PMC5283958_01
The serial changes in the MRI findings. T2-weighted MRI of the multi-locular cysts in the pancreatic tail during 11-year follow-up. Several new cystic lesions (arrow) were detected between the index lesions and the spleen in 2000. In 2010, an additional lesion, 2 cm in size, was observed in the splenic hilum (arrowhead); the images in 2009 also showed the presence of the new lesion retrospectively.
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Magnetic resonance imaging (MRI; Fig. 1) and endoscopic ultrasonography (EUS; Fig. 2) showed a 2-cm cystic lesion in the pancreatic tail. In 2000, a new cystic lesion located between the initial cysts and the spleen was discovered (Fig. 1, arrow), and the lesion grew slightly over the next three years. In 2010, additional 2-cm cystic lesions were discovered (Fig. 1, arrowhead) with lower intensity on T2-weighted MRI than the other cysts (Fig. 3, arrowhead).
The endoscopic ultrasound images. Imaging revealed a cystic lesion in the pancreatic tail with multi-locular lesions in 1999. Eleven years later, the lesion had enlarged with thick septa.
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EUS also revealed multi-locular cysts with thickened septa surrounded by a capsule (Fig. 2).
The pathological findings. (A) Grossly, the cut surface of the pancreas and spleen showed a lesion measuring 5.5x5.0x3.5 cm in the pancreatic tail containing multi-locular cysts. Most of the cystic lesions were surrounded by a thin layer of red-colored tissue connecting to the spleen. (B) A microscopic analysis showed that the cysts were lined with multi-layered flattened non-neoplastic epithelium positive for high-molecular-weight keratin (34bE12) and cytokeratin 5/6. The thin layer surrounding the cysts consisted of cells positive for CD8 and CD68, demonstrating that the layer was normal splenic pulp tissue.
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This layer was connected to the spleen; therefore, this multi-locular pancreatic cyst was diagnosed to be an invaginated splenic epidermoid cyst (Fig. 4).