ENDOSCOPIC ULTRASOUND IMAGING OF A RARE CYSTIC LESION IN THE PANCREAS

We would like to present the video of a rare case of cystic teratoma (dermoid cyst) in the tail of pancreas and role of endoscopic ultrasound guided imaging in diagnosis.

A fifty nine year old male patient found to have mildly raised bilirubin (33 [0 – 21] umol/L) on the routine screening bloods from primary care. He underwent trans-abdominal ultrasound showed possible left adrenal tumour. Subsequently cross sectional imaging confirmed pancreatic mass arising from the tail. EUS was undertaken to obtain diagnostic sampling which showed large cystic mass in the body and tail of pancreas, there are circular hyperechoic well defined area within the lesion without posterior echo shadowing. EUS video showing interrogation of this lesion is attached to this abstract. Cyst aspirate showed highly viscous, turbid, pale yellow colour fluid. Cytology from this specimen is negative but sample shown to have high CEA (29617).

Patient underwent distal pancreato-splenectomy and histology specimen confirmed there is large cyst lesion measuring 70 × 35 × 20 mm, which is variably lined by a mixture of stratified squamous glands (mature epidermis), metaplastic squamous epithelium and glandular epithelium. This is consistent with mature cystic teratoma (dermoid cyst) which is a very rare but recognised entity affecting the pancreas.

Pancreas is rare site of presentation of cystic teratoma. Only 35 cases re reported till date No pathognomonic data is known on imaging studies because the radiologic features depend on the proportions of their various components within the cyst. EUS guides as valuable diagnostic adjuvant for pre-operative evaluation.

References:

1. Tucci, Gianfranco, et al. “Dermoid cyst of the pancreas: presentation and management.” World journal of surgical oncology 5.1 (2007): 85.

2. Lyons, Daniel A., et al. “Case report of pancreatic dermoid cyst: can fine needle aspiration make the diagnosis?.” JOP. Journal of the Pancreas 14.6 (2013): 653