Lymphoepithelial cysts of the pancreas: can common features avoid resection?

Congress:

ECR 2019

Poster Number:

C-1544

Type:

Scientific Exhibit

Keywords:

Cysts, Education, MR, CT, Pancreas, Oncology, Abdomen, Neoplasia

Authors:

E. Esteban García¹, E. Kasatkina², H. U. Kauczor², T. Hackert², M. Klauss²; ¹Torrevieja/ES, ²Heidelberg/DE

DOI:

10.26044/ecr2019/C-1544

DOI-Link:

https://dx.doi.org/10.26044/ecr2019/C-1544

Fig. 1: CT scan in arterial and venous phase shows a cystic LEC in the pancreatic body...

Fig. 2: T2-HASTE MRI shows a solid-cystic LEC in the pancreatic body with diffuse solid...

Fig. 3: Same patient as Fig. 2. Native CT scan and contrast-enhanced CT scan in...

Fig. 4: T2-WI MRI shows a cystic LEC in the pancreatic tail with a mural nodule.

Aims and objectives

Lymphoepithelial cysts (LEC) of the pancreas arerarebenign lesions. The imaging appearance is often similar to other pancreatic lesions such as serous cystic neoplasms (SCNs), mucinous cystic neoplasms (MCNs) and intraductal papillary mucinous neoplasms (IPMNs). Both MCNs and IPMNs are characterized by a neoplastic mucin-producting epithelial lining and have a potential to a malignant transformation. The overlapping imaging features of these lesions make differentiation of LEC with potentially malignant pancreatic lesions a difficult and important radiological challenge. The aim of this study is to identify common...

Methods and materials

We retrospectively reviewed ten cases of resected and histopathological confirmed LECs in our institution in the last 12 years. Data like age, gender and imaging findings were retrospectively analyzed. Three patients underwent preoperative CT and MRI, four underwent MRI and three underwent CT. 10 patients with histologically confirmed MCNs and 10 patients with histologically confirmed side branch IPMNs (randomly selected out of the institutional study collective of 1271 IPMN patients) served as control groups.

Results

The patients were considered as symptomatic having a left upper quadrant (LUQ) or epigastric pain without other obvious pain cause rather than pancreas. Clinically abdominal pain was the most common clinical feature in all three groups. Other symptoms included post-prandial pain, cramps etc. LECs were most common in middle-aged males (nine males, one female), ranging between 43 to 63 years (mean: 50). All patients revealed a well-defined exophytic lesion within the tail (70%) or body (30%) of the pancreatic parenchyma, without communication with the pancreatic...

Conclusion

Overall, we were able to identify three imaging subtypes of LEC with the first one having a well-defined cystic morphology and the other two being subsolid lesions with either diffuse solid component or with a mural nodule. In some cases these features show a big overlap with other cystic pancreatic lesions, especially with MCN and IPMN. The later two have a potential to a malignant transformation making it curtail to different them on one hand to avoid an invasive disease and on the other hand...

Personal information

References

Terakawa H, Makino I, Nakagawara H, et al. Clinical and radiological feature of lymphoepithelial cyst of the pancreas. World J Gastroenterol. 2014;20(45):17247-17253. Domen H, Ohara M, Kimura N, et al. Lymphoepithelial Cyst of the Pancreas. Case Rep Gastroenterol. 2012;6:604-611. Kim YS, Cho JH. Rare Nonneoplastic Cysts of Pancreas. Clin Endosc. 2015;48:31-38. Kavutur S, Sarwani NE, Ruggeiro FM, Deshaies I, Kimchi ET, Kaifi JT, Staveley-O'Carroll KF, Gusani NJ. Lymphoepithelial Cysts of the Pancreas. Can Preoperative Imaging Distinguish This Benign Lesion from Malignant or Pre-Malignant Cystic Pancreatic...