Pancreatic Lymphoepithelial Cysts Diagnosed with Endosonography-guided Fine Needle Aspiration

Youngmin Oh; Yonghyeok Choi; Seung-Myoung Son; Jisun Lee; Yook Kim; Joung-Ho Han; Seon Mee Park

doi:10.4166/kjg.2017.69.4.253

Journal List > Korean J Gastroenterol > v.69(4) > 1007639

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Oh, Choi, Son, Lee, Kim, Han, and Park: Pancreatic Lymphoepithelial Cysts Diagnosed with Endosonography-guided Fine Needle Aspiration

Case Report

Korean J Gastroenterol 2017;69(4):253-258.

Published online: 4 October 2017

DOI: https://doi.org/10.4166/kjg.2017.69.4.253

Pancreatic Lymphoepithelial Cysts Diagnosed with Endosonography-guided Fine Needle Aspiration

Youngmin Oh, Yonghyeok Choi, Seung-Myoung Son¹, Jisun Lee², Yook Kim², Joung-Ho Han, Seon Mee Park

Department of Internal Medicine, Chungbuk National University College of Medicine, Cheongju, Korea

¹Department of Pathology, Chungbuk National University College of Medicine, Cheongju, Korea

²Department of Radiology, Chungbuk National University College of Medicine, Cheongju, Korea

Correspondence to: Seon Mee Park, Department of Internal Medicine, Chungbuk National University College of Medicine, 1 Chungdae-ro, Seowon-gu, Cheongju 28644, Korea. Tel: +82-43-269-6019, Fax: +82-43-273-3252, E-mail: smpark@chungbuk.ac.kr

Received 2 January 2017 Revised 10 February 2017 Accepted 2 March 2017

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Although lymphoepithelial cysts (LECs) of the pancreas are benign lesions, most of them have been treated with surgical resection due to diagnostic difficulty. We report a 66-year-old woman diagnosed with pancreatic LECs. Abdominal ultrasound revealed two masses in the pancreas, which were not visible on the abdominal computed tomography. In an abdominal magnetic resonance imaging, pancreas lesions showed solid tumors, which revealed a low signal intensity on T1-, moderate high signal intensity on T2 weighted images, and homogeneous delayed enhancement in the portal venous phase. Endosonography (EUS) revealed two hypoechoic round masses measuring 1.5 cm and 4.5 cm in the body and tail of the pancreas, respectively. EUS-guided fine needle aspiration (FNA) revealed squamous cells, amorphous keratinous debris, and lymphocytes. The patient was diagnosed with LECs of the pancreas. For the duration of the follow-up period of two years, imaging studies were unchanged. EUS-FNA is useful in making a definite diagnosis and avoiding unnecessary surgery. This is the first case of pancreatic LECs diagnosed with EUS-FNA in Korea.

Keywords: Pancreatic cyst, Pancreas, Endosonography, Fine needle aspiration

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Fig. 1.

Abdominal ultrasonography revealing approximately 1.2 cm and 1.6 cm sized low echoic round lesions (arrows).

Fig. 2.

Axial contrastenhanced abdominal computed tomography image showing no evidence of abnormal lesions and a normal pancreatic duct (A, B, arterial phase; C, D, delayed phase).

Fig. 3.

Abdominal magnetic resonance images. Pre-contrast T1 weighted axial magnetic resonance images showing hypointense masses, 1.5 cm (A, arrow) and 4.5 cm (B, arrow) sized round shapes in the body and tail of the pancreas, respectively. They show moderate high signal intensity on T2 weighted images (C, D) and homogeneous delayed enhancement in the portal venous phase after contrast enhancement (E, F), suggesting solid tumors (arrows).

Fig. 4.

Endosonography images. Radial endosonography revealing 1.5 cm (A, arrow) and 4.5 cm (B, arrow) sized hypoechoic, well-demarked, and round lesions in the body and tail of the pancreas, respectively. (C, arrow) Endosonography-guided fine needle aspiration using 22G needle.

Fig. 5.

Cytologic smear obtained with two rounds of endosonography-guided fine needle aspiration (A and B obtained from 1st exam; C and D obtained from 2nd exam). Viable benign squamous cells (arrows) with lymphoid tissues (arrowheads) were seen, which were suggestive of lymphoepithelial cyst (Papanicolaou stain; A, ×200; B, C, ×400; D, ×1,000).

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