Lymphoepithelial cyst of the pancreas: A case report and summary of imaging features of pancreatic cysts

INTRODUCTION: A lymphoepithelial cyst (LEC) of the pancreas is a benign and rare lesion that is difficult to diagnose preoperatively based on imaging studies. PRESENTATION OF CASE: We report a case of a 49-year-old man who presented with weight loss and diarrhea. The serum carcinoembryonic antigen and carbohydrate antigen 19-9 levels were slightly elevated to 6.7 ng/mL (reference value <5.0 ng/mL) and 45 U/mL (reference value <37 U/mL), respectively. Computed tomography showed a large cystic mass with internal septa in the pancreatic tail. The cystic wall and the septa showed enhancement while the cystic contents remained unenhanced. Magnetic resonance imaging (MRI) demonstrated a multiple-ball-like lesion with low signal intensity on T1-weighted image and high signal intensity on T2-weighted image. Diffusion-weighted MRI showed high signal intensity in the central and iso-signal intensity in the peripheral portions of the cystic lesion. The cystic wall and septa showed high signal intensity, and the cystic contents showed low signal intensity on an enhanced MRI. Endoscopic ultrasonography showed a cyst with multiple high-echoic lesions in the pancreatic tail. A mucinous cystic neoplasm and branch duct intraductal papillary mucinous neoplasm were considered among the differential diagnoses, and we performed distal pancreatectomy with concomitant splenectomy and lymphadenectomy for both diagnostic and therapeutic purposes. Histopathological findings revealed that the cystic wall was lined by stratified squamous epithelium, and several lymphoid follicles and a few sebaceous glands were observed within the cystic wall without hair follicles, leading to the final diagnosis of an LEC. CONCLUSION: We report a rare case of a pancreatic LEC, which was difficult to be diagnosed and summarize the imaging features of pancreatic cysts to differentiate from the malignancy preoperatively.