Epidermoid cyst in an intrapancreatic accessory spleen with abnormally high CEA level in cyst fluid: a case report

Abstract

Epidermoid cyst in an intrapancreatic accessory spleen is a rare benign lesion that is difficult to diagnose preoperatively. Cyst fluid analysis for biochemistry markers has been widely used to aid the diagnosis of pancreatic cysts. A high cyst fluid carcinoembryonic antigen (CEA) level (>800 ng/mL) is said to be useful in distinguishing intraductal papillary mucinous neoplasm (IPMN) and mucinous cystic neoplasm (MCN) from other non-mucinous cysts. We herein report a case of epidermoid cyst in an intrapancreatic accessory spleen with abnormally high CEA level (3582 ng/mL) in the cyst fluid, suggesting a potential pitfall in using cyst fluid CEA level as an indicator of mucinous neoplasms.

Fine‐needle aspiration of a pancreas with squamoid cyst of pancreatic duct and pancreatic duct stones: A case report of a rare pancreatic lesion and an unusual concurrent finding of stone‐related crystals

“…pancreatic pseudocyst) 6 . However, high cyst fluid CEA levels have also been described in some non‐IPMN epithelial‐lined cyst including SCOP, 1,3 ECIAS, 7 lymphoepithelial cyst 8 and mucinous non‐neoplastic cyst 9 . In our case, the elevated cyst fluid CEA level of 572 ng/mL (Figure 3F) and the mural nodule seen on EUS (due to incidental neuroendocrine tumor) swung the clinical impression to favor surgical resection.…”