Pancreas cystic lesion with surprise findings on confocal laser endomicroscopy

Lymphangiomas of the pancreas are rare, accounting for 0.2% of all pancreatic lesions. Targeted NGS performed at our institution on the surgical specimen showed absence of <i>KRAS</i> and <i>PIK3CA</i> mutations, suggesting an erroneous or false-positive initial analysis of the cyst fluid. The gray oval structures observed during EUS-nCLE correspond to adipocytes marking part of the cyst border. The dark lobular structures (coffee beans) observed during EUS-nCLE correspond to pancreatic acini marking another part of the cyst border. When these EUS-nCLE patterns are observed in a pancreas cystic lesion in the absence of any epithelial pattern, close follow-up with cross-sectional imaging should be considered instead, especially if the lesion is in a pancreas location that entails major surgery.