PMC9580076_01
Contrast-enhanced abdomen and pelvis computed tomography scan (CT). Axial CT image:dotted arrow shows a septated and cystic lesion within the pancreatic body to the left of the midline.
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An abdominopelvic computed tomography scan revealed an incidental 2.8 cm cystic lobulated exophytic lesion without associated calcifications within the pancreatic body, which was suspected to be a neoplasm (Figure 1).
(a) Romanowsky stain x200:bland epithelial cells with intracytoplasmic mucin and few scattered lymphocytes. (b) Papanicolaou stain x100:benign squamous component.
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The patient also had an elevated carbohydrate antigen 19-9 value (CA 19-9) of 59.1 U/mL (reference < 45.1 U/mL) and an unremarkable pancreatic cyst fluid carcinoembryonic antigen (CEA) of 2.4 ng/mL. The patient underwent further workup, including endoscopic ultrasonography and a fine-needle aspiration (EUS-FNA) of the lesion. The fine-needle aspiration cytology showed bland epithelial cells with vacuolated intracytoplasmic mucin and scattered lymphocytes as well as benign squamous epithelium (Figure 2); therefore, the differential diagnosis included a mucinous cystic neoplasm, among others.
(a) Hematoxylin and eosin x100:cyst wall lined by mature stratified squamous epithelium and a band of lymphocytes with foci of goblet cell metaplasia. (b) Hematoxylin and eosin x400:focus of goblet cell metaplasia.
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Microscopic examination of the specimen showed a cyst lined by mature stratified squamous epithelium with foci of goblet cell metaplasia, surrounded by dense lymphoid tissue (Figure 3).