Dermoid cyst of the pancreas: Presentation and management

Department of Surgery, University Hospital Tor Vergata, Viale Oxford 81 00133 Rome, Italy.
World Journal of Surgical Oncology (Impact Factor: 1.41). 02/2007; 5(1):85. DOI: 10.1186/1477-7819-5-85
Source: PubMed


Dermoid cyst of the pancreas is a benign, well-differentiated, extremely rare germ cell neoplasm. Published data indicate that differential diagnosis of cystic lesions of the pancreas is challenging and although ultrasonography, computed tomography and magnetic resonance may be useful, radiological findings are often inconclusive and the diagnosis is intraoperative. We report a case of a dermoid cyst of the tail of the pancreas intraoperatively diagnosed and successfully treated with left pancreatectomy. Further, characteristics, preoperative detection and differential diagnosis of this rare pathology are also discussed.
This report documents the findings of a 64-year-old male presenting with a well defined echogenic pancreatic mass on ultrasonography. Computerized Tomography (CT) showed a 5 cm cystic tumor arising from pancreatic tail and Magnetic Resonance Imaging (MRI) suggested a tumor extension to the middle side of the stomach without defined margins. A left pancreatectomy was performed. On surgical specimen, histological evaluation revealed a dermoid cyst of the tail of the pancreas measuring 8.5 x 3.0 cm.
Given the benign nature of the dermoid cyst, surgical resection most likely represents the definitive treatment and cure. In addition, resection is indicated in consideration of the difficulty in diagnosing dermoid cyst preoperatively. However, endoscopic ultrasound and fine needle aspiration cytology have recently been shown to be effective, safe, reliable and cost-saving preoperative diagnostic tools. Therefore, until more cases of dermoid cyst are identified to further elucidate its natural history and improve the reliability of the preoperative diagnostic tools, surgical resection should be considered the standard therapy in order to exclude malignancy.

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    • "Until quite recently only three major types of squamous-lined pancreatic cysts were recognized: dermoid cysts (teratomatous neoplasms containing squamous, sebaceous, and/or respiratory epithelium and hair follicles), lymphoepithelial cysts (non-neoplastic, intra- or peripancreatic keratinizing cysts with surrounding stroma that resembles lymph node), and epidermoid cysts of intrapancreatic accessory spleen (non-neoplastic keratinizing cysts surrounded by splenic parenchyma, including red pulp). Although recognition of pancreatic dermoid cyst dates back to at least 1918,1 squamous cyst of intrapancreatic accessory spleen was not described until 1980,2 and lymphoepithelial cyst until 1985.3 Recently, detailed characterization of these and other uncommon pancreatic cysts has been aided by the increasing use of radiologic examinations – which promote detection of small or otherwise clinically indolent lesions – as well as the increasing safety of pancreatic surgery relative to prior decades. "
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    ABSTRACT: We describe a 40-year-old man who was found to have a cystic mass in the pancreatic tail during workup for weight loss and abdominal discomfort. Although computed tomography scan showed a single cyst associated with dilatation of the main pancreatic duct, gross and histologic examination of the distal pancreatectomy specimen actually revealed a central cyst that was surrounded by multiple smaller cystic spaces. This distinctive appearance was formed from extensive cystic dilatation and squamous metaplasia of the native pancreatic duct system. Further, a traumatic neuroma was discovered near the junction between normal and abnormal parenchyma. We believe that this case represents a variant of the newly-described squamoid cyst of pancreatic ducts which we term squamoid cystosis of pancreatic ducts. The presence of chronic pancreatitis and a traumatic neuroma supports the hypothesis that squamoid cysts are non-neoplastic lesions arising from prior duct obstruction.
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