Published online Feb 14, 2017. doi: 10.3748/wjg.v23.i6.1113
Peer-review started: September 30, 2016
First decision: December 19, 2016
Revised: January 13, 2017
Accepted: January 17, 2017
Article in press: January 17, 2017
Published online: February 14, 2017
Pancreatic cysts include a variety of benign, premalignant, and malignant lesions. Endometrial cysts in the pancreas are exceedingly rare lesions that are difficult to diagnose pre-operatively. This report describes the findings in a 43-year-old patient with a recent episode of acute pancreatitis who presented with a large cyst in the tail of the pancreas. Imaging demonstrated a loculated pancreatic cyst, and cyst fluid aspiration revealed an elevated amylase and carcinoembryonic antigen. The patient experienced an interval worsening of abdominal pain, fatigue, diarrhea, and a 15-pound weight loss 3 mo after the initial episode of pancreatitis. With concern for a possible pre-malignant lesion, the patient underwent a laparoscopic distal pancreatectomy with splenectomy, which revealed a 16 cm × 12 cm × 4 cm lesion. Final histopathology was consistent with an intra-pancreatic endometrial cyst. Here we discuss the overlapping imaging and laboratory features of pancreatic endometrial cysts and mucinous cystic neoplasms of the pancreas.
Core tip: Intra-pancreatic endometrial cysts are an exceedingly rare entity. Imaging and laboratory assessments are valuable tools for diagnosing pancreatic cysts. However, pre-operative diagnosis of pancreatic endometrial cysts remains problematic. These lesions have overlapping radiographic and laboratory features with premalignant lesions, such as mucinous cystic neoplasms. Due to the diagnostic similarities between these rare endometrial cysts and the more common mucinous cystic lesions, the optimal diagnostic and therapeutic option is resection.