Lymphangioma of the pancreas: a multimodal approach to pre-operative diagnosis
Article first published online: 2 AUG 2011
© 2011 John Wiley & Sons Ltd
Volume 24, Issue 3, pages 172–176, June 2013
How to Cite
Fonseca, R. and Pitman, M. B. (2013), Lymphangioma of the pancreas: a multimodal approach to pre-operative diagnosis. Cytopathology, 24: 172–176. doi: 10.1111/j.1365-2303.2011.00897.x
- Issue published online: 27 MAY 2013
- Article first published online: 2 AUG 2011
- Accepted for publication 30 May 2011
- endoscopic ultrasound-guided FNA;
- multimodal diagnosis;
Background: Lymphangioma of the pancreas is an extremely rare benign tumour of lymphatic origin, with only four cases diagnosed by EUS-FNA reported to date.
Methods and materials: Five cases of either cytologically or histologically diagnosed pancreatic lymphangioma with pre-operative cytological analysis by EUS-FNAC were reviewed.
Results: All patients were female, with a mean age of 56.4 years. By imaging, the cystic lesions ranged in size from 2 to 7 cm (mean 4.5 cm) and were mainly located in the head of the pancreas. All cysts had thin walls and no cyst demonstrated a mural nodule. Diagnosis based on imaging features was benign in all cases due to the absence of high-risk features. Four samples were sent for biochemical analysis, which showed low CEA levels (range, <0.5–19.4 ng/ml; mean, 5.45 ng/ml) and CA 19.9 and CA 72.4 levels within normal range. All cyst fluids showed numerous small lymphocytes with no atypia; no epithelial cells were present, including no gastrointestinal contamination. Flow cytometry in two cases showed T lymphocytes with a mature phenotype. Surgical resection in two patients confirmed the cytological diagnosis. Benign clinical follow-up was available in three patients at 2, 3 and 3.5 years.
Conclusion: A multimodal approach to cytological diagnosis (combining clinical, radiological and cyst fluid gross, biochemical and cytological characteristics) can lead to the diagnosis of this cystic neoplasm and distinguish it from other more common cysts in the pancreas, potentially avoiding the need for unnecessary surgery.