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case_images: Computed tomography (CT): Enhanced CT showed enhancement of the cystic wall and septa while the cystic contents appeared unenhanced (arrow).
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case_images: The cystic wall and the septa showed enhancement; however, the cystic contents remained unenhanced (Fig. 1).
case_images: Magnetic resonance imaging (MRI): A. MRI demonstrated a multiple-ball-like lesion of low signal intensity on T1-weighted image (arrow). B. MRI showed the same lesion with high signal intensity on T2-weighted image (arrow). C. MRI showed high signal intensity in the central and iso-signal intensity in the peripheral portions of the cystic lesion on diffusion-weighted image (arrow). D. Enhanced MRI showed high signal intensity in the cystic wall and septa and low signal intensity of the cystic contents (arrow).
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case_images: Magnetic resonance imaging (MRI) demonstrated a multiple-ball-like lesion with low signal intensity on T1-weighted image and high signal intensity on T2-weighted image (Fig. 2a, b). Diffusion-weighted MRI showed high signal intensity in the central portion and iso-signal intensity in the peripheral portion of the cystic lesion (Fig. 2c). The cystic wall and the septa showed high signal intensity, and the cystic contents showed low signal intensity on an enhanced MRI (Fig. 2d).
case_images: Endoscopic imaging: A. Endoscopic ultrasonography (EUS) showed a cyst with multiple high-echoic lesions in the pancreatic tail (arrow). B. Endoscopic retrograde cholangiopancreatographic image showed a normal main pancreatic duct and no communication between the main pancreatic duct and the cystic lesion.
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case_images: Endoscopic ultrasonography (EUS) showed a cyst with multiple high-echoic lesions in the pancreatic tail (Fig. 3a). Endoscopic retrograde cholangiopancreatography (ERCP) showed a normal main pancreatic duct and no communication between the main pancreatic duct and the cystic lesion (Fig. 3b).
case_images: Histopathology: A. The cut surface of the resected specimen showed a multilocular cyst with solid nodules (arrow). B. The cyst was separated by a band of lymphoid tissue (arrow) (hematoxylin & eosin [H&E] stain x10). C. The cystic wall was primarily lined by stratified squamous epithelium, and the cyst contains keratinized material. Several subepithelial lymphoid follicles could be observed (arrow) (H&E stain x40). D. Sebaceous glands could be observed within the stratified squamous epithelium (arrow) (H&E stain x400).
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case_images: The cut surface of the resected specimen revealed a multilocular cyst with solid nodules (Fig. 4a). Histopathological findings revealed that the cystic wall was lined by stratified squamous epithelium, and several lymphoid follicles and a few sebaceous glands were located in the cystic wall without hair follicles, leading to the final diagnosis of a pancreatic LEC (Fig. 4b-d).