Lessons learned from 29 lymphoepithelial cysts of the pancreas: institutional experience and review of the literature

Vincent P Groot; Sameer S Thakker; Georgios Gemenetzis; Michaël Noë; Ammar A Javed; Richard A Burkhart; Behnoud B Noveiry; John L Cameron; Matthew J Weiss; Christopher J VandenBussche; Elliot K Fishman; Ralph H Hruban; Christopher L Wolfgang; Anne Marie Lennon; Jin He

doi:10.1016/j.hpb.2018.01.003

Lessons learned from 29 lymphoepithelial cysts of the pancreas: institutional experience and review of the literature

HPB (Oxford). 2018 Jul;20(7):612-620. doi: 10.1016/j.hpb.2018.01.003. Epub 2018 Mar 9.

Authors

Affiliations

¹ Department of Surgery, The Sol Goldman Pancreatic Cancer Research Center, The Johns Hopkins University School of Medicine, Baltimore, MD, USA; Department of Surgery, UMC Utrecht Cancer Center, University Medical Center Utrecht, Utrecht, The Netherlands.
² Department of Surgery, The Sol Goldman Pancreatic Cancer Research Center, The Johns Hopkins University School of Medicine, Baltimore, MD, USA.
³ Department of Pathology, The Sol Goldman Pancreatic Cancer Research Center, The Johns Hopkins University School of Medicine, Baltimore, MD, USA.
⁴ Department of Gastroenterology, The Sol Goldman Pancreatic Cancer Research Center, The Johns Hopkins University School of Medicine, Baltimore, MD, USA.
⁵ Department of Radiology, The Sol Goldman Pancreatic Cancer Research Center, The Johns Hopkins University School of Medicine, Baltimore, MD, USA.
⁶ Department of Surgery, The Sol Goldman Pancreatic Cancer Research Center, The Johns Hopkins University School of Medicine, Baltimore, MD, USA; Department of Gastroenterology, The Sol Goldman Pancreatic Cancer Research Center, The Johns Hopkins University School of Medicine, Baltimore, MD, USA; Department of Radiology, The Sol Goldman Pancreatic Cancer Research Center, The Johns Hopkins University School of Medicine, Baltimore, MD, USA.
⁷ Department of Surgery, The Sol Goldman Pancreatic Cancer Research Center, The Johns Hopkins University School of Medicine, Baltimore, MD, USA. Electronic address: [email protected].

PMID: 29530477
DOI: 10.1016/j.hpb.2018.01.003

Abstract

Background: Lymphoepithelial cysts (LECs) are rare pancreatic cystic lesions. Since LECs are benign, preoperative diagnosis is important to differentiate from a cystic neoplasm and avoid unnecessary surgery. The aim of this study was to identify clinical, radiographic and cytopathologic features associated with LECs.

Methods: A retrospective review was performed of patients diagnosed with LEC between 1995 and 2017 at our hospital. Clinicopathologic and radiographic imaging features were documented.

Results: Of 29 patients with pancreatic LEC, 22 underwent surgical resection. The majority were male (n = 24) with a median age of 55 years (range, 21-74). During the evaluation, all patients underwent a CT, with endoscopic ultrasound (EUS) guided fine needle aspiration (FNA) biopsy (n = 22) and/or MRI/MRCP (n = 11) performed in a smaller number of patients. A combination of exophytic tumor growth on imaging and the presence of specific cytomorphologic features on the EUS-FNA cytology biopsy led to the correct diagnosis of LEC and prevention of unnecessary surgery in 7 patients.

Discussion: Differentiating LECs from premalignant pancreatic cystic neoplasms remains difficult. Findings of an exophytic growth pattern of the lesion on abdominal imaging and the presence of specific cytomorphologic features in the EUS-FNA biopsy could help clinicians diagnose LEC preoperatively.

Publication types

Review

MeSH terms

Adult
Aged
Cholangiopancreatography, Magnetic Resonance
Diagnosis, Differential
Endoscopic Ultrasound-Guided Fine Needle Aspiration
Female
Humans
Magnetic Resonance Imaging
Male
Middle Aged
Neoplasms, Cystic, Mucinous, and Serous / diagnosis*
Neoplasms, Cystic, Mucinous, and Serous / diagnostic imaging
Neoplasms, Cystic, Mucinous, and Serous / pathology
Neoplasms, Cystic, Mucinous, and Serous / surgery
Pancreatectomy
Pancreatic Cyst / diagnosis*
Pancreatic Cyst / diagnostic imaging
Pancreatic Cyst / pathology
Pancreatic Cyst / surgery
Pancreatic Neoplasms / diagnosis*
Pancreatic Neoplasms / diagnostic imaging
Pancreatic Neoplasms / pathology
Precancerous Conditions / diagnosis*
Precancerous Conditions / diagnostic imaging
Precancerous Conditions / pathology
Predictive Value of Tests
Prognosis
Retrospective Studies
Tomography, X-Ray Computed
Unnecessary Procedures
Young Adult