What is it about?
A 50-year-old man was referred to our institute with a 1-month history of epigastric and back pain. Computed tomography detected a bi-locular lesion extending from the head of the pancreas showing the “beak sign”, which can be defined as two lines with an acute angle traced by a mass outline and the adjacent organ, forming a beak shape.
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Why is it important?
An exophytic lymphoepithelial cyst (LEC) of the pancreas mimics an extra-pancreatic mass such as a pseudocyst, epidermoid cyst, or mucinous neoplasm. Radiologically, LECs showing exophytic growing can be mistaken as DCs or mucinous neoplasms in the retroperitoneum. The presence of the “beak sign” deforming the edges of an adjacent organ such as the liver, pancreas, or kidneys increases the possible origination from that adjacent organ.
Perspectives
An exophytic lymphoepithelial cyst (LEC) of the pancreas mimics an extra-pancreatic mass such as a pseudocyst, epidermoid cyst, or mucinous neoplasm. The key histopathologic findings of LECs are cyst walls being lined with keratinizing epithelium and subepithelial dense lymphoid tissue admixed with germinal centers. The main pathological differentials include dermoid cysts (DCs) and epidermoid cysts in intrapancreatic accessory spleens (ECISs). The presence of splenic red pulp is pathognomonic of ECIS. DCs are frequently complicated with infection and suppuration. Foci of mucinous cells and respiratory-type mucosa are suggestive of DCs. Radiologically, LECs showing exophytic growing can be mistaken as DCs or mucinous neoplasms in the retroperitoneum. The presence of the “beak sign” deforming the edges of an adjacent organ such as the liver, pancreas, or kidneys increases the possible origination from that adjacent organ.
Professor Kyung Jin Seo
The Catholic University of Korea
Read the Original
This page is a summary of: Exophytic lymphoepithelial cyst of the pancreas, Clinics and Research in Hepatology and Gastroenterology, September 2015, Elsevier,
DOI: 10.1016/j.clinre.2014.09.004.
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