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    Epidermoid Cyst in Intrapancreatic Accessory Spleen

    Definition

    • Pancreatic cystic lesion lined by squamous epithelium arising within ectopic splenic tissue

    Alternate/historical Name

    • Splenic epidermoid cyst of the pancreas

    Diagnostic Criteria

    • Cystic lesion lined by stratified squamous epithelium
      • May be keratininzing or non-keratinizing
      • Some cases have partial mucinous lining
    • Cysts surrounded by splenic red pulp
      • May be unilocular or multilocular
    • Entire lesion surrounded by fibrous tissue
      • Pancreatic ducts and islets may be entrapped in fibrous layer
    • All reported cases in tail of pancreas

    Robert V Rouse MD
    Department of Pathology
    Stanford University School of Medicine
    Stanford CA 94305-5342

    Original posting : January 4, 2008
    Update : April 26, 2009

    Supplemental studies

    Immunohistology

    No diagnostically useful markers

     

    Differential Diagnosis

    Most other cysts are easily distinguished by their non-squamous lining

    Epidermoid Cyst in Intrapancreatic Accessory Spleen Dermoid Cyst
    No skin appendages or mesenchyme Skin appendages and mesenchyme common
    Surrounded by splenic red pulp Lacks surrounding splenic red pulp

    Lymphoepithelial Cyst of the Pancreas Epidermoid Cyst in Intrapancreatic Accessory Spleen
    Surrounding dense lymphoid tissue Surrounding splenic red pulp

    Epidermoid Cyst in Intrapancreatic Accessory Spleen Squamoid Cyst of Pancreatic Ducts
    Surrounded by splenic red pulp Lacks surrounding splenic red pulp
    May show overt keratinization Non-keratinized
    Involves tail of pancreas Intraductal

    Clinical

    • Mean age 38 years
    • Benign

    Lists

    Cystic Pancreatic Lesions

    Bibliography

    • Adsay NV, Hasteh F, Cheng JD, Klimstra DS. Squamous-lined cysts of the pancreas: lymphoepithelial cysts, dermoid cysts (teratomas), and accessory-splenic epidermoid cysts. Semin Diagn Pathol. 2000 Feb;17(1):56-65.
    • Tateyama H, Tada T, Murase T, Fujitake S, Eimoto T. Lymphoepithelial cyst and epidermoid cyst of the accessory spleen in the pancreas. Mod Pathol. 1998 Dec;11(12):1171-7.
    • Morohoshi T, Hamamoto T, Kunimura T, Yoshida E, Kanda M, Funo K, Nagayama T, Maeda M, Araki S. Epidermoid cyst derived from an accessory spleen in the pancreas. A case report with literature survey. Acta Pathol Jpn. 1991 Dec;41(12):916-21.
    • Tsutsumi S, Kojima T, Fukai Y, Kanoh K, Shimura T, Mochiki E, Kato R, Asao T, Kuwano H. Epidermoid cyst of an intrapancreatic accessory spleen--a case report. Hepatogastroenterology. 2000 Sep-Oct;47(35):1462-4.
    • Sasou S, Nakamura S, Inomata M. Epithelial splenic cysts in an intrapancreatic accessory spleen and spleen. Pathol Int. 1999 Dec;49(12):1078-83.
    • Basturk O, Coban I, Adsay NV. Pancreatic cysts: pathologic classification, differential diagnosis, and clinical implications. Arch Pathol Lab Med. 2009 Mar;133(3):423-38.
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