Lymphoepithelial cysts and cystic lymphangiomas: Under-recognized benign cystic lesions of the pancreas

Abstract

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. Key words: Lymphoepithelial cysts; Cystic lymphangiomas; Pancreas; Asymptomatic cysts; Benign cystic lesions of the pancreas Core tip: Lymphoepithelial cysts and cystic lymphangiomas of the pancreas represent rare, benign cystic lesions. The experience with their diagnosis and treatment is limited mostly to case reports. This report describes our experience with twelve lymphoepithelial cysts and cystic lymhangiomas of the pancreas, analyzing their clinicopathologic characteristics, the role of contrast enhanced computed tomography and endoscopic ultrasound with fine needle aspiration for their diagnosis with an emphasis on non-surgical management when a correct diagnosis can be established in an asymptomatic patient. 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

Lessons learned from 29 lymphoepithelial cysts of the pancreas: institutional experience and review of the literature

“…8 Twenty-three new studies since that period were additionally included. 3,6, After adding the 29 patients presented in this study, a cohort of 214 LECs was available for review (Table 3). Subsequent analysis of these patients showed that LECs were most commonly seen in men (79%) with a median age of 57 years at diagnosis.…”

“…3,4 However, the increasing use of abdominal cross-sectional imaging has resulted in an increase in the detection of asymptomatic benign pancreatic cysts. 5,6 LECs are often misdiagnosed as a pancreatic cystic neoplasm, resulting in surgical resection. Since LECs are entirely benign lesions, correct preoperative diagnosis is important in order to avoid unnecessary surgery.…”

Pancreatic lymphangioma: two case reports from an institutional experience with a rare entity and review of literature

“…However, this was not clearly specified for each patient. $The study by Konstantinidis et al [28] stated that the median age was 37.5 (range 19-69) and the median size was 9.2 cm (range 2.3-16.5). Two patients presented with abdominal pain and 2 patients were asymptomatic.…”

Linfangioma Quístico del Páncreas. Un Tumor poco Frecuente

“…Los linfangiomas quísticos son tumores benignos y poco frecuentes que resultan de la obstrucción de la circulación linfática por una malformación congénita del sistema linfático, una enfermedad inflamatoria o una neoplasia (Chairi et al, 2021). Por su parte, el LQP es una entidad más rara, tanto así, que se estima representan menos del 0,2% de todas las lesiones quísticas del páncreas (Konstantinidis et al, 2014). Es una de aquellas neoplasias quísticas raras, respecto de las cuales la información disponible es muy limitada (Santes & Chan, 2016).…”