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Surgical Pathology Criteria
http://surgpathcriteria.stanford.edu/

Squamoid Cyst of Pancreatic Ducts

Definition

  • Pancreatic ductal cystic lesion lined by squamoid epithelium

Diagnostic Criteria

  • Unilocular cystic dilation of duct
    • 0.8 - 9 cm
      • Smaller lesions may be noted incidentally
    • No papillae
    • No solid areas
  • Lined by bland squamoid epithelium
    • Flattened squamous to transitional
    • Single layer to transitional
    • No keratinization or granular layer
    • No columnar or mucinous component
  • Surrounded by thin band of fibrous tissue
    • No surrounding fibrosis or pancreatitis
  • Lacks following features
    • Lymphoid tissue
    • Splenic tissue
    • Ovarian type stroma

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

Original posting : August 1, 2007
Update : April 26, 2009

Supplemental studies

Immunohistology

p63 basal and parabasal positive
MUC1 positive
MUC6 positive
Inhibin

positive

GLUT1 negative to minimal
CK7, CK19 positive
CK20 negative

 

Differential Diagnosis

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

Lymphoepithelial Cyst of the Pancreas Squamoid Cyst of Pancreatic Ducts
Surrounding dense lymphoid tissue No surrounding lymphoid tissue
Overt keratinization Non-keratinized
Usually peripancreatic Intraductal

Squamoid Cyst of Pancreatic Ducts Dermoid Cyst
No skin appendages or mesenchyme Skin appendages and mesenchyme common
No overt keratinization Keratinized

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

Serous Macrocystic / Oligocystic Adenoma Squamoid Cyst of Pancreatic Ducts
Lined by clear cells Lined by squamoid cells
GLUT1 positive GLUT1 at most focally positive

Incidental squamous metaplasia of pancreatic ducts lacks cyst formation

Clinical

  • Rare, 1% of pancreas cystic lesions
  • Age range 52-79
  • M = F
  • May be associated with elevated CEA or CA19-9
  • Benign

Lists

Cystic Pancreatic Lesions

Bibliography

  • Othman M, Basturk O, Groisman G, Krasinskas A, Adsay NV. Squamoid cyst of pancreatic ducts: A distinct type of cystic lesion in the pancreas. Am J Surg Pathol. 2007 Feb;31(2):291-7.
  • 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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