Imaging features and pathological evaluation by EUS-FNA enable conservative management in patient of lymphoepithelial cy
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CASE REPORT
Imaging features and pathological evaluation by EUS‑FNA enable conservative management in patient of lymphoepithelial cyst of the pancreas: a case report Takuya Komura1,2 · Takashi Kagaya1 · Noriaki Orita1,2 · Hideo Takayama1,2 · Saiho Sugimoto1,2 · Yoshiro Asahina1,2 · Yuki Hattori1,2 · Masashi Nishikawa1,2 · Makiko Minami3 · Atsuhiro Kawashima4 · Masato Kayahara5 · Shuichi Kaneko2 · Masashi Unoura1 Received: 29 May 2020 / Accepted: 10 September 2020 © Japanese Society of Gastroenterology 2020
Abstract Pancreatic lymphoepithelial cysts (LECs) are rare cystic lesions filled with a keratinous substance and lined by squamous epithelium with underlying lymphoid tissue. Because pancreatic LECs are entirely benign, correct preoperative diagnosis is important to avoid unnecessary surgery. However, the imaging features of pancreatic LECs are not specific and preoperative diagnosis has proven difficult. A pancreatic mass was incidentally detected through abdominal ultrasonography in a 63-yearold male presenting without any symptoms. Computed tomography showed an exophytic cystic lesion in the pancreatic head. The lesion had heterogeneous high signal intensity with partial low intensity on T2-weighted magnetic resonance imaging (MRI) and high signal intensity on diffusion MRI. Endoscopic ultrasound (EUS) examination showed an encapsulated cystic lesion with relatively homogenous and highly echoic contents. EUS-guided fine-needle aspiration (EUS-FNA) revealed caseous appearance and rare fragments of apparently benign squamous epithelium on a background of keratinous debris, cyst contents, and scattered lymphocytes. We diagnosed a pancreatic LEC and opted for conservative management without surgery. Pathological evaluation based on images obtained through EUS-FNA showed macro- and microscopic features that were critical to determining the management strategy. In conclusion, the imaging and pathological features of pancreatic LECs can inform preoperative diagnosis, which may enable conservative management. Keywords Pancreatic lymphoepithelial cyst · EUS-FNA · Pancreatic cystic lesion
Introduction
* Takuya Komura [email protected] 1
Division of Gastroenterology, NHO Kanazawa Medical Center, Kanazawa 920‑8650, Japan
2
System Biology, Kanazawa University, Graduate School of Medical Science, Kanazawa, Japan
3
Division of Radiology NHO, Kanazawa Medical Center, Kanazawa, Japan
4
Division of Pathology NHO, Kanazawa Medical Center, Kanazawa, Japan
5
Division of Surgery NHO, Kanazawa Medical Center, Kanazawa, Japan
Pancreatic lymphoepithelial cysts (LECs) are a rare, benign cystic lesion consisting of a collection of keratinizing squamous epithelial cells encapsulated in lymphoid tissue [1]. Pancreatic LECs are estimated to account for less than 0.5% of all pancreatic cysts [2]. The increasing use of abdominal cross-sectional imaging has resulted in an increase in the detection of asymptomatic benign pancreatic cysts [3, 4]. One study found that pancreatic LECs were typically observed in men (7
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