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True cysts

Reviewer: Deepali Jain, M.D. (see Reviewers page)
Revised: 24 November 2012, last major update August 2012
Copyright: (c) 2001-2012, PathologyOutlines.com, Inc.

Congenital / dysgenetic cysts

● By definition are intrapancreatic, do not communicate with duct system, lined by a single layer of cuboidal, columnar, or flattened atrophic epithelium with a fibrous wall
● Most congenital pancreatic cysts are multiple, almost all are associated with underlying congenital diseases that primarily affect other organ systems (AJR Am J Roentgenol 2002;179:1375)
● Often associated with polycystic disease affecting kidney and liver, von Hippel Lindau syndrome or oral-facial-digital syndrome type I
● Single cysts may be due to abnormal duct development
● Other syndromes: Elejalde syndrome, glutaric aciduria II, Ivemark syndrome, Jeune syndrome, Meckel-Gruber syndrome, short-rib polydactyly syndrome Type 1, Trisomy 13, 14, 15, tuberous sclerosis
Case report: multilocular cysts associated with choledochal cyst (Hum Pathol 2003;34:99)

Congenital cyst: cysts are lined by small nonmucin producing cuboidal cells and are embedded in fibrous stroma

Cysts of cystic fibrosis

● Click here

Dermoid cysts

● Seen in young patients (2nd-3rd decade)
Case report: 64 year old man (World J Surg Oncol 2007;5:85)

Tail of pancreas cyst

Epidermoid cysts

● May be present within an intrapancreatic spleen (Pancreas 2011;40:956)
● In tail, unilocular, typically contain concentric enzymatic concretions, may communicate with acinar system
● Squamoid cyst of pancreatic ducts; has thin wall lined by transitional/squamous cells without keratinization or granular layer
Case report: 62 year old man with intrapancreatic spleen containing epidermoid cyst (JOP 2011;12:279)

62 year old man: intrapancreatic spleen has multiple cysts with stratified squamous epithelium that is CEA+

Foregut cysts attached to pancreas

● Rare; unilocular, smooth surfaced with clear mucoid material, ciliated epithelium resembles bronchogenic cyst, but no respiratory glands, no cartilage and had two smooth muscle layers (Am J Surg Pathol 1996;20:476)
Case reports: 34 year old woman with pancreatic mass (JSLS 2008;12:183), 37 year old woman with acute cholangitis (JOP 2011;12:420)

Foregut cyst (0.9 cm) attached to pancreas; retroperitoneal margins are inked

Foregut cyst and immunostains of lining: a-cyst compresses bile duct (arrow); b-cyst is lined by thin epithelial layer (arrowhead) covering loose connective tissue without smooth muscle bundles or cartilage; * depicts normal pancreas; c-pseudostratified ciliated epithelium with interspersed goblet cells (arrows)

Foregut cyst attached to pancreas

Ciliated foregut cyst-FNA

Mesothelial cysts

● May be multiple and involve pancreas, liver, kidney or other abdominal structures
Case report: 36 year old man with 3 cm cyst (Ann Diagn Pathol 2006;10:371)

Pancreatic hamartoma

● Initial report in 20 month old girl with 9 cm cystic mass (Hum Pathol 1992;23:1309)
● 52 year old woman with 2.5 cm mass in pancreatic head (J Korean Surg Soc 2012;83:330)
● Well demarcated and composed of cystic ductal structures embedded in focally inflamed stromal tissue (Am J Surg Pathol 2005;29:797)

Various images

Non-epithelial cysts

● Includes endometrial cyst, lymphangioma, pseudocysts, parasitic cyst

Pancreatic tissue derived cysts

● May appear in thorax or mediastinum, as components of gastroenteric duplication cysts, intralobar pulmonary sequestrations, teratomas or rarely from ectopic pancreatic tissue (Mod Pathol 1996;9:210)
● Paraduodenal wall cyst (cystic dystrophy): patients with paraduodenal (groove) pancreatitis, cysts may enlarge and adhere to duodenal wall, mimicking duodenal duplication; lined by granulation tissue, may be partly lined by ductal epithelium (Semin Diagn Pathol 2004;21:247)

Ectopic pancreas with cystic change in mediastinum

Paraduodenal wall cyst

Squamous cyst of pancreatic ducts

Tumors that are cystic

● Cystic tumors include: ductal adenocarcinoma, IOPN, IPMN, lymphoepithelial cyst, mucinous cystic neoplasm, mucinous non-neoplastic cyst, serous cystadenoma, solid-pseudopapillary tumor

End of Pancreas > Cysts > True cysts

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