Lymphoepithelial cyst of the pancreas: can common imaging features help to avoid resection?

Ekaterina Khristenko; Elena Esteban Garcia; Matthias M Gaida; Thilo Hackert; Philipp Mayer; Hans-Ulrich Kauczor; Miriam Klauss

doi:10.1007/s00423-023-02777-9

Lymphoepithelial cyst of the pancreas: can common imaging features help to avoid resection?

Langenbecks Arch Surg. 2023 Feb 11;408(1):82. doi: 10.1007/s00423-023-02777-9.

Authors

Ekaterina Khristenko¹, Elena Esteban Garcia², Matthias M Gaida³, Thilo Hackert⁴, Philipp Mayer⁵, Hans-Ulrich Kauczor⁵, Miriam Klauss⁵

Affiliations

¹ Department of Diagnostical and Interventional Radiology, Heidelberg University Hospital, Im Neuenheimer Feld 420, 69120, Heidelberg, Germany. katkhristenko@gmail.com.
² Department of Radiology, Sofia General University Hospital, Av. Intendente Jorge Palacois, 1, 30003, ReinaMurcia, Spain.
³ Department of Pathology, Johannes Gutenberg University, Saarstrasse 21, 55122, Mainz, Germany.
⁴ Department of General, Visceral, and Transplantation Surgery, Heidelberg University Hospital, Im Neuenheimer Feld 420, 69120, Heidelberg, Germany.
⁵ Department of Diagnostical and Interventional Radiology, Heidelberg University Hospital, Im Neuenheimer Feld 420, 69120, Heidelberg, Germany.

Abstract

Background: Differentiation of cystic pancreatic neoplasms remains a challenging task for radiologists regarding the main aim of identifying malignant and premalignant lesions.

Purpose: The study aimed to compare the radiological features of lymphoepithelial cysts (LEC) with other cystic pancreatic lesions, which could help to differentiate them in order to avoid unnecessary resection.

Material and methods: We retrospectively reviewed 10 cases of resected and histopathologically confirmed LECs during a 12-year period with available imaging studies; 20 patients with mucinous cystic neoplasms (MCN), 20 patients with branch-duct intraductal papillary mucinous neoplasms (BD-IPMN), and 20 patients with serous cystic neoplasms (SCN) were selected to serve as control groups. Imaging findings as well as clinical data were analyzed.

Results: The following imaging morphology of LEC was identified: simple cystic appearance (20%) and mixed cystic-solid appearance (80%) with either a diffuse subsolid component (30%) or mural nodule(s) (50%). All lesions revealed exophytic location with a strong male predominance (9:1). MCNs occurred exclusively in middle-aged women, IPMN in both sexes showed slight male predominance (13:7), and SCN showed female predominance (5:15). Median patient age in LEC (48.5, IQR 47-54.5) was significantly younger compared to IPMN (p < 0.001) and SCN (p = 0.02). Unenhanced CT attenuation of LEC was higher than MCNs (p = 0.025) and IPMNs (p = 0.021), showing no significant difference to SCN (p = 0.343).

Conclusion: The present study provides key radiological features of LEC for the differentiation from other cystic pancreatic lesions such as increased CT attenuation in the unenhanced phase, absence of a connection to the main pancreatic duct (MPD), and exophytic location. In addition to these imaging features, clinical data, such as male predominance in LEC, must be considered for the differentiation of cystic pancreatic lesions.

Keywords: Imaging features; LEC; Pancreatic cysts; Pancreatic surgery; Prognosis.

MeSH terms

Carcinoma, Pancreatic Ductal* / diagnostic imaging
Carcinoma, Pancreatic Ductal* / pathology
Carcinoma, Pancreatic Ductal* / surgery
Female
Humans
Male
Middle Aged
Neoplasms, Cystic, Mucinous, and Serous*
Pancreas
Pancreatic Cyst* / diagnostic imaging
Pancreatic Cyst* / pathology
Pancreatic Cyst* / surgery
Pancreatic Intraductal Neoplasms*
Pancreatic Neoplasms* / diagnostic imaging
Pancreatic Neoplasms* / pathology
Pancreatic Neoplasms* / surgery
Retrospective Studies