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Lymphoepithelial Cyst of Pancreas - Case Report and Analysis of 235 Cases Reported In Literature

J M V Amarjothi, Prabakaran Raju, Bennet Duraisamy, Amudhan Anbalagan, O L Naganath Babu

Background Lympho Epithelial Cysts are rare benign lesions, mostly seen involving the tail of pancreas in middle aged men. But precious little is known of these cysts as most are described in case reports only. So a comprehensive analysis of these case reports is needed to glean useful information and form an algorithm for effective treatment. Methodology An analysis done of all available case reports in literature reveals most are symptomatic though asymptomatic cases are increasingly detected on routine imaging. Usually solitary, they are mostly multilocular with a mean size of 4.7 cm. The most common markers include fluid carcinoembryonic antigen and serum CA 19- 9. Both can be markedly elevated in lympho epithelial cysts. Conservative wait and watch management can be followed if the patient is asymptomatic and diagnosis is certain. However, only 11.5% underwent such a management revealing an inability to rule out malignancy beyond reasonable doubt or symptomatology of these lesions in most instances. Pancreas preserving enucleation and pancreatic resection procedures are most commonly performed in lympho epithelial cysts depending on the accuracy of diagnosis with an enucleation of the cyst being preferred for those with a definite diagnosis of lympho epithelial cysts. Conclusion Lympho epithelial cysts which are asymptomatic with an accurate preoperative diagnosis can be followed by surveillance. Pre operatively diagnosed symptomatic lesions can be managed by pancreatic parenchyma preserving over radical pancreatic procedures. For patients with doubtful diagnosis, radical pancreatic resection may be necessary. Tumor markers like serum CA 19-9 and fluid carcinoembryonic antigen are most commonly elevated in lympho epithelial cysts further confounding the diagnosis in equivocal cases. Further diagnostic clarity is needed in this subgroup of patients to clearly characterize these lesions. But till then, a low threshold for surgery is required in these patients for effective management.