Abstract
BackgroundPancreatic lymphoepithelial cyst (LEC) is a rare nonmalignant cyst consisting of a benign collection of keratinizing squamous epithelial cells with lymphoid tissue. Diagnosing LEC preoperatively is considered difficult because of its non-specific clinical features; therefore, LEC is generally treated the same as a malignant tumor.Case presentationOur case was a 65-year-old man who underwent pancreatoduodenectomy 3 years previously for carcinoma arising from the ampulla of Vater. A pancreatic mass in the remnant pancreatic tail was detected through follow-up abdominal contrast-enhanced computed tomography (CT). This revealed two adjacent ring-enhanced masses that had been in tight contact with the left diaphragm and were enlarged. The tumors had high signal intensity in diffusion-weighted images of magnetic resonance imaging, and fluorodeoxyglucose-positron emission tomography (FDG-PET) showed abnormal uptake (standardized uptake value maximum: 17.4). Therefore, we conducted a partial resection of the remnant pancreas with concomitant resection of the left diaphragm. Microscopically, one of the tumors revealed rare fragments of apparently benign squamous epithelium on a background of keratinous debris, cyst contents, and scattered lymphocytes, and the adjacent mass revealed infiltrated neutrophils. The histopathological diagnosis was an LEC with chronic abscess. The patient recovered uneventfully and was discharged on postoperative day 10.ConclusionsWe reported a rare case of LEC with chronic abscess that was positively visualized on FDG-PET. When a pancreatic malignancy cannot be excluded, surgical resection is considered inevitable.
Highlights
Pancreatic lymphoepithelial cyst (LEC) is a rare nonmalignant cyst consisting of a benign collection of keratinizing squamous epithelial cells with lymphoid tissue
We reported a rare case of LEC with chronic abscess that was positively visualized on fluorodeoxyglucose-positron emission tomography (FDG-PET)
It is important to make the diagnosis non-invasively if possible. This is often difficult because LEC does not have specific clinical features, including those that can be detected by computed tomography (CT) or magnetic resonance imaging (MRI)
Summary
Pancreatic lymphoepithelial cyst (LEC) is a relatively rare benign cyst consisting of a collection of keratinizing squamous epithelial cells with lymphoid tissue [1]. Case presentation A 65-year-old man was referred to our hospital for follow-up of gastric cancer and carcinoma of the ampulla of Vater In the former, total gastrectomy with splenectomy. Examinations of the pancreatic juice cytology, EUS, and endoscopic retrograde cholangiopancreatography were difficult to perform because the patient had undergone total gastrectomy and pancreatoduodenectomy with gastrointestinal reconstruction. These tumors were diagnosed as suspected anaplastic pancreatic cancer or benign cystic tumor. In this case, during two previous surgeries for advanced gastric cancer and carcinoma of the ampulla of Vater, regional lymph node dissection was performed. There were no signs of recurrence on follow-up imaging examinations performed 1 year after surgery
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