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Ciers P, Vanderhaeghe D, Vansteenkiste F, Moubax K, Vanooteghem S, Vanneste A, Van Moerkercke W. Lymphoepithelial cysts of the pancreas: case report and review of the literature. Acta Chir Belg 2023; 123:550-554. [PMID: 35249466 DOI: 10.1080/00015458.2022.2050032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2021] [Accepted: 03/02/2022] [Indexed: 11/01/2022]
Abstract
BACKGROUND Lymphoepithelial cysts (LECs) of the pancreas are a rare type of true pancreatic cysts and represent an estimated 0.5% of all pancreatic cystic lesions. They are benign lesions and have no malignant potential. However, they are hard to differentiate from malignant lesions because their imaging and clinical presentation vary greatly. Seeing as these are benign lesions which are increasingly found incidentally during imaging for other indications, correct diagnosis is important to prevent unnecessary intervention and morbidity. CASE REPORT We report the case of a 41-year-old female who presented with abdominal discomfort, bloating and dyspepsia. An abdominal computed tomography (CT) showed a large mass in the left fossa. We describe the diagnostic and therapeutic measures taken in this case. METHODS We reviewed the literature for common features of the LEC. We grouped common imaging and histological features of the LEC of the pancreas to provide easily identifiable characteristics to facilitate diagnosis. For the review, we focused on papers, mostly case reports, presenting these common characteristics. We also reviewed the literature for key topics that should be taken into account when considering therapeutic interventions in a patient with a possible diagnosis of a LEC. CONCLUSION Cysts of the pancreas are increasingly identified due to widespread use and improved resolution of cross-sectional imaging. To obtain the correct diagnosis, it is sometimes necessary to combine advanced imaging, i.e. CT and MRI-imaging, and endoscopic ultrasound with fine needle aspiration (EUS/FNA), while CA 19-9 also has diagnostic value. We summarize all diagnostic characteristics in a table for ease of use. Furthermore we summarized possible therapeutic interventions.
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Affiliation(s)
- Philippe Ciers
- Department of Vascular Surgery, Klinikum Westmunsterland GmbH, Bocholt, Germany
| | | | | | - Kim Moubax
- Department of Gastroenterology, AZ Groeninge, Kortrijk, Belgium
| | - Sofie Vanooteghem
- Department of Gastroenterology, OLV van Lourdes Hospital, Waregem, Belgium
| | - Alain Vanneste
- Department of Pathological Anatomy, AZ Groeninge, Kortrijk, Belgium
| | - Wouter Van Moerkercke
- Department of Gastroenterology, AZ Groeninge, Kortrijk, Belgium
- Department of Gastroenterology and Hepatology, University Hospitals Leuven, UZ Leuven, Leuven, Belgium
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Hirabayashi K, Saika T, Nakamura N. Background features in the cytology of pancreatic neoplasms. DEN OPEN 2022; 2:e105. [PMID: 35873514 PMCID: PMC9302047 DOI: 10.1002/deo2.105] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/29/2021] [Revised: 02/09/2022] [Accepted: 02/13/2022] [Indexed: 11/05/2022]
Abstract
Cytology is a useful method for diagnosing pancreatic neoplasms. Although endoscopic ultrasound‐guided fine‐needle aspiration has recently become the mainstream method for the diagnosis of pancreatic neoplasms, pancreatic juice and pancreatic duct brushing cytology continue to be useful diagnostic methods for the investigation of pancreatic neoplasms. Diagnoses using pancreatic cytology are primarily based on the features related to tumor cells; however, evaluation of the background features provides important information that could further aid the diagnosis. Pancreatic neoplasms show various histological types, each of which is associated with its own characteristic background features. The necrotic background, desmoplastic stroma, and presence of cancer‐associated fibroblasts are background features of pancreatic ductal adenocarcinoma, a mucinous background is associated with intraductal papillary mucinous neoplasms and mucinous cystic neoplasms, and hyaline globules are observed in solid pseudopapillary neoplasms. However, some background features are associated with more than one histological type of pancreatic neoplasm, highlighting the importance to base a diagnosis on the results of a comprehensive analysis of not only the background features but also the tumor cells. Here, we provide a review of the key background cytological features of pancreatic neoplasms, which can serve as a guide to improve diagnosis and research.
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Affiliation(s)
| | - Tsubasa Saika
- Diagnostic Pathology Center Tokai University Hospital Kanagawa Japan
| | - Naoya Nakamura
- Department of Pathology Tokai University School of Medicine Kanagawa Japan
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Farooq A, Evans JJ, Hagen CE, Hartley CP. Lymphoepithelial cyst of the pancreas: A challenging diagnosis on fine needle aspiration. Ann Diagn Pathol 2020; 49:151603. [PMID: 32949892 DOI: 10.1016/j.anndiagpath.2020.151603] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2020] [Accepted: 08/17/2020] [Indexed: 11/27/2022]
Abstract
Lymphoepithelial cysts (LECs) of the pancreas are rare, benign pancreatic cysts comprising approximately 0.5% of all pancreatic cysts. They occur predominantly in men in the 5th and 6th decades of life. LECs are true cysts lined by stratified squamous epithelium with adjacent subepithelial lymphoid tissue. They range in size from 1.2 to 17 cm (mean size 4.6 cm) and can arise in any part of the pancreas. 1 LEC resembles other benign and malignant pancreatic cysts clinically and radiologically. The cytomorphologic features of LECs have been described in a small number of case reports and it has been indicated that features may overlap with other benign and malignant pancreatic lesions. Herein, we report clinical, radiological, cytological and histopathological features of a pancreatic LEC in a 62-year-old male.
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Affiliation(s)
- Ayesha Farooq
- Department of Pathology, Medical College of Wisconsin, Milwaukee, WI, USA
| | - John J Evans
- Department of Pathology, Medical College of Wisconsin, Milwaukee, WI, USA
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A Rare Presentation of Pancreatic Lymphoepithelial Cyst: A Case Report and Review. Case Rep Med 2020; 2020:4590758. [PMID: 32099546 PMCID: PMC7040412 DOI: 10.1155/2020/4590758] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2019] [Accepted: 01/18/2020] [Indexed: 11/21/2022] Open
Abstract
Pancreatic lymphoepithelial cyst (LEC) is a rare, benign collection of keratinizing squamous epithelial cells encapsulated by lymphoid tissue. Because of its limited data and nonspecific features that can mimic malignant lesions, LECs can lead to unnecessary operations. A 62-year-old male with a known pancreatic mass presented with abdominal pain. CT scan showed an increased mass in the pancreatic head, and endoscopic ultrasound-guided fine needle aspiration (EUS-FNA) revealed “rare fragments of benign-appearing squamous epithelium in a background of keratin debris, cyst contents, and scattered lymphocytes,” consistent with a lymphoepithelial cyst. Pancreatic LEC is an extremely rare lesion that comprises of only 0.5% of all pancreatic cysts. EUS-FNA has become the mainstay for diagnosing pancreatic LECs. Given the slow growing and benign nature, conservative management and observation is adequate for pancreatic LECs with excellent long-term outcome. With increasing number of imaging ordered by clinicians, it is anticipated that there will be a greater number of incidental pancreatic LECs detected. Thus, EUS-FNA should be utilized more frequently to help distinguish benign pancreatic LECs from premalignant or malignant lesions to avoid surgery.
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Borhani AA, Fasanella KE, Iranpour N, Zureikat AH, Singhi AD, Furlan A, Dasyam AK. Lymphoepithelial cyst of pancreas: spectrum of radiological findings with pathologic correlation. Abdom Radiol (NY) 2017; 42:877-883. [PMID: 27738791 DOI: 10.1007/s00261-016-0932-3] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
PURPOSE The purpose of the study was to investigate imaging features as well as pathologic and clinical findings of lymphoepithelial cyst (LEC) of pancreas. MATERIALS AND METHODS Ten patients with surgically resected and pathologically proven LEC, found in a single institution database between 2000 and 2015, were evaluated in a retrospective fashion. Patients' demographics, clinical presentation, co-morbidities, imaging features, cytology and histopathology results, and serum/aspirate biomarkers levels were recorded. RESULTS Eighty percent of patients were male with median age of 59. All lesions were exophytic, with median size of 36 mm. 80% were classified as complex cystic lesions, showing enhancing septa or enhancing rim without measurable enhancing solid component. 80% were located in tail or body. In one patient with MRI, the lesion was mildly T1 hyperintense and markedly T2 hyperintense. All cases were anechoic or hypoechoic on EUS, and majority of them showed posterior acoustic enhancement. Of patients with available fluid aspirate analysis, 3 out of 4 had CEA level > 192 ng/mL and 1 out of 3 had elevated (>250 IU/ml) amylase level. Four out of 7 patients had elevated serum CA 19-9 levels (>37 U/mL); one patient with a value of 361 U/mL had co-existing pancreatic adenocarcinoma. CONCLUSION Round shape, mild complexity, and exophytic location in pancreatic body and tail can be suggestive of LECs. These features however are not specific and may be seen with other cystic pancreatic lesions. CT findings should be used in conjunction with EUS, cytology, and tumor marker studies to secure the diagnosis of LEC.
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Affiliation(s)
- Amir A Borhani
- Division of Abdominal Imaging, University of Pittsburgh School of Medicine, UPMC Presbyterian, Radiology Suite 200 East Wing, 200 Lothrop Street, Pittsburgh, PA, 15213, USA.
| | - Kenneth E Fasanella
- Division of Gastroenterology and Hepatology, University of Pittsburgh School of Medicine, UPMC Presbyterian, 200 Lothrop Street, Pittsburgh, PA, 15213, USA
| | - Negaur Iranpour
- Division of Abdominal Imaging, Department of Radiology, University of Pittsburgh Medical Center, UPMC Presbyterian, Radiology Suite 200 East Wing, 200 Lothrop Street, Pittsburgh, PA, 15213, USA
| | - Amer H Zureikat
- Division of Surgical Oncology, University of Pittsburgh Medical Center, 5150 Centre Ave, Suite 421, Pittsburgh, PA, 15232, USA
| | - Aatur D Singhi
- Department of Pathology, University of Pittsburgh School of Medicine, 200 Lothrop Street, Scaife Hall A616.2, Pittsburgh, PA, 15213, USA
| | - Alessandro Furlan
- Division of Abdominal Imaging, University of Pittsburgh School of Medicine, UPMC Presbyterian, Radiology Suite 200 East Wing, 200 Lothrop Street, Pittsburgh, PA, 15213, USA
| | - Anil K Dasyam
- Division of Abdominal Imaging, University of Pittsburgh School of Medicine, UPMC Presbyterian, Radiology Suite 200 East Wing, 200 Lothrop Street, Pittsburgh, PA, 15213, USA
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Kim YS, Cho JH. Rare nonneoplastic cysts of pancreas. Clin Endosc 2015; 48:31-8. [PMID: 25674524 PMCID: PMC4323429 DOI: 10.5946/ce.2015.48.1.31] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/06/2015] [Revised: 01/14/2015] [Accepted: 01/14/2015] [Indexed: 01/04/2023] Open
Abstract
Pancreatic cysts represent a small proportion of pancreatic diseases, but their incidence has been recently increasing. Most pancreatic cysts are identified incidentally, causing a dilemma for both clinicians and patients. In contrast to ductal adenocarcinoma, neoplastic pancreatic cysts may be cured by resection. In general, pancreatic cysts are classified as neoplastic or non-neoplastic cysts. The predominant types of neoplastic cysts include intraductal papillary mucinous neoplasms, mucinous cystic neoplasms, serous cystic neoplasms, and solid pseudopapillary neoplasms. With the exception of serous type, neoplastic cysts, have malignant potential, and in most cases requires resection. Non-neoplastic cysts include pseudocyst, retention cyst, benign epithelial cysts, lymphoepithelial cysts, squamous lined cysts (dermoid cyst and epidermal cyst in intrapancreatic accessory spleen), mucinous nonneoplastic cysts, and lymphangiomas. The incidence of nonneoplastic, noninflammatory cysts is about 6.3% of all pancreatic cysts. Despite the use of high-resolution imaging technologies and cytologic tissue acquisition with endosonography, distinguishing nonneoplastic from neoplastic cysts remains difficult with most differentiations made postoperatively. Nonetheless, the definitive distinction between non-neoplastic and neoplastic cysts is crucial as unnecessary surgery could be avoided with proper diagnosis. Therefore, consideration of these rare disease entities should be entertained before deciding on surgery.
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Affiliation(s)
- Yeon Suk Kim
- Division of Gastroenterology, Department of Internal Medicine, Gachon University Gil Medical Center, Gachon University of Medicine and Science, Incheon, Korea
| | - Jae Hee Cho
- Division of Gastroenterology, Department of Internal Medicine, Gachon University Gil Medical Center, Gachon University of Medicine and Science, Incheon, Korea
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Abstract
OBJECTIVES Lymphoepithelial cyst (LEC) of the pancreas is an unusual and benign cystic tumor. Accurate preoperative diagnosis is difficult; hence, most of pancreatic LECs are resected. The aim was to describe clinicopathological features of pancreatic LEC to guide appropriate management. METHODS We retrospectively collected data about LEC patients treated in our department between 1987 and 2012 and added cases from review of the literature during the same period. RESULTS One hundred seventeen cases (3 from our institution and 114 from literature review) were identified. Most patients were men (78%). The discovery was generally fortuitous. Serum CA19-9 was elevated in half of the cases. No specific radiological feature was identified. Fine needle aspiration and cytologic analysis allowed a correct preoperative diagnosis in 21% of the patients, showing presence of squamous cells, lymphocytes, and keratinous debris. Half of them were treated conservatively, whereas other patients underwent surgery. Neither malignant transformation nor recurrence after resection was observed. CONCLUSIONS The LEC of the pancreas is a rare benign tumor that could be treated conservatively. Fine needle aspiration is the only tool that can achieve a diagnosis without resection. If no certain diagnosis can be made, surgery is warranted to rule out a malignant differential diagnosis.
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Konstantinidis IT, Kambadakone A, Catalano OA, Sahani DV, Deshpande V, Forcione DG, Wargo JA, Fernandez-del Castillo C, Lillemoe KD, Warshaw AL, Ferrone CR. Lymphoepithelial cysts and cystic lymphangiomas: Under-recognized benign cystic lesions of the pancreas. World J Gastrointest Surg 2014; 6:136-141. [PMID: 25068011 PMCID: PMC4110531 DOI: 10.4240/wjgs.v6.i7.136] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2014] [Revised: 05/05/2014] [Accepted: 07/14/2014] [Indexed: 02/06/2023] Open
Abstract
AIM: To identify their diagnostic and prognostic clinical characteristics in a large series.
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 1/1/1997 and 8/1/2007. Their median age was 55.5 years (range 19-78 years), and 6 were females. The lesion was incidentally discovered in half of the patients. 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.
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9
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Ancillary Studies, Including Immunohistochemistry and Molecular Studies, in Pancreatic Cytology. Surg Pathol Clin 2014; 7:1-34. [PMID: 26839266 DOI: 10.1016/j.path.2013.11.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Fine-needle aspiration biopsy of the pancreas is indicated for sampling of solid and cystic masses. Preoperative cytologic diagnosis of pancreatic ductal adenocarcinoma and cystic lesions on cytology can be problematic, and ancillary studies may help confirm diagnosis. Ancillary studies in pancreatic cytology include special stains, immunohistochemistry, mutational analyses of specific genes, cyst fluid analysis of tumor markers and enzymes, and, in some instances, flow cytometry. Proteomics, microRNA sequencing, and whole-exome gene sequencing have been used to illustrate the progression of pancreatic neoplasms and identify key diagnostic markers. This article summarizes recent literature on ancillary studies in pancreatic fine-needle aspiration samples.
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10
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VandenBussche CJ, Maleki Z. Fine-needle aspiration of squamous-lined cysts of the pancreas. Diagn Cytopathol 2013; 42:592-9. [DOI: 10.1002/dc.23080] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2013] [Accepted: 12/03/2013] [Indexed: 11/10/2022]
Affiliation(s)
| | - Zahra Maleki
- Department of Pathology; The Johns Hopkins Medical Institutions; Baltimore Maryland
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11
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Shindoh J, Seyama Y, Umekita N. Huge atypical cyst arising from the pancreas. Gastroenterology 2012; 143:e8-e9. [PMID: 22841732 DOI: 10.1053/j.gastro.2012.01.048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2012] [Accepted: 01/27/2012] [Indexed: 12/02/2022]
Affiliation(s)
- Junichi Shindoh
- Department of Surgery, Tokyo Metropolitan Bokutoh Hospital, Tokyo, Japan
| | - Yasuji Seyama
- Department of Surgery, Tokyo Metropolitan Bokutoh Hospital, Tokyo, Japan
| | - Nobutaka Umekita
- Department of Surgery, Tokyo Metropolitan Bokutoh Hospital, Tokyo, Japan
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12
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Sakorafas GH, Smyrniotis V, Reid-Lombardo KM, Sarr MG. Primary pancreatic cystic neoplasms of the pancreas revisited. Part IV: rare cystic neoplasms. Surg Oncol 2012; 21:153-63. [PMID: 21816607 DOI: 10.1016/j.suronc.2011.06.007] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2011] [Revised: 05/16/2011] [Accepted: 06/29/2011] [Indexed: 02/07/2023]
Abstract
Primary pancreatic cystic neoplasms are being recognized with increasing frequency due to modern imaging techniques. In addition to the more common cystic neoplasms-serous cystadenoma, primary mucinous cystic neoplasm, and intraductal papillary mucinous neoplasm-there are many other less common neoplasms that appear as cystic lesions. These cystic neoplasms include solid pseudopapillary neoplasm of the pancreas (the most common rare cystic neoplasm), cystic neuroendocrine neoplasm, cystic degeneration of otherwise solid neoplasms, and then the exceedingly rare cystic acinar cell neoplasm, intraductal tubular neoplasm, angiomatous neoplasm, lymphoepithelial cysts (not true neoplasms), and few others of mesenchymal origin. While quite rare, the pancreatic surgeon should at the least consider these unusual neoplasms in the differential diagnosis of potentially benign or malignant cystic lesions of the pancreas. Moreover, each of these unusual neoplasms has their own natural history/tumor biology and may require a different level of operative aggressiveness to obtain the optimal outcome.
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Affiliation(s)
- George H Sakorafas
- 4th Department of Surgery, Medical School, University of Athens, Attikon University Hospital, Athens, 12462, Greece.
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13
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Conway AB, Cook SM, Samad A, Attam R, Pambuccian SE. Large platelet aggregates in endoscopic ultrasound-guided fine-needle aspiration of the pancreas and peripancreatic region: a clue for the diagnosis of intrapancreatic or accessory spleen. Diagn Cytopathol 2011; 41:661-72. [PMID: 22045629 DOI: 10.1002/dc.21832] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2011] [Accepted: 08/09/2011] [Indexed: 11/06/2022]
Abstract
Intrapancreatic and intraabdominal accessory spleens (IPIASs) are rarely encountered in endoscopic ultrasound-guided fine-needle aspiration (EUS-FNA) biopsies. However, as incidentally discovered IPIAS can mimic a benign or malignant pancreatic neoplasm on imaging studies, a definitive diagnosis made by EUS-FNA can avert an unnecessary surgical intervention or additional radiologic follow-up. We report five cases of intrapancreatic splenules and one case of accessory spleen (AS) in which a definitive diagnosis was made on EUS-FNA. Previously recognized FNA cytomorphologic features of splenic tissue, including ASs and splenosis, are endothelial cells and polymorphous lymphocytes admixed with neutrophils, eosinophils, plasma cells, histiocytes, and lymphoglandular bodies. We describe the additional finding of abundant large platelet aggregates as another distinguishing feature of splenic tissue on FNA. In all six cases, large platelet aggregates were identified along with polymorphous lymphoid cells, lymphoglandular bodies, loose aggregates of endothelial cells and scattered or aggregated bland spindle cells. A review of 10 consecutive cases of EUS-FNA-sampled benign intraabdominal lymph nodes showed that the presence of large platelet aggregates, three-dimensional aggregates of lymphoid cells and of bland slender spindle cells and the absence of follicular germinal cell components (tingible body macrophages and lymphohistiocytic aggregates) are useful in differentiating IPIASs from reactive lymph nodes. Immunoperoxidase stains were useful to confirm a suspected IPIASs by showing CD31-positive acellular flocculent material, consistent with large platelet aggregates and a rich CD8-positive endothelial cell network between CD45-positive lymphoid cells and CD68-positive histiocytes in all six cases.
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Affiliation(s)
- Andrea B Conway
- Department of Laboratory Medicine and Pathology, University of Minnesota Medical School, Minneapolis, Minnesota, USA
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Selected case from the Arkadi M. Rywlin International Pathology Slide Seminar: benign lymphoepithelial cyst, head of pancreas. Adv Anat Pathol 2011; 18:98-100. [PMID: 21169743 DOI: 10.1097/pap.0b013e3182026d8f] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Pancreatic lymphoepithelial cysts are more common in men, can occur anywhere in the pancreas, are sharply demarcated from surrounding tissues, and range in size from 1.2 to 17 cm. Patients are usually middle aged, presenting symptoms include abdominal pain, nausea, vomiting, and diarrhea, although many tumors are asymptomatic and are discovered incidentally on organ imaging or at autopsy. An elevated serum carbohydrate-associated antigen 19-9 may wrongly suggest a mucinous neoplasm. The diagnosis can be made preoperatively with a combination of organ imaging, fine needle aspiration biopsy, or ultrasound-guided Trucut biopsies. Cysts can be unilocular, bilocular, or multilocular, have walls up to 0.6 cm thick which are lined by squamous epithelium, occasional columnar mucinous cells, and small foci of sebaceous cells. The epithelium is surrounded by a dense rim of lymphoid tissue with scattered lymphoid follicles. Invaginations of the epithelium into the lymphoid tissue, reminiscent of a Warthin tumor, are occasionally observed. The pathogenesis is unknown. Pancreatic lymphoepithelial cysts are cured by conservative resection but if they are asymptomatic and are diagnosed before surgery, no treatment is necessary.
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15
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Laparoscopic Distal Pancreatectomy for a Large Pancreatic Lymphoepithelial Cyst. Surg Laparosc Endosc Percutan Tech 2010; 20:e211-4. [DOI: 10.1097/sle.0b013e3181fec893] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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16
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Sewkani A, Purohit D, Singh V, Jain A, Varshney R, Varshney S. Lymphoepithelial cyst of the pancreas: a rare case report and review of literature. Indian J Surg 2010; 72:427-32. [PMID: 22131649 DOI: 10.1007/s12262-010-0152-y] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2009] [Accepted: 09/02/2010] [Indexed: 11/25/2022] Open
Abstract
UNLABELLED Lymphoepithelial cysts are rare pancreatic lesions of undetermined pathogenesis. The literature on this entity is limited to case reports or small series. We describe a case of 66 year male, incidentally diagnosed as lymphoepithelial cyst of pancreas that was managed by enucleation. This is the first case report of lymphoepithelial cyst from India. An extensive Medline search was carried out for lymphoepithelial cyst of pancreas. Till date less than 100 cases were identified in available literature. All these cases (including our case) were analyzed. This entity has uniform and distinctive clinicopathological features. About half of the reported cases were asymptomatic with most of the lesions diagnosed incidentally. Majority of patients presents with non-specific symptoms making preoperative diagnosis difficult. Lymphoepithelial cyst of the pancreas is a rare benign lesion, which is difficult to diagnose preoperatively. High index of suspicion and preoperative fine needle aspiration cytology may help in making diagnosis and avoiding surgery in asymptomatic patients. ELECTRONIC SUPPLEMENTARY MATERIAL The online version of this article (doi:10.1007/s12262-010-0152-y) contains supplementary material, which is available to authorized users.
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Bixler HA, Castro MJ, Stewart J. Cytologic differentiation of squamous elements in the pancreas. Diagn Cytopathol 2010; 39:536-9; quiz 539-40. [PMID: 20949450 DOI: 10.1002/dc.21479] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2010] [Accepted: 06/03/2010] [Indexed: 11/07/2022]
Affiliation(s)
- Heather A Bixler
- Department of Pathology and Laboratory Medicine, Division of Cytopathology, University of Wisconsin School of Medicine and Public Health, 600 Highland Avenue, Madison, WI 53792, USA
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Hébert-Magee S, Garvin D, Ahlawat S, Haddad N. Lymphoepithelial cyst of the pancreas with sebaceous differentiation: Cytologic diagnosis by fine-needle aspiration. Diagn Cytopathol 2009; 37:937-9. [DOI: 10.1002/dc.21182] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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19
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Lymphoepithelial cyst of the pancreas that was difficult to distinguish from branch duct-type intraductal papillary mucinous neoplasm: report of a case. Surg Today 2009; 39:901-4. [PMID: 19784732 DOI: 10.1007/s00595-009-3949-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2008] [Accepted: 01/20/2009] [Indexed: 01/03/2023]
Abstract
A 58-year-old woman was admitted to our hospital to optimize the management of her diabetes mellitus. A computed tomography (CT) scan showed a 30-mmdiameter, multilocular cyst in the head of the pancreas. The tumor markers, including DUPAN 2, SPAN-1, and carbohydrate antigen 19-9, were within the normal ranges. A contrast-enhanced CT scan showed a nonenhanced, multilocular cyst. Abdominal magnetic resonance imaging showed a multilocular cyst. Endoscopic retrograde cholangiopancreatography showed that the main pancreatic duct was normal. Based on these findings, we suspected a branch duct type intraductal papillary mucinous neoplasm. A distal pancreatectomy with a splenectomy was performed, since more of the mass was located on the dorsolateral side, inconsistent with the preoperative imaging results. On the resected specimen, a 4-cm-diameter, multilocular cyst containing serous fluid was found. Pathologically, the cyst wall was lined with squamous epithelium surrounded by abundant lymphoid tissue with follicles, consistent with a lymphoepithelial cyst of the pancreas, which is an unusual benign cyst.
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Bellizzi AM, Stelow EB. Pancreatic cytopathology: a practical approach and review. Arch Pathol Lab Med 2009; 133:388-404. [PMID: 19260745 DOI: 10.5858/133.3.388] [Citation(s) in RCA: 51] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/06/2008] [Indexed: 11/06/2022]
Abstract
CONTEXT Pancreatic cytopathology plays an important role in the diagnosis and management of patients with solid and cystic lesions of the pancreas. OBJECTIVE To serve as a practical guide to pancreatic cytopathology for the practicing pathologist. Data Sources.-A comprehensive assessment of the medical literature was performed. CONCLUSIONS We review pancreatic cytopathology, with specific discussions of its role in patient management, specimen types and specimen processing, specific diagnostic criteria, and the use of ancillary testing and advanced techniques.
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Affiliation(s)
- Andrew M Bellizzi
- Department of Pathology, Universityof Virginia Health System, Charlottesville,VA 22908, USA
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Early DS, Krishnamurthy S. Clinical challenges and images in GI. Endoscopic ultrasound trucut needle biopsy of a rare pancreatic lesion. Gastroenterology 2009; 136:773, 1124. [PMID: 19167393 DOI: 10.1053/j.gastro.2008.05.057] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2008] [Revised: 05/05/2008] [Accepted: 05/22/2008] [Indexed: 12/02/2022]
Affiliation(s)
- Dayna S Early
- Department of Gastroenterology, Pathology, and Immunology, Washington University in St Louis, St Louis, Missouri, USA
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Jian B, Kimbrell HZ, Sepulveda A, Yu G. Lymphoepithelial cysts of the pancreas: Endosonography-guided fine needle aspiration. Diagn Cytopathol 2008; 36:662-5. [DOI: 10.1002/dc.20865] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
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Nasr J, Sanders M, Fasanella K, Khalid A, McGrath K. Lymphoepithelial cysts of the pancreas: an EUS case series. Gastrointest Endosc 2008; 68:170-3. [PMID: 18513719 DOI: 10.1016/j.gie.2008.02.044] [Citation(s) in RCA: 52] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/29/2007] [Accepted: 02/18/2008] [Indexed: 12/13/2022]
Abstract
BACKGROUND Lymphoepithelial cysts (LEC) of the pancreas are rare benign lesions that can be misdiagnosed as pancreatic masses or cystic neoplasms. With widespread use of abdominal cross-sectional imaging, more pancreatic lesions are being discovered, with EUS being used to further evaluate the abnormality. OBJECTIVE Our purpose was to describe EUS and cyst aspirate features of LEC of the pancreas. DESIGN Case series. SETTING Single tertiary referral center. PATIENTS Nine patients with lymphoepithelial cysts who underwent EUS-FNA. RESULTS Five male and 4 female patients were identified (mean age 51 years). All lesions were discovered by CT and described as "peripancreatic" in 67% of cases (6/9). EUS examination described a solid-appearing hypoechoic and heterogeneous mass with subtle postacoustic enhancement in 5 of 9 cases. Four lesions were described as purely cystic: 2 were septated, 1 was unilocular, and 1 had internal papillary fronds. Mean cyst size was 5.2 cm (range 1.7-12 cm). Cyst aspirates revealed a thick milky, creamy, or frothy aspirate in 56% of cases (5/9). Cyst cytologic examination revealed squamous material (nucleated/anucleated cells or keratin debris) in all cases. Lymphocytes were seen in 56% of aspirates (5/9). Carcinoembryonic antigen (CEA) levels were obtained in 5 cases (median 6.5 ng/mL [range 2.9-493.4 ng/mL]). Six patients have avoided surgery on the basis of EUS-FNA cytologic results confirming the diagnosis of LEC. Three patients underwent surgical resection: 2 for symptomatic lesions and 1 for concern for a mucinous cystic neoplasm given an elevated aspirate CEA level. Surgical pathologic examination confirmed LEC in each. LIMITATIONS Retrospective single-center study. CONCLUSIONS LEC should be considered whenever a large, well-defined solid or cystic peripheral pancreatic lesion is found. A thick milky, creamy, or frothy aspirate is common. The presence of squamous material and lymphocytes on cytologic examination is diagnostic of LEC. Aspirate CEA level may be elevated and should be considered in conjunction with cytologic results to avoid misdiagnosis as a mucinous cystic neoplasm. Asymptomatic LEC should be managed conservatively.
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Affiliation(s)
- John Nasr
- Department of Medicine, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania 16046, USA
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Le kyste lymphoépithélial du pancréas : à propos d’un nouveau cas. ACTA ACUST UNITED AC 2008; 32:640-4. [DOI: 10.1016/j.gcb.2008.01.036] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2007] [Revised: 12/30/2007] [Accepted: 01/02/2008] [Indexed: 11/21/2022]
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Diagnosis and management of cystic neoplasms of the pancreas: an evidence-based approach. J Am Coll Surg 2008; 207:106-20. [PMID: 18589369 DOI: 10.1016/j.jamcollsurg.2007.12.048] [Citation(s) in RCA: 47] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2007] [Revised: 11/30/2007] [Accepted: 12/19/2007] [Indexed: 02/06/2023]
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