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

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

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