PMC9935956_01
A 29-year-old female with ciliated foregut cyst and accessory spleen in the pancreas.. A. Abdominal US images show a 4.1-cm thick-walled, anechoic cystic lesion (thick arrow) with internal echogenic debris without intratumoral vascularity and a 1.6-cm multiseptated cystic lesion in the tail region of the the pancreas (empty arrow).. B. Axial dynamic CT pre-contrast (left), arterial (middle), and portal venous (right) phase images show a 4.6-cm unilocular cystic lesion and a 1.5-cm multiseptated cystic lesion in the tail portion of pancreas. On the pre-contrast image, two cystic lesions show lower attenuation than that of the normal pancreatic parenchyma. Contrast-enhanced CT images show small, homogeneously enhancing, solid components (arrows) between two cystic lesions.. C. Axial MRI scan T2-weighted image (1st), pre-contrast T1-weighted image (2nd), arterial phase (3rd), portal venous phase (4th), 3-minute transitional phase (5th), hepatobiliary phase images (6th). The cystic component shows a bright high signal on T2-weighted image and hypointensity on pre-contrast T1-weighted image. On dynamic contrast enhanced scan using gadoxetic acid, solid components (arrows) show homogeneous enhancement. Diffusion-weighted image (7th) and apparent diffusion coefficient map (8th) reveal diffusion restriction of the solid component and the cystic components are communicated.. D. Grossly, the resected specimen shows two relatively well-circumscribed cystic masses (left upper). The specimen consists of well-demarcated cysts (left side of red dot), inflamed pancreas (center), and an intrapancreatic accessory spleen (right side of black dot) (H&E stain, x 40) (right upper). The cysts are lined by ciliated columnar epithelium (black dot), loose connective tissue and fibrous capsule. No cytologic atypia is observed (H&E stain, x 400) (left lower). The lining epithelial cells were positive for cytokeratin 7 immunohistochemical stain (x 100) (right lower).. H&E = hematoxylin and eosin
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F1
On abdominal ultrasonography, the lesion appeared as an approximately 4.1 cm sized, thick-walled, anechoic cystic lesion with internal echogenic debris and a 1.6 cm multiseptated cystic lesion in the tail portion of the pancreas (Fig. 1A). Contrast-enhanced CT images showed a small, homogenously enhanced solid component between the two cystic lesions (Fig. 1B). The solid component showed hyperintensity on diffusion-weighted imaging (DWI) at b = 800 s/mm2 and a low apparent diffusion coefficient map (Fig. 1C). On immunohistochemistry, the lining epithelial cells and pancreatic ductal cells were positive for cytokeratin 7 (CK 7), but negative for D2-40 and anti-mesothelial antibodies (Fig. 1D).