James Matthew Lloyd Williamson, Newton ACS Wong, Andrew D Stickland
Introduction Pancreatic lymphoepithelial cysts are rare benign pancreatic lesions that mimic more common neoplastic mucinous tumours. Preoperative diagnosis may be uncertain, which leads to subsequent resection and confirmation of their identification on pathological examination. Endoscopic ultrasound and biopsy can indicate the nature of this pancreatic cyst, therefore precluding the need for operative intervention. Methods Four consecutive patients with a pancreatic lymphoepithelial cyst were identified over a two-year period (March 2012 to February 2014); three from resected specimens and one from endoscopic ultrasound guided fine needle aspiration biopsy. Details of patient demographics, investigations and management were retrospectively analysed. Results Four male patients aged 45-69 years (mean 59 years) were identified; three underwent pancreatic resection (two distal pancreatectomies and one median pancreatectomy) and one was diagnosed following endoscopic ultrasound guided biopsy. Pathological examination revealed keratin and squamous epithelium in all cases consistent with a lymphoepithelial cyst. Conclusions Lymphoepithelial pancreatic cysts are rare and present a diagnostic dilemma. Definitive preoperative diagnosis is seldom achieved due to their non-specific radiological and endoscopic ultrasound features, combined with variations in tumour marker expression and difficulties in achieving cytological and histological assessment. As a result these lesions tend to be over-treated with pancreatic resection. An increasing awareness of these cysts and the role of endoscopic ultrasound may allow conservative management.
