Image-diagnostic features of mature cystic teratomas of the pancreas: report on two cases difficult to diagnose preoperatively

Abstract

This report documents the findings of two rare cases of mature cystic teratoma of the pancreas. Although they could not be diagnosed preoperatively, our retrospective report suggests that the combined diagnosis of ultrasonography (US), enhanced computed tomography (CT), and magnetic resonance cholangiopancreatography (MRCP) might allow differentiation from other cystic lesions such as mucinous cystic tumors (MCTs) and intraductal papillary-mucinous tumors (IPMTs). Since the cystic teratomas were both filled with keratinous and sebaceous material, they were echogenic, appearing as solid masses on US. Enhanced CT showed their cystic nature, with values slightly higher than water, and MRCP revealed defects of internal signals.

Dermoid cyst of the pancreas: a case report

“…Occurrence in the pancreas, though, is very rare (1-5, 7, 8, 11-13, 15) . They may appear in any site in the pancreas, being lightly more common in the pancreas head (3,7,11,15) , what differs from the case presented here, in which the lesion was found in the pancreatic tail.…”

“…There is also report of the conduction of endoscopic ultrasound-guided FNA (8) , but there are no pathognomonic data to recognize a dermoyd cyst, and many times preoperative diagnosis is inconclusive (9,11,13) , as well as in this case, in which the pancreatic dermoyd cyst was not a differential diagnosis according to the surgery team.…”

“…The dermoid cyst of the pancreas, also called mature cystic teratoma of the pancreas, is an uncommon mesenchymal neoplasm, firstly described in 1918 (4,5,(10)(11)(12)(13) , with 35 cases reported in the world literature (7) . This is the 36 th reported case up to now, according to a bibliographic survey.…”

“…However, one of the main differential diagnoses is the lymphoepithelial cyst, different from the dermoid cyst for the absence of skin annexes (7,11,13) .…”

“…Dermoid cysts, in general, occur in all ages, have no sex preference, and are commonly found in ovaries, but may occur in any pathway of ectodermal cell migration. The pancreas is extremely rare as a primary site (1-5, 7, 8, 12, 13, 15) , where there is a slight preference for the pancreatic head (3,11,15) .…”