Clin Endosc.  2015 Jan;48(1):31-38. 10.5946/ce.2015.48.1.31.

Rare Nonneoplastic Cysts of Pancreas

• Kim YS
• Cho JH

• KMID: 2221756
• DOI: http://doi.org/10.5946/ce.2015.48.1.31

Abstract

Pancreatic cysts represent a small proportion of pancreatic diseases, but their incidence has been recently increasing. Most pancreatic cysts are identified incidentally, causing a dilemma for both clinicians and patients. In contrast to ductal adenocarcinoma, neoplastic pancreatic cysts may be cured by resection. In general, pancreatic cysts are classified as neoplastic or non-neoplastic cysts. The predominant types of neoplastic cysts include intraductal papillary mucinous neoplasms, mucinous cystic neoplasms, serous cystic neoplasms, and solid pseudopapillary neoplasms. With the exception of serous type, neoplastic cysts, have malignant potential, and in most cases requires resection. Non-neoplastic cysts include pseudocyst, retention cyst, benign epithelial cysts, lymphoepithelial cysts, squamous lined cysts (dermoid cyst and epidermal cyst in intrapancreatic accessory spleen), mucinous nonneoplastic cysts, and lymphangiomas. The incidence of nonneoplastic, noninflammatory cysts is about 6.3% of all pancreatic cysts. Despite the use of high-resolution imaging technologies and cytologic tissue acquisition with endosonography, distinguishing nonneoplastic from neoplastic cysts remains difficult with most differentiations made postoperatively. Nonetheless, the definitive distinction between non-neoplastic and neoplastic cysts is crucial as unnecessary surgery could be avoided with proper diagnosis. Therefore, consideration of these rare disease entities should be entertained before deciding on surgery.

Keyword

Pancreatic cyst; Neoplastic cyst; Nonneoplastic cyst

MeSH Terms

Adenocarcinoma
Diagnosis
Endosonography
Epidermal Cyst
Humans
Incidence
Lymphangioma
Mucins
Pancreas*
Pancreatic Cyst
Pancreatic Diseases
Rare Diseases
Unnecessary Procedures
Mucins

Figure

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  Fig. 1 A unilocular cyst measuring 1.6 cm was revealed on abdominal computed tomography scan.

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  Fig. 2 A 1.6 cm anechoic cystic lesion with peripheral hyperechoic spots suggestive of debris on endoscopic ultrasound.

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  Fig. 3 Mucosal layer of retetion cyst (H&E stain, ×200).

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  Fig. 4 A large cyst with thin wall and peripheral calcified lesions was revealed on abdominal computed tomography scan.

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  Fig. 5 A large cyst measuring 6 cm with inhomogeneous internal echogenicity was observed on endoscopic ultrasound.

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  Fig. 6 Mucosal layer of lymphoepithelial cyst (H&E stain, ×200).

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  Fig. 7 A small unilocular cyst in pancreas tail was observed on abdominal computed tomography scan.

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  Fig. 8 An arrow showed a small homogeneous hypoechoic lesion in pancreas tail on endoscopic ultrasound.

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  Fig. 9 Histologic finding of epidermoid cyst arising from an intrapancreatic accessory spleen showed a stratified mucosal epithelium (H&E stain, ×100).

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  Fig. 10 Abdominal computed tomography scan showed 4 cm sized well-demarcated low density cystic lesion in pancreas head.

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  Fig. 11 Endoscopic ultrasound finding showed a 4 cm sized unilocular, anechoic lesion in pancreas head.

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  Fig. 12 Mucosal layer of mucinous nonneoplastic cyst (H&E stain, ×200).

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