Mucin-containing pancreatic lymphoepithelial cyst a potential surgical pitfall

A 58-year-old man presented to the emergency department with a computed tomography (CT) finding of a 2.6 × 2.8 × 3.5 cm pancreatic soft tissue mass in the head and uncinate process (Fig. 1). He described a subacute history of abdominal discomfort. Blood tests were unremarkable with normal liver function tests and a slightly raised carcinoembryonic antigen (CEA) and CA 19-9. A 3 × 2.8 cm cystic pancreatic head lesion involving the portal vein with peripancreatic nodes was seen on endoscopic ultrasonography. Fine needle aspirate revealed degenerate acellular mucoid material (Fig. 2a) and a fine needle biopsy was suggestive of acellular mucin with keratin suspicious for a mucinous cystic lesion (Fig. 2b). He proceeded to have a pancreaticoduodenectomy (Whipple’s) for a suspected mucinous cyst adenoma (MCA).