Clinicopathologic analysis of epidermoid cyst in intrapancreatic accessory spleen: a report of 12 cases / 中华胰腺病杂志

ABSTRACT

Objective:To explore the clinical and pathological characteristics of epidermoid cyst in intrapancreatic accessory spleen (ECIPAS).Methods:The clinical and pathological data on 12 cases of confirmed ECIPAS in the First Affiliated Hospital of Naval Medical University and Huashan Hospital Affiliated to Fudan University from January 2011 to December 2020 were retrospectively analyzed. Patients′ sex, age, serum tumor markers, tumor size, tumor location and distant metastasis were recorded. Tissue expression of synaptophysin (Syn), chromogranin A(CgA), cytokeratin (CK) and CK5/6, estrogen receptor (ER), progesterone receptor (PR), proliferation index Ki-67 and tumor suppressor gene p53 were evaluated by immunohistochemistry.Results:All the patients were incidentally diagnosed during routine body examination. Among them, there were 4(33.3%) men and 8(66.7%) women. Patient's average age was 42 years old. All the lesions were located at the tail of the pancreas. 3 patients had elevated carbohydrate antigen 19-9(CA19-9). The ECIPAS were demonstrated as clear-boundary low or no echo on abdominal ultrasound, low-density mass on CT, and cystic and solid lesion on pancreas MRI, respectively. Eleven patients received resection of body and tail of pancreas and spleen, one patient received pancreatectomy with preservation of the spleen. The resected specimens from the 12 patients were showed as cystic and solid mass in the pancreatic tail with a maximal diameter ranging from 1.4 cm to 4.0 cm. Under microscopy, multi-cystic lesions covered with stratified squamous epithelial cells were observed. Immunohistochemistry showed that the squamous cell marker CK was expressed. In a follow-up period of 5 to 119 months, and no recurrence were diagnosed.Conclusions:ECIPAS is a rare lesion often occurring in tails of pancreas and the patients usually have no clinical symptoms. It is challenging to make a correct diagnosis by imaging, but this lesion has unique pathological manifestations and good prognosis.