胰腺内副脾表皮样囊肿的影像特征及病理对照

 目的  探讨胰腺内副脾表皮样囊肿(epidermoid cyst in intrapancreatic accessory spleen,ECIPAS)的影像学特征,以提高对该少见病变的认识。方法  回顾性分析经手术病理证实的5例ECIPAS的临床、影像及病理资料。4例行CT平扫加双期增强检查,其中2例同时行磁共振胰胆管造影(magnetic resonance cholangiopancreatography,MRCP)检查,1例行超声内镜检查,另1例行MR平扫加增强检查。观察病灶的大小、形态、密度信号及强化特点,并与组织病理进行对照。结果  所有病灶均位于胰尾部,囊肿最大径1.7~5.0 cm,平均2.7 cm。2例囊内可见分隔。CT平扫3例为边界清楚的类圆形低度灶,1例呈高密度伴边缘点状钙化;增强后3例可见环绕囊肿的实质显著强化,动脉期和静脉期密度均高于胰腺组织。1例MR扫描未见明显实性成分,囊肿呈T1WI低信号,T2WI高信号。MRCP均未见囊肿与胰管相通。结论  ECIPAS是少见的胰尾良性病变,其典型影像表现为囊肿伴周边类脾脏强化的实性成分。

The imaging features of epidermoid cyst in intrapancreatic accessory spleen: correlated with pathological findings

Objective  To investigate the imaging features of epidermoid cyst in intrapancreatic accessory spleen (ECIPAS) for better understanding of the rare disease. Methods  The clinical,radiological and pathological data of 5 patients with pathologically confirmed ECIPAS were retrospectively reviewed.Four cases underwent plain and dual-phase enhancement CT scan,of which 2 cases received magnetic resonance cholangiopancreatography (MRCP),and 1 case received endoscopic ultrasonography,and the other 1 case underwent plain and contrast-enhanced MRI scan.The size,shape,density/signal and enhancement mode of the lesions were analyzed and correlated with pathologic findings. Results  All lesions were situated in the pancreatic tail,wherein the mean size of the cyst was 2.7 cm,ranging from 1.7 cm to 5.0 cm.The cyst appeared multilocular in 2 cases.On plain CT,3 cases showed oval well-defined low density foci,while 1 case showed high density with stippled calcification in the periphery.In 3 cases,the solid component surrounding the cyst displayed marked enhancement on postcontrast CT,which density were higher than the pancreatic parenchymaduring both arterial and portal venous phase.Solid component was not seen on MR in 1 case,the  cyst was hypo-intense on T1WI and hyper-intense on T2WI.No communication with pancreatic duct was shown on MRCP. Conclusions  ECIPAS is a rare benign lesion situated in the tail of the pancreas,the typical imaging manifestation is a cyst with surrounding solid component that enhancing similar to the spleen.