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Pancreatic Lymphoepithelial Cyst Showing Multiple Floating Ball-like Appearances
Hiroyuki Matsubayashi1, Yoshiko Aikawa2, Teiichi Sugiura2
1Division of Endoscopy, Shizuoka Cancer Center, Nagaizumi, Suntogun, Shizuoka, 411-8777, Japan. h.matsubayashi@scchr.jp.
Insights
This study reports a rare pancreatic lymphoepithelial cyst (LEC) presenting as multiple floating ball-like components on imaging. Awareness of these varied imaging presentations is crucial for diagnosing pancreatic cystic lesions.
Area of Science:
- Gastroenterology
- Radiology
- Pathology
Background:
- Pancreatic lymphoepithelial cysts (LECs) are uncommon cystic lesions characterized by squamous epithelium, lymphoid tissue, and keratin.
- Typical imaging reveals well-demarcated cysts without solid components.
Observation:
- A rare case of pancreatic LEC presented with multiple floating ball-like components visualized by endoscopic ultrasound.
- These components exhibited specific signal characteristics across CT, T1-weighted MRI, DWI, and T2-weighted MRI, with minimal enhancement.
Findings:
- Laparotomy confirmed the presence of keratin balls within the pancreatic LEC.
- This case highlights that keratin within LECs can manifest in liquid, sludge, or solid forms.
Implications:
- Radiologists and clinicians should recognize the diverse imaging appearances of pancreatic LECs.
- Understanding these variations aids in the accurate differentiation and effective management of pancreatic cystic lesions.
Abstract:
A lymphoepithelial cyst (LEC) is a rare pancreatic lesion, histologically showing squamous epithelia, dense lymphoid tissues, and a keratin substance. Cross-section images of the pancreatic LEC typically show a well demarcated unilocular or multilocular cyst without a solid component. Here we report a rare case of pancreatic LEC in which multiple floating ball-like components were depicted via endoscopic ultrasound. The ball-like components were also depicted by various imaging methods such as computed tomography (CT) showing low-density components, T1-weighted magnetic resonance imaging (MRI) and diffusion-weighted imaging (DWI) showing high-intensity components, and T2-weighted MRI showing low-intensity components. The ball-like components in all images were not well enhanced. Laparotomic cyst resection was performed, and the surgical material revealed keratin balls inside the pancreatic LEC. Keratin components of a pancreatic LEC can take a liquid, sludge, or solid form. Clinicians must be aware of the variations in imaging to facilitate the differentiation and management of pancreatic cystic lesions.
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