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Z Gastroenterol 2008; 46(10): 1188-1193
DOI: 10.1055/s-2008-1027220
Case Report

© Georg Thieme Verlag KG Stuttgart · New York

Two Cases of Lymphoepithelial Cyst of the Pancreas: First – a Cyst Coexisting with a Primary Gastric Lymphoma, Second – Incidentally Found Pancreatic Cyst

Zwei Fälle der lymphoepithelialen Zysten (LEC) der Bauchspeicheldrüse – LEC koexistierend mit primärem Magenlymphom und zufällige EntdeckungE. Zieliñska-Pająk1 , Ł. Liszka1 , J. Pająk1 , D. Gołka2 , P. Lampe3 , J. Pilch-Kowalczyk4 , S. Mrowiec3
  • 1Department of Histopathology, Medical University of Silesia, Katowice, Poland
  • 2Department of Pathology, Victoria Hospital, Blackpool, UK
  • 3Department of Gastrointestinal Surgery, Medical University of Silesia, Katowice, Poland
  • 4Department of Radiology, Medical University of Silesia, Katowice, Poland
Weitere Informationen

Publikationsverlauf

manuscript received: 31.10.2007

manuscript accepted: 24.1.2008

Publikationsdatum:
20. Oktober 2008 (online)

Auch verfügbar auf
    Lizenzen und Reprints

Zusammenfassung

Hintergrund und Ziel: Zwei Fälle der lymphoepithelialen Zysten (LEC) der Bauchspeicheldrüse: 1. LEC koexistierend mit primärem Magenlymphom, 2. zufällige Entdeckung der LEC während bildlicher Untersuchung. Ergebnisse: 1. Bei dem 47-jährigen Patienten mit Oberbauchschmerzen wurde mittels Computertomografie eine 2 × 1,5 cm Zyste diagnostiziert. Die histologische Untersuchung der Biopsate zeigte ein gering differenziertes Neoplasma, möglicherweise Karzinom. Bei dem Patienten wurde eine Gastrektomie mit Lymphadenectomie D 2 durchgeführt. Die Veränderung der Bauchspeicheldrüse wurde entfernt. Die histologische Untersuchung zeigte ein diffuses großzelliges B-Zell-Lymphom (pT4N1 M0BX) und LEC. Der Patient verweigerte eine adjuvante Therapie. Während der 24 Monate langen Beobachtungsperiode wurden keine Rezidivsymptome gefunden. 2. Bei dem 50-jährigen Patienten mit unspezifischen Miktionsbeschwerden wurde mittels CT-Untersuchung eine 4,2 × 3,5 cm Zyste in dem Pankreaskorpus festgestellt. Die Zyste wurde entfernt und eine LEC diagnostiziert. Während der 42 Monate langen Nachbeobachtungsperiode hatte der Patient keine Beschwerden. Schlussfolgerung: Der erste von den 2 präsentierten Fällen ist nach Kenntnis der Autoren die erste Beschreibung einer Koexistenz einer LEC mit einem Magenlymphom. Es ist schwer, festzustellen, ob es einen kasuistischen Zusammenhang zwischen LEC der Bauchspeicheldrüse und Lymphom gibt oder er rein zufällig ist. Zufällig festgestellte Bauchspeicheldrüsen-Zysten sind immer häufiger in chirurgischer Praxis zu beobachten.

Abstract

Background/Aims: The aim of this report is to describe two cases of lymphoepithelial cysts (LEC) of the pancreas: 1. LEC coexisting with primary gastric lymphoma, 2. an incidental finding of LEC during imaging examination. Results: 1. A 47-year old man complaining of epigastric pain showed a 2 × 1.5 cm cyst of the pancreatic head on computed tomography (CT) scan. Endoscopic biopsy revealed infiltration by a poorly differentiated neoplasm, probably carcinoma. The patient underwent gastrectomy with lymphadenectomy D 2. The pancreatic lesion was excised. Diffuse large B-cell lymphoma (pT4N1 M0BX) and LEC were diagnosed. Patient refused adjuvant therapy. No symptoms of recurrence were observed during 24-months follow-up period. 2. 50-year-old male with non-specific urinary complaints revealed a 4.2 × 3.5 cm cyst in the body of pancreas on CT scan. The cyst was excised and LEC was diagnosed. Patient had not reported any complaints during 42 months follow-up period. Conclusions: To the best of the authors’ knowledge, the first of two presented cases is the first described case of coexistence of LEC of the pancreas and gastrointestinal lymphoma. It is difficult to ascertain if there is any causative relationship or if this coexistence is purely incidental. Incidental pancreatic cysts are more and more common finding in surgical practice.

Schlüsselwörter

lymphoepitheliale Zyste - Pankreas-Zyste - Magenlymphom - diffuses großzelliges B-Zell-Lymphom

Key words

lymphoepithelial cyst - pancreatic cyst - stomach neoplasm - diffuse large-cell lymphoma

References

  • 1 Adsay N V, Hasteh F, Cheng J D. et al . Lymphoepithelial cyst of the pancreas: a report of 12 cases and a review of the literature.  Mod Pathol. 2002;  15 492-501
    Google Scholar
  • 2 Bernd H W, Burmester E, Horny H P. Unusual coincidence of lymphoepithelial cyst and mucinous cystadenoma of the pancreas.  Virchows Arch. 2002;  441 303-305
    Google Scholar
  • 3 Anagnostopoulos P V, Pipinos I I, Rose W W. et al . Lymphoepithelial cyst of the pancreas. A case report and review of the literature.  Dig Surg. 2000;  17 309-314
    Google Scholar
  • 4 Madura J A, Yum M N, Lehman G A. et al . Mucin secreting cystic lesions of the pancreas: treatment by enucleation.  Am Surg. 2004;  70 106-113
    Google Scholar
  • 5 Solcia E, Capella C, Kloppel G. Atlas of tumor pathology. Tumors of the pancreas. 3 rd Series Fascicle Washington; Armed Forces Institute of Pathology 1997
    Google Scholar
  • 6 Adsay N V, Hasteh F, Cheng J D. et al . Squamous-lined cysts of the pancreas: lymphoepithelial cysts, dermoid cysts (teratomas), and accessory-splenic epidermoid cysts.  Semin Diagn Pathol. 2000;  17 56-65
    Google Scholar
  • 7 Strapko A, Botash R J, Murthy U K. et al . Lymphoepithelial cyst of the pancreas. A case report and review of the literature.  Dig Dis Sci. 1998;  43 870-874
    Google Scholar
  • 8 Capitanich P, Iovaldi M L, Medrano M. et al . Lymphoepithelial cysts of the pancreas: case report and review of the literature.  J Gastrointest Surg. 2004;  8 342-345
    Google Scholar
  • 9 Worrall N K, Drebin J A. Pancreaticoduodenectomy for lymphoepithelial cyst of the pancreas.  Am Surg. 2000;  66 732-734
    Google Scholar
  • 10 Walsh R M, Vogt D P, Henderson J M. et al . Natural history of indeterminate pancreatic cysts.  Surgery. 2005;  138 665-671
    Google Scholar
  • 11 Fernandez-del Castillo C, Targarona J, Thayer S P. et al . Incidental pancreatic cysts. Clinicopathologic characteristics and comparison with symptomatic patients.  Arch Surg. 2003;  138 427-434
    Google Scholar
  • 12 ASGE Guideline: the role of endoscopy in the diagnosis and the management of cystic lesions and inflammatory fluid collections of the pancreas.  Gastrointest Endosc. 2005;  61 363-370
    Google Scholar
  • 13 Brugge W R. Cystic pancreatic lesions: can we diagnose them accurately what to look for? FNA marker molecular analysis resection, surveillance, or endoscopic treatment?.  Endoscopy. 2006;  38 (S1) S40-S47
    Google Scholar
  • 14 Brugge W R, Lauwers G Y, Sahani D. et al . Cystic neoplasms of the pancreas.  N Engl J Med. 2004;  351 1218-1226
    Google Scholar
  • 15 Barbaros U, Erbil Y, Kapran Y. et al . Lymphoepithelial cyst: a rare cystic tumor of the pancreas which mimics carcinoma.  JOP J Pancreas (Online). 2004;  5 392-394
    Google Scholar
  • 16 Ruskone-Fourmestraux A, Dragosics B, Morgner A. et al . Paris staging system for primary gastrointestinal lymphomas.  Gut. 2003;  52 912-913
    Google Scholar
  • 17 Yen T L, Murr A H, Rabin J. et al . Role of cytomegalovirus, Epstein-Barr virus, and human herpes virus-8 in benign lymphoepithelial cysts of the parotid gland.  Laryngoscope. 2004;  114 1500-1505
    Google Scholar
  • 18 Albrecht H, Stellbrink H J, Greten H. Resolution of HIV-associated cystic benign lymphoepithelial lesion of the parotid gland in a patient undergoing chemotherapy for non-Hodgkin’s lymphoma.  Scand J Infect Dis. 1996;  28 621-623
    Google Scholar
  • 19 Chetty R. HIV-associated lymphoepithelial cysts and lesions: morphological and immunohistochemical study of the lymphoid cells.  Histopathology. 1998;  33 222-229
    Google Scholar
  • 20 Bernier J L, Bhaskar S N. Lymphoepithelial lesions of salivary glands. Histogenesis and classification based on 186 cases.  Cancer. 1958;  11 1156-1179
    Google Scholar
  • 21 Maiorano E, Favia G, Viale G. Lymphoepithelial cysts of salivary glands: An immunohistochemical study of HIV-related and HIV-unrelated lesions.  Hum Pathol. 1998;  29 260-265
    Google Scholar
  • 22 Ellis G L, Auclair P L. Atlas of tumor pathology. Tumors of the salivary glands. 3 rd Series Fascicle 17 Washington; Armed Forces Institute of Pathology 1996
    Google Scholar
  • 23 San Miguel Fraile P, Fernandez Perez G C, Ortiz Rey J A. et al . Lymphoepithelial cyst of the thyroid gland: a case report and review of the literature.  An Med Interna. 2006;  23 232-234
    Google Scholar
  • 24 Asami S, Naomoto Y, Yamatsuji T. et al . Lymphoepithelial cyst of the cervical esophagus.  J Gastroenterol. 2006;  41 88-89
    Google Scholar
  • 25 Ulku R, Yilmaz F, Eren S. et al . Lymphoepithelial cyst of the mediastinum.  Tex Heart Inst J. 2005;  32 440-441
    Google Scholar
  • 26 Luchtrath H, Schriefers K H. Pankreaszyste unter dem Bild einer sogenannten brachiogenen Zyste.  Der Pathologe. 1985;  6 217-219
    Google Scholar
  • 27 Truong L D, Rangdaeng S, Jordan P H. Lymphoepithelial cyst of the pancreas.  Am J Surg Pathol. 1987;  11 899-903
    Google Scholar
  • 28 Policarpio-Nicolas M L, Sharmi V M, Kahaleh M. et al . Fine-needle aspiration cytology of pancreatic lymphoepithelial cysts.  Cancer (Cancer Cytopathol). 2006;  108 501-506
    Google Scholar
  • 29 Shinmura R, Gabata T, Matsui O. Lymphoepithelial cyst of the pancreas: case report with special reference to imaging-pathologic correlation.  Abdom Imaging. 2006;  31 106-109
    Google Scholar
  • 30 Fukukura Y, Inoue H, Miyazono N. et al . Case report. Lymphoepithelial cyst of the pancreas: demonstration of lipid component using CT and MRI.  J Comput Assist Tomogr. 1998;  22 311-313
    Google Scholar
  • 31 Gafa R, Grandi E, Cavazzini L. Lymphoepithelial cyst of the pancreas.  J Clin Pathol. 1997;  50 794-795
    Google Scholar
  • 32 Christein J D, Smoot R L, Farnell M B. Central pancreatectomy. A technique for the resection of pancreatic neck lesions.  Arch Surg. 2006;  141 293-299
    Google Scholar
  • 33 Schwarz R E, Weiss L M. Lymphoepithelial cyst of the pancreas. No-evidence for Epstain-Barr virus related pathogenesis.  Int J Pancreatol. 1999;  25 223-227
    Google Scholar
  • 34 Wotherspoon A, Chott A, Gascoyne R D. et al .K. Lymphoma of the stomach. Hamilton SR, Aaltonen LA World Health Organization classification of tumors. Pathology and genetics of tumors of the digestive system Lyon; IARC Press 2000: 57-61
    Google Scholar
  • 35 Ferrucci P F, Zucca E. Primary gastric lymphoma pathogenesis and treatment: what has changed over the past 10 years?.  Br J Haematol. 2007;  136 521-538
    Google Scholar
  • 36 Aviles A, Nambo M J, Neri N. et al . The role of surgery in primary gastric lymphoma: results of a controlled clinical trial.  Ann Surg. 2004;  240 44-50
    Google Scholar
  • 37 Gatter K C, Warnke R A. Diffuse large B-cell lymphoma. Jaffe ES, Harris NL, Stein H, Vardiman JW World Health Organization Classification of Tumours. Pathology and genetics of tumours of haematopoietic and lymphoid tissues Lyon; IARC Press 2001: 171-174
    Google Scholar
  • 38 Hiyama T, Haruma K, Kitadai Y. et al . Clinicopathological features of gastric mucosa-associated lymphoid tissue lymphoma: a comparison with diffuse large B-cell lymphoma without a mucosa-associated lymphoid tissue lymphoma component.  J Gastroenterol Hepatol. 2001;  16 734-739
    Google Scholar
  • 39 Yoshino T, Omonishi K, Kobayashi K. et al . Clinicopathological features of gastric mucosa associated lymphoid tissue (MALT) lymphomas: high grade transformation and comparison with diffuse large B cell lymphomas without MALT lymphoma features.  J Clin Pathol. 2000;  53 187-190
    Google Scholar
  • 40 Iwano M, Watanabe N, Matsushima Y. et al . Rapid development of diffuse large B-Cell lymphoma after successful eradication of Helicobacter pylori for gastric MALT lymphoma.  Am J Gastroenterol. 2006;  101 2878-2883
    Google Scholar
  • 41 Alsolaiman M M, Bakis G, Nazeer T. et al . Five years of complete remission of gastric diffuse large B cell lymphoma after eradication of Helicobacter pylori infection.  Gut. 2003;  52 507-509
    Google Scholar
  • 42 Yoshino T, Nakamura S, Matsuno Y. et al . Epstein-Barr virus involvement is a predictive factor for the resistance to chemoradiotherapy of gastric diffuse large B-cell lymphoma.  Cancer Sci. 2006;  97 163-166
    Google Scholar
  • 43 Jarrett R F, Stark G L, White J. et al . Impact of tumor Epstein-Barr virus status on presenting features and outcome in age-defined subgroups of patients with classic Hodgkin lymphoma: a population-based study.  Blood. 2005;  106 2444-2451
    Google Scholar
  • 44 Kekis P B, Murtin C, Kunzli B M. et al . Epstein-Barr virus-associated lymphoepithelial carcinoma in the pancreas.  Pancreas. 2004;  28 98-102
    Google Scholar
  • 45 Larbcharoensub N, Tubtong N, Praneetvatakul V. et al . Epstein-Barr virus associated lymphoepithelial carcinoma of the parotid gland; a clinicopathological report of three cases.  J Med Assoc Thai. 2006;  89 1536-1541
    Google Scholar
  • 46 Ueo T, Kashima K, Daa T. et al . Coexistence of Epstein-Barr virus-associated gastric carcinoma with malignant lymphoma: report of two cases.  Virchows Arch. 2006;  449 215-219
    Google Scholar
  • 47 Hui P K, Tokunaga M, Chan W Y. et al . Epstein-Barr virus-associated gastric lymphoma in Hong Kong Chinese.  Hum Pathol. 1994;  25 947-952
    Google Scholar
  • 48 Xu W S, Ho F C, Ho J. et al . Pathogenesis of gastric lymphoma: the enigma in Hong Kong.  Ann Oncol. 1997;  8 (Suppl 2) 41-44
    Google Scholar
  • 49 Winter J M, Cameron J L, Lillemoe K D. et al . Periampullary and pancreatic incidentaloma. A single institution’s experience with a increasingly common diagnosis.  Ann Surg. 2006;  243 673-683
    Google Scholar
  • 50 Goh B K, Tan Y M, Cheow P C. et al . Cystic lesions of the pancreas: an appraisal of an aggressive resectional policy adopted at a single institution during 15 years.  Am J Surg. 2006;  192 148-154
    Google Scholar
  • 51 Barthet M, Napoleon B, Palazzo L. et al . Management of cystic pancreatic lesions found incidentally.  Endoscopy. 2007;  39 926-928
    Google Scholar

Łukasz Liszka, M. D.

Department of Histopathology, Medical University of Silesia

ul. Medyków 14

40-754 Katowice

Poland

Fax: ++ 48/32/2 52 50 80

eMail: LLISZKA@MP.PL