Original Article
Copyright ©2014 Baishideng Publishing Group Inc. All rights reserved.
World J Gastrointest Surg. Jul 27, 2014; 6(7): 136-141
Published online Jul 27, 2014. doi: 10.4240/wjgs.v6.i7.136
Lymphoepithelial cysts and cystic lymphangiomas: Under-recognized benign cystic lesions of the pancreas
Ioannis T Konstantinidis, Avinash Kambadakone, Onofrio A Catalano, Dushyant V Sahani, Vikram Deshpande, David G Forcione, Jennifer A Wargo, Carlos Fernandez-del Castillo, Keith D Lillemoe, Andrew L Warshaw, Cristina R Ferrone
Ioannis T Konstantinidis, Jennifer A Wargo, Carlos Fernandez-del Castillo, Keith D Lillemoe, Andrew L Warshaw, Cristina R Ferrone, Departments of Surgery, Massachusetts General Hospital, Boston, MA 02114, United States
Ioannis T Konstantinidis, Department of Surgery, University of Arizona, Tucson, AZ 85724, United States
Vikram Deshpande, Departments of Pathology, Massachusetts General Hospital, Boston, MA 02114, United States
Avinash Kambadakone, Onofrio A Catalano, Dushyant V Sahani, Departments of Radiology, Massachusetts General Hospital, Boston, MA 02114, United States
Onofrio A Catalano, Department of Radiology, University of Napoli, 80138 Napoli, Italy
David G Forcione, Departments of Gastroenterology, Massachusetts General Hospital, Boston, MA 02114, United States
Author contributions: All the authors contributed to this work.
Correspondence to: Cristina R Ferrone, MD, Assistant Professor, Departments of Surgery, Massachusetts General Hospital, Wang Ambulatory Care Center 460, 15 Parkman Street, Boston, MA 02114, United States. cferrone@partners.org
Telephone: +1-617-6436189 Fax: +1-617-6436116
Received: March 10, 2014
Revised: May 5, 2014
Accepted: July 12, 2014
Published online: July 27, 2014
Processing time: 137 Days and 16.6 Hours
Abstract

AIM: To identify their diagnostic and prognostic clinical characteristics in a large series.

METHODS: Retrospective review of clinicopathologic and imaging characteristics of patients diagnosed with lymphoepithelial cysts and cystic lymphangiomas of the pancreas at Massachusetts General Hospital.

RESULTS: Twelve patients were identified between 1/1/1997 and 8/1/2007. Their median age was 55.5 years (range 19-78 years), and 6 were females. The lesion was incidentally discovered in half of the patients. Contrast enhanced computed tomography demonstrated that the cysts had thin walls, without calcifications, pancreatic duct dilation or pancreatic parenchyma invasion. Endoscopic ultrasound with fine needle aspiration (EUS/FNA) confirmed the diagnosis of a lymphoepithelial cyst in 3 patients, one of whom was spared an operation and continues to do well after 6 years. Eleven patients had a resection: 3 pancreaticoduodenectomies, 7 distal pancreatectomies, and 1 enucleation. The median size of the cysts was 3 cm (range 2-20 cm). At a median follow-up of 57 mo no recurrences or other pancreas-related conditions occurred.

CONCLUSION: Lymphoepithelial cysts and cystic lymphangiomas of the pancreas can be diagnosed with a combination of contrast-enhanced computed tomography scans and EUS/FNA. If the lesion is asymptomatic, an operation might be avoided.

Keywords: Lymphoepithelial cysts; Cystic lymphangiomas; Pancreas; Asymptomatic cysts; Benign cystic lesions of the pancreas

Core tip: Lymphoepithelial cysts and cystic lymphangiomas of the pancreas represent rare, benign cystic lesions. The experience with their diagnosis and treatment is limited mostly to case reports. This report describes our experience with twelve lymphoepithelial cysts and cystic lymhangiomas of the pancreas, analyzing their clinicopathologic characteristics, the role of contrast enhanced computed tomography and endoscopic ultrasound with fine needle aspiration for their diagnosis with an emphasis on non-surgical management when a correct diagnosis can be established in an asymptomatic patient.