Epidermoid Cyst of Pancreas Can Be Safely and Precisely Diagnosed by EUS-Guided FNA

Abstract

Introduction: Pancreatic cystic lesions have a broad differential diagnosis incorporating both benign and malignant entities. Epidermoid cysts of pancreas is a type of squamous lined cysts which are extremely uncommon, usually associated with intrapancreatic accessory spleen and are found in tail of pancreas. We hereby report a case of epidermoid cyst of pancreas that was found in the body of pancreas and was diagnosed using EUS guided FNA. Case Report: A 58-year-old female was referred to our department after undergoing L1-S1 laminectomy and fusion, for a cystic pancreatic lesion found incidentally on CT scan of lumbar spine. Patient did not have any abdominal pain, nausea, vomiting, weight loss or jaundice. There was no history of pancreatic cancer in the family. Physical examination was unremarkable and laboratory values including amylase, lipase and Ca19-9 were within normal limits. CT scan reported an exophytic cystic lesion in the body of the pancreas measuring 22 x 20 x 16 mm. EUS revealed a 22 x 18 mm hypoechoic, well demarcated pancreatic body cystic mass with scattered hyperechoic foci giving granular appearance. FNA with 19 gauge needle revealed soft, whitish colored solid material. This material along with sample from cyst wall was submitted for cytology. Cytology revealed few squamous cells, keratinous debris, rare lymphocytes and plate like cholesterol crystals consistent with epidermoid cyst. Conclusion: EUS- FNA is a safe, accurate and cost effective tool to diagnose epidermoid cyst of the pancreas.Figure 1: A 22 x 18 mm hypoechoic, well demarcated pancreatic body cystic mass with hyperechoic foci and granular appearance.Figure 2: Orangeophilic keratinous debris and cholesterol crystals (original magnification, x20; pap stain).