Benign Enterogenous Cyst of the Pancreas

James Majeski, MD, PhD, Department of Surgery, East Cooper Hospital, Mt. Pleasant, SC; Joseph Harmon, MD, Department of Pathology, Roper Hospital, Charleston, SC

South Med J. 2000;93(3) 

In This Article

Case Report

A 26-year-old white woman was referred for evaluation of a cystic mass found on CT and radiographically resembling a pancreatic cystadenoma. The patient related a history of several years of mild abdominal pain in the left upper quadrant to her family physician. Five months before the CT scan, low grade fever and frequent indigestion had developed. There was no history of alcohol abuse. A CT scan showed a 7.2 x 6.2 x 5 cm cystic mass of the pancreas with scattered calcifications in its wall (Fig 1). No internal septations were identified in the mass on the CT scan. The mass was found at the junction of the pancreatic body and tail and extended anteriorly and caudally into the lesser sac. Because of the nondescript nature of the patient's complaints, many tests had been done before referral, which included gallbladder ultrasonography, upper endoscopy, colonoscopy, and cholecystokinin-stimulated Descida scan. All results were normal. Serum amylase and lipase levels were normal.

Computed tomography of abdomen shows 7.2 x 6.2 x 5 cm thin-walled cystic structure, apparently arising at junction of body and tail of pancreas. Scattered calcifications can be seen in cyst wall.

At the time of surgical exploration, a single-chambered cystic mass was found inferior to the pancreas in the lesser sac. The cystic structure was connected to the pancreas only by a single tubular structure, which was suture ligated and divided. A frozen section of the cystic mass was reported as a benign simple cyst.

The final histologic evaluation of the specimen revealed a bilayered muscular wall (Fig 2). The inner surface was lined by ciliated respiratory epithelium (Fig 3), transitional epithelium (Fig 4), and gastric mucosa (Fig 5). In a few areas, epithelial invagination occurred in the muscular wall. The external surface of the cyst was covered by fibro-fatty tissue, and a serosal surface was found in at least one area. There was no evidence of malignancy. Histology of the tissue confirmed the unilocular cyst to be a benign enterogenous cyst of the pancreas. Chemical analysis of the cyst fluid was not obtained. The patient was discharged on the fourth postoperative day and was free of all previous symptoms 1 year after surgery.

Full-thickness section of benign enterogenous cyst mass. (Hematoxylin-eosin, original magnification x 1.25)

Section of cyst inner wall shows ciliated epithelium. (Hematoxylin-eosin, original magnification x 40).

Section of cyst inner wall shows transitional epithelium. (Hematoxylin-eosin, original magnification x 20)

Section shows gastric mucosa on inner lining of cyst. (Hematoxylin-eosin, original magnification x 10).

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