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Benign lymphoepithelial cyst of the pancreas: a case report.Rozhl
Chir. 2007 Jun;86(6):300-2
Lymphoepithelial
cyst of the pancreas represents an extremely rare and benign entity of
undetermined pathogenesis. This lesion must be taken into
consideration in the differential diagnosis of pancreatic cystic
lesions. A case of resected lymphoepithelial cyst of pancreas in
59-year-old man with an attack of acute pancreatitis in anamnesis is
reported. The postoperative period was uneventful, and the
histopathological examination revealed the structures of
lymphoepithelial cyst. The aim of this report is to describe the
clinical and pathological features of this unusual true cyst of the
pancreas.
Fine-needle
aspiration cytology of pancreatic lymphoepithelial cysts.
Cancer. 2006 Dec 25;108(6):501-6.
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.
Lymphoepithelial cyst of the pancreas.Srp
Arh Celok Lek. 2006
Jan-Feb;134(1-2):64-6.
Lymphoepithelial cysts of the pancreas are very rare with less than 35
cases described in the literature. A 49-year old male with a cystic
tumor in the tail of the pancreas of 8 cm in diameter discovered
during the investigation for mild pain in the upper abdomen was
presented. The tumor was easily removed during the open surgery. It
contained yellowish dense pus-like fluid whose culture remained
sterile. Histology showed the lymphoepithelial cyst of the pancreas.
Postoperative recovery was uneventful and preoperative pain
disappeared. Eight and a half years later, he died due to
complications after orthopedic surgery of the spine.
Lymphoepithelial cyst of the pancreas: case report with special
reference to imaging--pathologic correlation. Abdom
Imaging. 2006 ;31(1):106-9.
We report a
case of resected lymphoepithelial cyst of the pancreas with special
reference to the imaging-pathologic correlation. Visualization of a
multilocular cystic nature with internal heterogeneous
hyperechogenicity on ultrasound, hyperdensity on precontrast computed
tomography, and granular hypointensity on T2-weighted image due to
abundant internal keratin substances were considered to be keys to the
differential diagnosis from other cystic lesions of the pancreas.
Lymphoepithelial cyst of the pancreas: a case report.J
Radiol. 2005 Mar;86 (3):335-6.
Lymphoepithelial cyst is a rare benign dysembryoplastic lesion of the
pancreas, difficult to diagnose before surgery. The authors report the
case of a 44 year old man with low left sided chest pain. CT-scan
described a multilocular cystic tumor of the tail of the pancreas. The
patient underwent a distal pancreatectomy with splenectomy. Histologic
analysis led to the diagnosis of lymphoepithelial cyst of the
pancreas. Through this observation, the authors stress the value of
imaging in this benign entity that must be considered when evaluating
a cystic pancreatic lesion because a different therapeutic approach
may be required.
Lymphoepithelial cyst of the pancreas. A case report.Ann
Chir. 2004 Jun; 129 (5): 293-6.
Lymphoepithelial cyst of the pancreas is a benign and rare pathology.
Its histogenesis is still unknown. The diagnosis is difficult to
establish before surgery. We report a new case of a 20-year-old woman
admitted for abdominal pain and vomiting. Radiologic investigations
described a multilocular cystic tumor of the tail of the pancreas. The
patient underwent a left pancreatectomy with splenectomy. Histologic
investigations revealed pancreatic cysts lined by squamous epithelium
surrounded by dense lymphoid tissue. The diagnosis of lymphoepithelial
cyst of the pancreas was done.
Lymphoepithelial cysts of the pancreas: case report and review of the
literature.
J Gastrointest Surg. 2004
Mar-Apr;8(3):342-5.
The aim
of this report was to describe the clinical and pathologic features of
lymphoepithelial cysts of the pancreas, establish the differential
diagnosis of other pancreatic cysts, and review the literature. A
53-year-old man was incidentally diagnosed with a pancreatic lesion
after an abdominal CT scan. This study showed a solid mass in the tail
of the pancreas not enhanced by helical CT. Endoscopic ultrasound
examination revealed a low-density tissue mass on the surface of the
pancreas, less echogenic than the surrounding parenchyma. Distal
pancreatectomy and splenectomy were performed with a suspected
diagnosis of mucinous cystic tumor. The patient has had an uneventful
postoperative period, and the pathologic finding was a
lymphoepithelial cyst of the pancreas. Lymphoepithelial cyst of the
pancreas is an unusual and benign entity that must be taken into
consideration when evaluating a cystic lesion of the pancreas because
a different therapeutic approach may be required.
Lymphoepithelial cyst of the pancreas: a case report.Hepatobiliary
Pancreat Dis Int. 2004 Feb;3(1):155-7.
BACKGROUND:
Lymphoepithelial cyst of the pancreas is a rare lesion of undetermined
pathogenesis that had been documented almost exclusively in males. The
literature on this entity is limited to reports of single or a small
number of cases. METHODS: The case we described herein was compared
with a total of 36 cases reported elsewhere. RESULTS: The 37 cases of
lymphoepithelial cyst of the pancreas including our case were
reviewed. Lymphoepithelial cysts have uniform and distinctive
clinicopathologic features. Approximately 46% of the reported cases
were asymptomatic with the lesions found incidentally, and their
symptoms were non-specific. CONCLUSIONS: Lymphoepithelial cyst is a
rare benign lesion of the pancreas. Fine-needle aspiration biopsy (FNAB)
is a rapid and reliable technique that can be used as the first
diagnostic step in cases of cystic lesions of the pancreas.
Lympho-epithelial
cyst of the pancreas: a difficult diagnosis. About two cases.Gastroenterol
Clin Biol. 2002 Oct;26(10):935-8.
We report two
cases of lymphoepithelial cyst of the pancreas discovered incidentally
on imaging in two men aged 50 and 61 years. One cyst contained
hyperdense spots on CT-scan and in this case the biochemical analysis
of the cyst fluid revealed high level of CEA. The unilocular cysts
measured 4 and 5 cm on the surgical specimen. On microscopic
examination, the cysts were lined by squamous keratinized epithelium
positive for CEA, with rare mucin-secreting cells, lining on lymphoid
tissue. The lymphoepithelial cyst is a rare dysembryoplastic benign
lesion of the pancreas difficult to diagnose before surgery. The
presence of keratin plugs on imaging is inconstant and the biochemical
analysis of the cyst fluid can mislead to a diagnosis of mucinous
cystic tumour. Cytological and histological analysis of fine needle
aspiration material is of diagnostic interest and can avoid surgical
resection when patients are symptom-free.
Lymphoepithelial cysts of the pancreas: a report of 12 cases and a
review of the literature.
Mod Pathol. 2002
May;15(5):492-501.
Lymphoepithelial cyst (LEC) of the pancreas is a rare lesion of
undetermined pathogenesis that had been documented almost exclusively
in males. The literature on this entity is limited to reports of
single or small numbers of cases. Here is presented a
clinicopathologic analysis of 12 patients with LEC, 4 of whom were
female. The mean age of the patients was 56 years. Four patients
presented with abdominal pain and nausea, but in two patients, the
cysts were detected incidentally. Only one patient had a history of
chronic pancreatitis, and another had a family member with pancreatic
cancer. In one patient, a clinical diagnosis of pseudocyst was
rendered, and the remaining patients were clinically thought to have
cystic neoplasms. None of the patients had any identifiable
immunosuppression, HIV positivity, autoimmune disorder (such as
Sjogren syndrome) or lymphoma. Seven cysts were located in the head of
the pancreas, and 5 were in the tail. The mean size was 4.8 cm (range,
1.2-17 cm). Five LECs were multilocular, three were unilocular; in
others, the number of loculi was not recorded. All were "macrocystic"
lesions. Two patients had two separate lesions, both in the tail of
the pancreas. Histologically, all cases were characterized by cysts,
some containing keratin, and lined by mature stratified squamous
epithelium surrounded by dense lymphoid tissue, often with prominent
follicles. In some areas, the lining epithelium had more cuboidal,
flattened, or transitional appearance. Mucinous goblet-like cells were
seen in one case. Acute inflammation was not seen. Four cases
contained solid lymphoepithelial islands, a feature not previously
described in LECs. No squamous metaplasia was identified in the
uninvolved pancreatic tissue and no epithelial elements were
identified in peripancreatic lymph nodes. In summary, LEC of the
pancreas is a rare but distinctive lesion that may be seen in the tail
of the organ where most cystic pancreatic neoplasms are encountered.
In contrast to the impression from the literature, LECs may also
develop in females and, therefore, should be considered in the
clinical differential diagnosis of mucinous cystic neoplasms that
affect a similar age group. LECs are not associated with the clinical
syndromes that are seen with their analogues in the salivary glands.
Lymphoepithelial cyst of the pancreas: report of a case.Surg
Today. 2000;30(9):856-60.
An
extremely rare case of a lymphoepithelial cyst (LEC) of the pancreas
is described herein. A pancreatic cystic tumor was initially detected
in a 50-year-old man at a medical checkup. On admission, his serum
carbohydrate antigen (CA) 19-9 level was 8100 U/ml and a computed
tomography scan revealed a well-circumscribed multilocular cystic
tumor in the pancreatic head and body. Magnetic resonance
cholangiopancreatography showed no communication between the
pancreatic ducts and the tumor. A distal pancreatectomy with lymph
node dissection was performed because the lesion was suspected to be a
mucinous cystadenoma or cystadenocarcinoma of the pancreas. However,
histological examination revealed that the cyst was lined by
stratified squamous epithelium and surrounded by lymphoid tissue.
thereby confirming the diagnosis of LEC of the pancreas. The
superficial layer of squamous epithelium and the cystic contents were
found to be immunohistologically positive for CA19-9. Establishing a
preoperative diagnosis of LEC is quite difficult because it resembles
other cystic neoplasms of the pancreas in radiographic features and is
frequently associated with an elevation of serum tumor markers such as
CA19-9.
Lymphoepithelial cyst in the pancreas: a case report and review of the
literature.
Dig Surg.
2000;17(3):309-14.
BACKGROUND:
Lymphoepithelial cysts of the pancreas constitute a rare
clinicopathologic entity. CASE REPORT: We report a case of
lymphoepithelial cyst of the pancreas and review the world literature.
RESULTS: Lymphoepithelial cysts are true pancreatic cysts lined by
squamous epithelium and surrounded by mature lymphoid tissue. The cyst
arises typically in middle aged men, and is usually asymptomatic or
causes nonspecific abdominal complaints. There is no specific
serologic marker for this entity. None of its radiologic
characteristics can help differentiate it from other cystic lesions of
the pancreas. Fine-needle aspiration cytology may be able to suggest
its benign nature and identify it as a true cyst of the pancreas. The
outcome after surgical excision is uniformly good with good symptom
control and no recurrences. RECOMMENDATIONS: In the symptomatic
patient or the asymptomatic patient with acceptable surgical risk a
simple cyst excision should be performed after verification of the
diagnosis with frozen section. In the asymptomatic patient with a high
surgical risk, in whom fine-needle aspiration suggests the diagnosis
of a lymphoepithelial cyst, observation of the lesion is recommended.
When simple cyst excision is technically not possible, extensive
resections/reconstructions should be avoided and drainage/bypass
procedures may be considered.
Lymphoepithelial cyst of the pancreas with sebaceous differentiation. J
Gastroenterol. 2000;35(5):396-401.
We recently
encountered a patient with a lymphoepithelial cyst of the pancreas
with sebaceous differentiation. We sought to compare the
characteristics of this patient with those previously reported in
order to foster a keener understanding of this rare clinical entity.
After reviewing the present patient's case in detail, we conducted a
comprehensive review of the English-language literature and analyzed
the clinical characteristics of reported cases of lymphoepithelial
cysts. Our patient was an asymptomatic 60-year-old man who presented
with an incidental finding of a cystic lesion in the tail of the
pancreas documented by computed tomography. The cyst was enucleated,
and was found to contain keratinized material. It was lined by
squamous epithelium with small sebaceous glands, and surrounded by
lymphoid tissue with germinal centers. Of 33 reported cases, only 6
(18%) contained sebaceous glands. In all patients who underwent
operation, the cysts were easily resected, and the outcome was
favorable. Lymphoepithelial cyst of the pancreas is rare, and may be
difficult to differentiate from cystic neoplasms preoperatively.
Therefore resection is indicated. The diagnosis, however, can be
confirmed by careful histologic review, and the prognosis is
excellent.
Squamous-lined
cysts of the pancreas: lymphoepithelial cysts, dermoid cysts (teratomas),
and accessory-splenic epidermoid cysts.Semin
Diagn Pathol. 2000 Feb;17(1):56-65.
In the
pancreas, 3 types of morphologically similar lesions may present as "squamous
cysts": Lymphoepithelial cysts, dermoid cysts (monodermal teratomas),
and epidermoid cysts in intrapancreatic accessory spleen.
Lymphoepithelial cysts (LECs) are seen predominantly in men (M/F: 4/1)
and in adulthood (mean age, 56, and range, 35 to 74 years). They may
occur at any site of the organ (head, body, or tail). LECs are
well-delineated cysts that may be multilocular (60%) or unilocular
(40%), and they are characterized microscopically by stratified
squamous epithelium surrounded by a band of mature lymphoid tissue
with intervening well-formed germinal centers. Solid lymphoepithelial
clusters are seldom seen. The pathogenesis of LECs is unclear;
clinical diseases that are known to be associated with their
counterparts in the salivary glands such as Sjogren disease or human
immunodeficiency virus have not been documented for the LECs of the
pancreas. The second type of squamous-lined cyst in the pancreas is
the epidermoid cyst arising in intrapancreatic accessory spleen. These
are located almost exclusively in the tail of the pancreas, in the
fourth decade of life (mean age = 38). Their mean size is 4.5 cm
(range, 2.3 to 6.5). In some cases, the cyst lining may be partly
mucinous. Dermoid cysts of the pancreas are also rare. The cases that
appear to be true dermoid cysts occur in a younger age group (mean
age, 23, range, 2 to 53 years), and in contrast with LEC, there is no
gender predominance. Mucinous epithelium, respiratory-type mucosa and
sebaceous units are more readily identifiable in dermoid cysts, and
they may contain hair. Subepithelial lymphoid tissue is not a feature.
They are sometimes complicated by suppurative infections. The
importance of these lesions is in their distinction from other cystic
neoplasms, especially mucinous cystic tumors.
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