Case Report. Lymphoepithelial Cysts of the Pancreas: Demonstration of Lipid Component Using CT and MRI

Fukukura, Yoshihiko; Inoue, Hiroki; Miyazono, Nobuaki; Kajiya, Yoriko; Fujiyoshi, Fumito; Yano, Takeshi; Sakoda, Koro; Tanaka, Sadao; Aiko, Takashi; Nakajo, Masayuki

doi:10.1097/00004728-199803000-00029

Cited by 37 publications

(17 citation statements)

References 7 publications

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“…This finding is similar to those reported in previous reports (6,8,9). Radiologists should be aware of this contradictory finding, in order to narrow the differential diagnosis when a cystic lesion of the pancreas is present.…”

Section: Discussionsupporting

confidence: 91%

“…Occasionally, mural calcifications can be seen (6,7). The attenuation values of the internal contents sometimes exhibit negative Hounsfield units, implying the presence of lipid contents (6,8).…”

Section: Discussionmentioning

confidence: 99%

“…The attenuation values of the internal contents sometimes exhibit negative Hounsfield units, implying the presence of lipid contents (6,8). It has been suggested that a combination of a cystic appearance on CT and a nonhomogeneous echogenicity on sonography can provide a clue to the correct diagnosis (6,8,9).…”

Section: Discussionmentioning

confidence: 99%

“…The cholesterol cleft in the keratin contents of the cyst may appear hyperintense on the T1-weighted images, and hypointense on the T2-weighted images (6,7). Fat saturation and chemical shift imaging techniques are helpful in identifying the fat component (6).…”

Section: Discussionmentioning

confidence: 99%

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Lymphoepithelial Cyst of the Pancreas: A Case Report

Joo

Kim

et al. 2005

J Korean Radiol Soc

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Lymphoepithelial cyst (LEC) is a rare, benign disease. The radiographic differentiation of LECs from other cystic lesions of the pancreas with malignant potential is challenging. We describe the radiographic features of LEC in the hope that the knowledge of the distinctive radiography of this entity may minimize unnecessary surgery. Case ReportA 45-year-old man was referred to our hospital for the evaluation of a cystic mass in the head of the pancreas that was incidentally detected in an ultrasonography (US) examination performed at a local clinic. The patient had undergone subtotal gastrectomy 20 years earlier due to a perforated ulcer. He had no abdominal discomfort, tenderness or palpable masses. Laboratory testing revealed an elevated serum carbohydrate antigen (CA19 9) level of 55.5 U/mL (normal level < 37 U/mL).A contrast-enhanced abdominal computed tomography (CT) scan demonstrated a 5 cm multilobulated, multilocular cystic mass with septations at the superior aspect of the body of the pancreas. The attenuation value of the internal content was approximately 22 Hounsfield units. (Figs. 1A and 1B). Endoscopic retrograde cholangio-pancreatography (ERCP) showed no abnormality or communication between the pancreatic duct and the mass.Laparotomy revealed a well-defined, grayish, multilobular solid-like mass located at the head of the pancreas. Intraoperative sonography depicted a well-defined lobulated mass with moderate echogenicity mimicking a solid lesion (Fig. 2). The mass was completely enucleated.On gross examination, the cyst was found to be covered by a thin capsule and to measure 6 cm in diameter. On examination of the cut section, it was found to be multilobulated and multilocular without a solid portion (Fig. 3). The cyst's contents were caseous in appearance and gray-yellow to tan in color. Upon microscopic examination, the cyst was found to be lined by a keratinized stratified squamous epithelial layer with abundant mature lymphocytes present in the cyst wall. These findings were histologically consistent with a lymphoepithelial cyst. The patient's postoperative We present a case of lymphoepithelial cyst of the pancreas. The cyst showed moderate echogenicity, mimicking a solid lesion on ultrasonography (US), and had a cystic appearance on computed tomography (CT). This ambivalent finding may be a distinctive feature of lymphoepithelial cysts of the pancreas.

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Section: Discussionsupporting

confidence: 91%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Lymphoepithelial Cyst of the Pancreas: A Case Report

Joo

Kim

et al. 2005

J Korean Radiol Soc

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“…Features that support a lymphoepithelial cyst include visualization of a multilocular cyst on the surface of the pancreas with decreased attenuation (low Hounsfield units) on CT, hyperintensity on T1-weighted MRI, granular hypointensity on T2-weighted MRI and internal heterogeneous hyperechogenicity on ultrasound, findings that likely reflect the lipid and keratin contents of the cysts. 13,14 However, lymphoepithelial cysts can have nonspecific and even misleading imaging features. The cysts can be unilocular and not obviously located on the surface of the pancreas.…”

Section: Discussionmentioning

confidence: 99%

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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Cyst Fluid Cytology and Chemical Features in a Case of Lymphoepithelial Cyst of the Pancreas: A Rare and Difficult Preoperative Diagnosis

Centeno

Stockwell²,

Lewandrowski

1999

Diagn. Cytopathol.

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Most pancreatic cysts (90%) are inflammatory pseudocysts. Approximately 10% of pancreatic cysts are neoplasms, including serous cystadenomas, and mucinous tumors, some of which are malignant. Analysis of pancreatic cyst fluid obtained by percutaneous or endoscopic fine‐needle aspiration is increasingly being used for the preoperative diagnosis of pancreatic or peripancreatic cysts. However, cyst fluid chemical and cytologic features in less common types of pancreatic cysts have not been reported. Lymphoepithelial cyst of the pancreas is exceedingly rare, and only occasional individual reports have described cyst fluid findings. We report on a case of lymphoepithelial cyst of the pancreas developing in a middle‐aged man. Cyst fluid aspirated under radiological guidance showed elevated levels of carcinoembryonic antigen (CEA), CA19‐9, CA 125, and amylase, and a viscosity greater than that of serum. A cell block preparation of a fine‐needle aspiration showed tissue fragments with a keratinized squamous lining and a lymphocytic infiltrate in the wall, and abundant background keratinous debris. The cytologic and biochemical findings in this case exhibit similarities to the findings reported in other reports, and may represent a recognizable pattern on cyst fluid analysis. Diagn. Cytopathol. 1999;21:328–330. © 1999 Wiley‐Liss, Inc.

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Case Report. Lymphoepithelial Cysts of the Pancreas: Demonstration of Lipid Component Using CT and MRI

Cited by 37 publications

References 7 publications

Lymphoepithelial Cyst of the Pancreas: A Case Report

Lymphoepithelial Cyst of the Pancreas: A Case Report

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

Cyst Fluid Cytology and Chemical Features in a Case of Lymphoepithelial Cyst of the Pancreas: A Rare and Difficult Preoperative Diagnosis

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