1/13. Lymphoepithelial cyst of the pancreas. No evidence for Epstein-Barr virus-related pathogenesis.Compared to pseudocyst formation after prior pancreatitis, true cysts of the pancreas are rare. Pancreatic cysts with irregular wall components or a mucinous content raise the suspicion for the presence of a cystic neoplasm, and surgical resection is recommended. A case of a patient with a history of prostate cancer is described in whom a cyst of the pancreatic tail was discovered incidentally. Based on the radiographic features, which did not support the presence of a serous cystadenoma, a spleen-preserving distal pancreatectomy was performed. Histologic features were characteristic for a lymphoepithelial cyst (LEC) of the pancreas, lined with thinned squamous epithelium surrounded by benign lymphoid tissue. Since LECs of the parotid gland, which are associated with acquired human immunodeficiency, are frequently related to Epstein-Barr virus (EBV) infection, EBV in situ hybridization was performed and did not reveal evidence for EBV. Twenty-eight instances of pancreatic LECs have been reported, primarily affecting adult males, without evidence of increased numbers of EBV-positive cells. The pathogenesis, differential diagnosis, and clinical implications of lymphoepithelial pancreatic cysts are discussed.- - - - - - - - - - ranking = 1keywords = gland (Clic here for more details about this article) |
2/13. Lymphoepithelial cyst of the pancreas with sebaceous differentiation.We recently encountered a patient with a lymphoepithelial cyst of the pancreas with sebaceous differentiation. We sought to compare the characteristics of this patient with those previously reported in order to foster a keener understanding of this rare clinical entity. After reviewing the present patient's case in detail, we conducted a comprehensive review of the English-language literature and analyzed the clinical characteristics of reported cases of lymphoepithelial cysts. Our patient was an asymptomatic 60-year-old man who presented with an incidental finding of a cystic lesion in the tail of the pancreas documented by computed tomography. The cyst was enucleated, and was found to contain keratinized material. It was lined by squamous epithelium with small sebaceous glands, and surrounded by lymphoid tissue with germinal centers. Of 33 reported cases, only 6 (18%) contained sebaceous glands. In all patients who underwent operation, the cysts were easily resected, and the outcome was favorable. Lymphoepithelial cyst of the pancreas is rare, and may be difficult to differentiate from cystic neoplasms preoperatively. Therefore resection is indicated. The diagnosis, however, can be confirmed by careful histologic review, and the prognosis is excellent.- - - - - - - - - - ranking = 2keywords = gland (Clic here for more details about this article) |
3/13. endometriosis of the pancreas presenting as a cystic pancreatic neoplasm with possible metastasis.The authors report a case of endometriosis that presented as a cystic mass in the tail of the pancreas, leading to extensive evaluation and ultimately a major surgical resection. The diagnosis was made by histopathological evaluation, revealing endometrial glands and stroma in the wall of the mass with hemorrhagic fluid in the cystic lumen, compatible with pancreatic involvement by an endometrial cyst.- - - - - - - - - - ranking = 1keywords = gland (Clic here for more details about this article) |
4/13. Clinical, imaging, and cytopathological features of solid pseudopapillary tumor of the pancreas: a clinicopathologic study of three cases and review of the literature.Solid pseudopapillary tumors are rare pancreatic neoplasms of uncertain pathogenesis that rarely metastasize and usually occur in young women. We describe the clinical, imaging, and cytopathological features of solid pseudopapillary tumor of the pancreas. We reviewed the clinical presentation, imaging, morphologic/immunochemical features, and follow-up of three women (age range 26-44). Cases 1, 2, and 3 presented with abdominal wall abscess, multiple endocrine neoplasia, and solid/cystic mass in the pancreatic head, respectively, and computed tomography of abdomen revealed solid/cystic masses with heterogeneous enhancement in body, tail and head of the pancreas, respectively. Case 2 also exhibited a left adrenal mass. Case 3 underwent endoscopic ultrasound of the pancreas, which showed a complex solid/cystic mass with septations. Sampling consisted of fine-needle aspiration (percutaneous or endosonography-guided), and additionally, core biopsy of the pancreatic mass and adrenal lesion in case 2. Aspirates and core biopsy revealed vascular structures with attached monotonous neoplastic cells in papillary-like arrays. Tumor cells had bland nuclear features with grooves, cytoplasmic periodic acid Schiff-positive hyaline globules, and associated myxoid/stromal fragments. immunochemistry expressed alpha-1-antitrypsin, alpha-1-antichymotrypsin, vimentin, and focal neuron-specific enolase. Cases 1 and 3 underwent pancreatectomy with follow-up consisting of yearly imaging and no recurrences. Case 2 proved metastatic disease to adrenal gland and no follow-up was available. In the setting of typical clinical and imaging findings, an accurate preoperative diagnosis of pancreatic solid pseudopapillary tumor can be established by aspiration cytology and immunochemistry with or without concomitant core biopsy, on the basis of which clinicians decide treatment. This tumor can behave in a malignant fashion.- - - - - - - - - - ranking = 1keywords = gland (Clic here for more details about this article) |
5/13. Duodenal duplication cyst with profound elevation of intracystic carbohydrate antigen (CA 19-9) and carcinoembryonic antigen (CEA): a rare but important differential in the diagnosis of cystic tumours of the pancreas.CONTEXT: Enteric duplication cysts are rare lesions of uncertain incidence and natural history. Pre-operative confirmation of diagnosis can be difficult. This case reports an adult duodenal duplication cyst presenting with grossly elevated intra-lesional levels of tumour markers. CASE REPORT: A 57-year-old female was found to have a complex cystic lesion of the head of the pancreas. Intra-lesional fluid analysis revealed a grossly elevated CA 19-9 and CEA. Resection was undertaken under the assumption that this was a cystic tumour. Macroscopic examination after opening the duodenum revealed a villous, circumferential tumour in the proximal duodenum measuring 4 cm in length. A cystic lesion was present in the medial wall of the tumour and did not communicate with the duodenal lumen. Microscopically, the tumour comprised Brunner's gland hyperplasia with associated mucosal thickening. The wall of the underlying cystic lesion was comprised of muscularis formed by the outer muscle coat of the duodenal wall. The final diagnosis was of a duodenal duplication cyst. There was no evidence of dysplasia or malignancy. CONCLUSION: This is the first report of a duodenal duplication cyst having elevated intra-cyst fluid levels of amylase, carbohydrate antigen CA 19-9 and carcinoembryonic antigen (CEA). Although rare, this is an important differential diagnosis in the management of cystic tumours of the pancreas.- - - - - - - - - - ranking = 1keywords = gland (Clic here for more details about this article) |
6/13. Pancreatic involvement in von hippel-lindau disease: report of two cases and review of the literature.BACKGROUND: Von Hippel-Lindau (VHL) disease is an autosomal dominant multicancer syndrome caused by the germline mutation of a tumor suppressor gene. Affected individuals develop benign and malignant tumors of the central nervous system, kidneys, adrenal glands, pancreas, and reproductive system. Although VHL disease is mainly diagnosed after the detection of central nervous system tumors, they may not always be the first presentation. CASE REPORT: We report the case of a patient presenting with pancreatic cysts for whom the final genetic diagnosis of VHL disease was formulated. During management, the use of endoscopic ultrasonography (EUS) proved to be valid in the characterization of the pancreatic lesions. family screening also revealed the genetic mutation in the patient's son and imaging investigations showed the presence of multiple tumors. The diagnosis allowed us to plan appropriate follow-up for both, thus improving their life expectancy. CONCLUSIONS: Gastroenterologists should be aware of the frequent pancreatic involvement in VHL disease and EUS can be useful in this setting.- - - - - - - - - - ranking = 1keywords = gland (Clic here for more details about this article) |
7/13. Cystic lymphoepithelial lesion of the pancreas.A rare lymphoepithelial lesion of the pancreas was discovered incidentally at autopsy. This lesion is composed of epithelial-lined cystic spaces encompassed by lymphoid stroma, similar to lesions reported in the salivary glands. review of the literature revealed only three similar cases. This lesion should be considered in the differential diagnosis of pancreatic cysts.- - - - - - - - - - ranking = 1keywords = gland (Clic here for more details about this article) |
8/13. Fine-needle aspiration cytology of neoplastic cysts of the pancreas.Herein is reported the cytologic features of four cases of cystic neoplasms of the pancreas as seen in fine-needle aspirates. Cytologically, the cases fall into two distinct groups: mucinous cystic neoplasm and serous cystadenoma. The aspirates from the mucinous cystic neoplasms characteristically showed columnar mucus-secreting epithelial cells, some of which were arranged in a papilloglandular pattern, with abundant mucous material in the background. The aspirates from the serous cystadenoma yielded small sheets of cuboidal cells with small nuclei and clear cytoplasm, without a background of mucous material. This cytologic division corresponds closely to the histologic classification proposed by Compagno and Oertel and hence is of prognostic and therapeutic value. The diagnostic challenges confronted by the cytopathologist are (1) to differentiate neoplastic cysts from the inflammatory pseudocysts; (2) to differentiate neoplastic epithelium from the normal epithelium of the bowel and pancreatic ducts; and (3) to differentiate mucinous cystic neoplasms from serous cystadenomas.- - - - - - - - - - ranking = 1keywords = gland (Clic here for more details about this article) |
9/13. Pseudocyst of the head of the pancreas: relationship to the duct of Santorini.A series of 14 patients with chronic alcoholic pancreatitis is presented which illustrates that cysts originating in the superior segment of the head of the pancreas communicate with the duct of Santorini which normally drains this area of the gland. cysts in this location do not communicate with the major pancreatic duct (Wirsung) in most instances, and therefore may be overlooked in the standard retrograde drainage procedures employed to relieve pancreatic exocrine obstruction.- - - - - - - - - - ranking = 1keywords = gland (Clic here for more details about this article) |
10/13. Symposium on pancreatitis: 4. Surgery in chronic pancreatitis.When the pain associated with chronic pancreatitis is due to ductal obstruction, it is logical that surgical management should be designed to relieve that obstruction while preserving as much of the functioning gland as possible. A number of cases are described to illustrate the various procedures available and to indicate the features that govern the selection of the one most appropriate for a particular patient. The operations include partial pancreatectomy, Roux-en-Y pancreaticojejunostomy and longitudinal pancreaticojejunostomy; these can be modified to suit the peculiar circumstances of a given case.- - - - - - - - - - ranking = 1keywords = gland (Clic here for more details about this article) |
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