Pancreatic cystic lymphangiomas (PCLs) are rare, benign neoplasms classically diagnosed on post-surgical histopathological examination. We describe a rare case of diagnosis and drainage of a PCL using EUS-FNA.[1]
A 60-year-old male with a past medical history of follicular thyroid cancer s/p thyroidectomy was referred for an evaluation of a subepithelial lesion in the posterior wall of the greater curve of the stomach. A computed tomography scan showed a 2.5 cm × 1.8 cm cystic lesion arising from the pancreatic head [Figure 1]. Upon EUS examination, the lesion appeared to be loculated, well marginated, with anechoic contents and thin internal septae. It measured 32.9 mm × 24.7 mm in maximal cross-sectional diameter, arising from the uncinate process of the pancreas [Figure 2]. It did not appear to communicate with the pancreatic duct. There was no associated mass, internal debris, or perilesional lymphadenopathy. No vascularity was evident in the cystic lesion on color doppler examination. A fine-needle aspiration using a 22-gauge needle yielded opaque-milky white fluid [Figure 3]. Biochemical cyst fluid analysis revealed a markedly elevated Triglyceride level of 5980 mg/dL, normal amylase of 105 U/L, and normal carcinoembryonic antigen. Normal serum triglyceride level of 139 mg/dL. This was consistent with a diagnosis of chylous PCL.
Figure 1.
Computed tomography of abdomen and pelvis revealed 2.5 cm × 1.8 cm cystic mass arising from the pancreatic head (arrow)
Figure 2.
EUS image of a 32.9 mm × 24.7 mm anechoic, well-loculated lesion arising from the uncinate process of the pancreas
Figure 3.
Milky opaque fluid aspirated from pancreatic cyst
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REFERENCE
- 1.Carvalho D, Costa M, Russo P, et al. Cystic pancreatic lymphangioma-diagnostic role of endoscopic ultrasound. GE Port J Gastroenterol. 2016;23:254–8. doi: 10.1016/j.jpge.2016.01.006. doi:10.1016/j.jpge.2016.01.006. [DOI] [PMC free article] [PubMed] [Google Scholar]