Lymphoepithelial cysts of the pancreas: case report and review of the literature

Capitanich, Pablo; Iovaldi, Mario L.; Medrano, Mario A.; Malizia, Patricio; Herrera, Javier; Celeste, Francisco; Boerr, Luis A.; Obiol, Carlos Moran; Mezzadri, Norberto A

doi:10.1016/j.gassur.2003.09.004

Cited by 26 publications

(20 citation statements)

References 21 publications

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“…By CT, lymphoepithelial cyst can appear to have solid components (due to dense keratinous material), or appear as a hypoechoic mass with an enhancing rim. 15,16 By ultrasonography, lymphoepithelial cysts can appear solid or solid and cystic. 15,16 Hence, although imaging studies provide information on size, location, presence or absence of solid components, and other physical descriptions, cluster is an example of the atypical glandular cells that can be encountered by these cyst aspirates (Papanicolaou stain); it is not known whether these glandular cells represent the mucous cells that can be present within the squamous lining of lymphoepithelial cysts.…”

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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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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“…However, the presence of posterior acoustic enhancement and lateral shadowing may be useful to correctly determine its cystic nature (5). The contents of the LEC, mostly consisting of keratinous material, correspond to the echogenic structure found on US.…”

Section: Discussionmentioning

confidence: 97%

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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“…10 This theory would explain the often extrinsic location of the lesions and the fact that pancreatic tissue can be found throughout these entire lesions. 17 Furthermore, benign ectopic pancreatic tissue has been reported in peripancreatic lymph nodes. 18 The first description of the cytologic findings of LECs was published by Mitchell in 1990.…”

Section: Discussionmentioning

confidence: 99%

Fine-needle aspiration cytology of pancreatic lymphoepithelial cysts

Policarpio‐Nicolas

Shami

Kahaleh

et al. 2006

Cancer

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BACKGROUND. Lymphoepithelial cysts (LECs) of the pancreas are extremely rare, benign, nonneoplastic cysts that can mimic pseudocysts or cystic neoplasms clinically and radiographically. The cytologic features of LECs have been described only in a handful of case reports and may overlap with both benign and malignant pancreatic tumors. METHODS. The authors conducted a 5‐year, retrospective, computerized review of the cytopathology files of 2 institutions for all diagnoses of pancreatic LECs. Clinical, radiographic, cytologic, and chemical findings were reviewed. RESULTS. Four patients were identified. The study group consisted of 3 men and 1 woman who ranged in age from 33 years to 63 years. The masses were located throughout the pancreas. Tumor sizes ranged from 1.8 cm to 5.7 cm in greatest dimension. Smears from all patients revealed numerous anucleated squamous cells, rare benign nucleated cells, amorphous debris, and an absence of lymphocytes. Mildly atypical mucinous glandular and parakeratotic epithelium were identified in 2 patients, leading to diagnoses of atypical and suspicious for malignancy. Subsequent surgical follow‐up of 3 patients revealed pancreatic LECs. CONCLUSIONS. Pancreatic LECs are extremely rare, and certain cytologic pitfalls may hinder a correct prospective diagnosis. Familiarity with the lesion's clinical and cytologic features may help clinicians arrive at the appropriate prospective diagnosis and, thus, permit conservative management. Cancer (Cancer Cytopathol) 2006. © 2006 American Cancer Society.

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Lymphoepithelial cysts of the pancreas: case report and review of the literature

Cited by 26 publications

References 21 publications

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

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

Lymphoepithelial Cyst of the Pancreas: A Case Report

Fine-needle aspiration cytology of pancreatic lymphoepithelial cysts

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