature. The diagnosis of this entity in the past has always been established after surgery. We are reporting a case of thymic carcinoma that developed in a pre-existing multilocular thymic cyst in an elderly male. The diagnosis was based on imaging findings and confirmed on fine needle aspiration cytology (FNAC).KEY WORDS : Thymic cyst, carcinoma, fine needle aspiration cytology     

Diagnosis and management of relapsing pancreatitis associated with cystic neoplasms of the pancreas

One of the most important causes of relapsing pancreatitis is a cystic neoplasm of the pancreas. These low grade malignancies may cause pancreatitis by obstructing or communicating with a pancreatic duct. Patients with relapsing pancreatitis and a focal fluid fluid collection should be investigated for the possibility of a mucinous cystic neoplasm. Cross sectional imaging can provide a diagnosis with the imaging findings of a low attenuation cystic lesion containing mural calcification （CT scanning） or a lobular T2 enhancing lesion （MRCP）. Endoscopic ultrasound can provide more detailed imaging with the ability to guide fine needle aspiration of the cyst fluid. Cyst fluid analysis can provide a diagnosis of a mucinous cystic lesion with the combination of cytology （mucinous epithelium）, elevated carcinoembryonic antigen （CEA）, and the presence of DNA mutations. Management of these patients consists of surgical resection and monitoring in patients not able to withstand surgery.     

Lymphoepithelial cyst in the pancreas: A case report

A case of lymphoepithelial cyst in the pancreas was reported. A 64-year-old man without any specific compalints was found to have a cystic lesion in the anterior portion of the pancreas, as revealed by ultrasonography of the abdomen at an annual medical examination in 1988. This was dissected easily from the pancreas. Histologically, it was diagnosed to be a benign lymphoepithelial cyst in the pancreas. Cysts of this type are rare, and their histogenesis is also not well understood.     

Lymphoepithelial cyst in the pancreas: a case report

A case of lymphoepithelial cyst in the pancreas was reported. A 64-year-old man without any specific complaints was found to have a cystic lesion in the anterior portion of the pancreas, as revealed by ultrasonography of the abdomen at an annual medical examination in 1988. This was dissected easily from the pancreas. Histologically, it was diagnosed to be a benign lymphoepithelial cyst in the pancreas. Cysts of this type are rare, and their histogenesis is also not well understood.