Sana Rabeeah, MD1, Hayder Alamily, MD2, Hasan Elshebiny, MD3, Ahmad Mahdi, MD4, Mohammed Abu-Rumaileh, MD1, Bisher Sawaf, MD5, Vikash Kumar, MD6, Caroline Durham, MD3, Maram Albandak, MD1, Zohaib Ahmed, MD7, Ali Nawras, MD1 1The University of Toledo, Toledo, OH; 2University of Colorado Anschutz Medical Campus, Denver, CO; 3University of Toledo, Toledo, OH; 4Marshall University, Toledo, OH; 5University of Toledo Medical Center, Toledo, OH; 6Creighton University School of Medicine, Phoenix, AZ; 7University of Toledo College Medicine and Life Sciences, Toledo, OH Introduction: Lymphoepithelial cysts (LECs) of the pancreas are rare, benign, true cystic lesions characterized by squamous epithelium and dense lymphoid tissue. Despite their benign nature, LECs often mimic neoplastic pancreatic cysts radiographically, leading to diagnostic uncertainty and potentially unnecessary surgical intervention. Given their rarity, accounting for less than 0.5% of all pancreatic cysts, LECs are frequently overlooked in differential diagnoses. Endoscopic ultrasound-guided fine-needle aspiration (EUS-FNA) is essential for diagnosis, cytological confirmation and guiding management.
Case Description/
Methods: A 64-year-old female with a history of hypertension and depression presented with persistent nausea for over one year, unaccompanied by vomiting, abdominal pain, weight loss, or gastrointestinal bleeding. An initial abdominal and pelvic CT scan was unremarkable. Subsequent evaluation, including EGD, colonoscopy, and a gastric emptying study, was non-diagnostic. Trials of antiemetics (ondansetron, promethazine, scopolamine) failed to relieve symptoms. Abdominal MRI revealed an incidental 1.8 × 0.9 cm multiloculated cyst adjacent to the pancreatic tail, with no contrast enhancement. EUS identified a complex anechoic lesion measuring 17.9 × 17.1 mm near the pancreatic tail, and FNA yielded 3 mL of white, viscous fluid. Cytopathologic analysis showed stratified squamous epithelium with dense lymphoid tissue, consistent with an LEC. No elevated tumor markers or mucin were detected. The pancreas was noted to be shortened and malpositioned, likely due to congenital anomaly. The cyst was deemed unrelated to her symptoms, and conservative management with surveillance imaging was pursued. Discussion: Pancreatic LECs pose a diagnostic challenge due to their overlapping imaging features with mucinous cystic neoplasms (MCNs), serous cystic neoplasms (SCNs), and intraductal papillary mucinous neoplasms (IPMNs). However, cytology demonstrating squamous epithelium, keratinous debris, and lymphoid tissue, along with the absence of mucin, CEA, or amylase elevation, is diagnostic. A literature review reveals that most LECs are asymptomatic and identified incidentally. Management should be individualized, with conservative observation appropriate for confirmed benign lesions. This case reinforces the importance of recognizing LECs in the differential diagnosis to avoid overtreatment. Increased awareness and appropriate use of EUS-FNA can prevent unnecessary surgery while ensuring accurate diagnosis.
Disclosures: Sana Rabeeah indicated no relevant financial relationships. Hayder Alamily indicated no relevant financial relationships. Hasan Elshebiny indicated no relevant financial relationships. Ahmad Mahdi indicated no relevant financial relationships. Mohammed Abu-Rumaileh indicated no relevant financial relationships. Bisher Sawaf indicated no relevant financial relationships. Vikash Kumar indicated no relevant financial relationships. Caroline Durham indicated no relevant financial relationships. Maram Albandak indicated no relevant financial relationships. Zohaib Ahmed indicated no relevant financial relationships. Ali Nawras indicated no relevant financial relationships.
Sana Rabeeah, MD1, Hayder Alamily, MD2, Hasan Elshebiny, MD3, Ahmad Mahdi, MD4, Mohammed Abu-Rumaileh, MD1, Bisher Sawaf, MD5, Vikash Kumar, MD6, Caroline Durham, MD3, Maram Albandak, MD1, Zohaib Ahmed, MD7, Ali Nawras, MD1. P0159 - Lymphoethelial Cyst of the Pancreas: A Case Study, ACG 2025 Annual Scientific Meeting Abstracts. Phoenix, AZ: American College of Gastroenterology.
