Uncommon Lymphoepithelial Cyst with Sebaceous Glands of the Pancreas

Tsukasa Nakamura; Yoshio Osaka; Shoichi Ishikawa; Hirotaka Sako; Naoaki Akamatsu; Yoshihiro Yamamoto; Yohei Hosokawa; Norio Yoshimura

doi:10.6092/1590-8577/1670

Tsukasa Nakamura Department of Organ Transplantation and General Surgery, Kyoto Prefectural University of Medicine. Kamigyo-ku, Kyoto, Japan
Yoshio Osaka Department of Surgery, Omihachiman Medical Community Center. Omihachiman, Shiga, Japan
Shoichi Ishikawa Department of Surgery, Omihachiman Medical Community Center. Omihachiman, Shiga, Japan
Hirotaka Sako Department of Surgery, Omihachiman Medical Community Center. Omihachiman, Shiga, Japan
Naoaki Akamatsu Department of Gastroenterology, Omihachiman Medical Community Center. Omihachiman, Shiga, Japan
Yoshihiro Yamamoto Department of Pathology, Omihachiman Medical Community Center. Omihachiman, Shiga, Japan
Yohei Hosokawa Department of Pathology, Omihachiman Medical Community Center. Omihachiman, Shiga, Japan
Norio Yoshimura Department of Organ Transplantation and General Surgery, Kyoto Prefectural University of Medicine. Kamigyo-ku, Kyoto, Japan

DOI: https://doi.org/10.6092/1590-8577/1670

Keywords: Epidermal Cyst, Pancreas, Pancreatic Cyst, Pancreatic Diseases, Sebaceous Glands

Abstract

Context Lymphoepithelial cysts with sebaceous glands of the pancreas are extremely rare, with only 7 cases, including this case, published in English literature. Case report We herein present the case of a 67-year-old Asian man who underwent a resection of a lymphoepithelial cyst of the pancreas during the follow up care for lung cancer. Fourteen years previously he underwent a right lower lobectomy at the right segment nine for lung cancer. A 20 mm mass in the body of the pancreas was identified by CT scan 4 years ago, and the diagnosis was intraductal papillary mucinous neoplasm (IPMN) at that time. Over a 5-year period, this mass grew to 42 mm without dilatation of the main pancreatic duct. The preoperative evaluation, including endoscopic ultrasound-guided fine-needle aspiration (EUS-FNA), indicated a cystic neoplasm with suspicion of malignancy. Intraoperative frozen section revealed a squamous-lined cyst accompanied by sebaceous glands without any malignant findings. Following this pathological finding, resection of the cyst was performed. Consequently, microscopic examination revealed that it was a lymphoepithelial cyst with sebaceous glands of the pancreas. Conclusions Pancreatic lymphoepithelial cysts can be cured by conservative resection, but if they are asymptomatic and are diagnosed before surgery, no treatment is necessary. To our knowledge, this is the first ever published case of a lymphoepithelial cyst with sebaceous glands of the pancreas, which was found during the follow up care for lung cancer.

Image: Cysts enveloped by a fibrotic capsule.

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References

Adsay, N. V., F. Hasteh, J. D. Cheng, and D. S. Klimstra, Squamous-lined cysts of the pancreas: lymphoepithelial cysts, dermoid cysts (teratomas), and accessory-splenic epidermoid cysts. Semin Diagn Pathol, 2000. 17(1): p. 56-65.

Osiro, S., J. R. Rodriguez, K. J. Tiwari, Rodriguez, II, N. Mathenge, R. S. Tubbs, et al., Is preoperative diagnosis possible? A clinical and radiological review of lymphoepithelial cysts of the pancreas. JOP, 2013. 14(1): p. 15-20.

Horn, A. J., and S. M. Lele, Epidermoid cyst occurring within an intrapancreatic accessory spleen. A case report and review of the literature. JOP, 2011. 12(3): p. 279-82.

Tucci, G., M. G. Muzi, C. Nigro, F. Cadeddu, D. Amabile, F. Servadei, et al., Dermoid cyst of the pancreas: presentation and management. World J Surg Oncol, 2007. 5: p. 85.

Luchtrath, H., and K. H. Schriefers, A pancreatic cyst with features of a so-called branchiogenic cyst. Pathologe, 1985. 6(4): p. 217-9.

Fitko, R., P. A. Kampmeier, F. H. Batti, R. A. Benjoya, and S. M. Rao, Lymphoepithelial cyst of the pancreas with sebaceous differentiation. Int J Pancreatol, 1994. 15(2): p. 145-7.

Koga, H., K. Takayasu, K. Mukai, Y. Muramatsu, Y. Mizuguchi, H. Furukawa, et al., CT of lymphoepithelial cysts of the pancreas. J Comput Assist Tomogr, 1995. 19(2): p. 221-4.

Rino, Y., T. Morohoshi, K. Funo, T. Imada, Y. Yamamoto, T. Jojima, et al., Lymphoepithelial cyst of the pancreas: a preoperatively diagnosed case based on an aspiration biopsy. Surg Today, 1995. 25(12): p. 1043-6.

Fukukura, Y., H. Inoue, N. Miyazono, Y. Kajiya, F. Fujiyoshi, T. Yano, et al., Lymphoepithelial cysts of the pancreas: demonstration of lipid component using CT and MRI. J Comput Assist Tomogr, 1998. 22(2): p. 311-3.

Fujiwara, H., N. Kohno, S. Nakaya, and Y. Ishikawa, Lymphoepithelial cyst of the pancreas with sebaceous differentiation. J Gastroenterol, 2000. 35(5): p. 396-401.

Hebert-Magee, S., D. Garvin, S. Ahlawat, and N. Haddad, Lymphoepithelial cyst of the pancreas with sebaceous differentiation: cytologic diagnosis by fine-needle aspiration. Diagn Cytopathol, 2009. 37(12): p. 937-9.

Steehler, M. K., M. W. Steehler, and S. P. Davison, Benign lymphoepithelial cysts of the parotid: long-term surgical results. HIV AIDS (Auckl), 2012. 4: p. 81-6.

Bedat, B., M. Genevay, J. M. Dumonceau, J. L. Frossard, J. Forget, P. Morel, et al., Association between lymphoepithelial cysts of the pancreas and HIV infection. Pancreatology, 2012. 12(1): p. 61-4.

Vilmann, P., G. K. Jacobsen, F. W. Henriksen, and S. Hancke, Endoscopic ultrasonography with guided fine needle aspiration biopsy in pancreatic disease. Gastrointest Endosc, 1992. 38(2): p. 172-3.

Shigeta, M., K. Okamura, Y. Fujita, Y. Kouchi, and H. Miyashita, Lymphoepithelial cyst of the pancreas associated with carcinoma of the pancreas: a case report. Jpn J Gastroenterol Surg, 2005. 38(4): p. 447-451.