Foregut duplication cysts of the stomach with respiratory epithelium

Abstract

spherical hollow structure with a smooth muscle coat, lined by a mucous membrane and attached to any part of the gastrointestinal (GI) tract from the base of the tongue to the anus [1] . These malformations are believed to be congenital and are formed before differentiation of the lining epithelium and, therefore, are named for the organs with which they are associated [2] . Foregut duplications may or may not communicate with the GI tract and usually are diagnosed in a younger age; in adults non-specific symptoms delay diagnosis, which is established during surgical exploration [3] . Herein, two gastric duplication cysts with respiratory epithelium are reported. CASE REPORTA 46-year-old female patient was admitted to our Surgical Department from another medical center, where the patient was evaluated for an episode of loss of consciousness. Past medical history, present status and physical examination were non disease-specific. Diagnostic workup included an abdominal computed tomography (CT) which demonstrated a cystic lesion measuring 6 cm × 6 cm × 7 cm attached to the posterior wall of the gastric fundus, was well circumscribed and had no contrast enhancement ( Figure 1). Interestingly CT coronary sections revealed a pulmonary sequestration in the basal segment of the left lower lobe (Figure 2). Moreover, upper GI endoscopy showed a bulging deformation of the gastric fundus by an extrinsic mass, without any mucosal abnormalities. An exploratory laparotomy was performed and revealed two cystic lesions; the first was attached to the fundus of the stomach and the second was embedded within the gastrosplenic ligament, close to the spleen. Therefore, intact excision of both cysts and splenectomy were carried out. Postoperative course was uneventful and the patient has been asymptomatic since then.Pathologic examination of the surgical specimens reported a large cyst, measuring 8 cm × 5.5 cm in diameter and 0.3 cm thick and a smaller cyst (removed from the gastrosplenic ligament), measuring 3 cm in diameter and 0.2 cm thick. Both consisted of a smooth muscular wall, were lined by a pseudostratified, ciliated and columnar (respiratory type) epithelium and contained a clear, gelatinous fluid. Sub-epithelium seromucous glands were microscopically identified (Figure 3), a histologic appearance reminiscent of bronchial wall; however no cartilage was present. CASE REPORT Foregut duplication cysts of the stomach with respiratory epithelium AbstractGastrointestinal duplication is a congenital rare disease entity. Gastric duplication cysts seem to appear even more rarely. Herein, two duplications cysts of the stomach in a 46 year-old female patient are presented.Abdominal computed tomography demonstrated a cystic lesion attached to the posterior aspect of the gastric fundus, while upper gastrointestinal endoscopy was negative. An exploratory laparotomy revealed a non-communicating cyst and a smaller similar cyst embedded in the gastrosplenic ligament. Excision of both cysts along with the spleen was performed and pathology...

Foregut duplication cysts: A report of two cases with emphasis on embryogenesis

“…Histologically, they are usually lined with a typical gastric mucosa [15] . As in the present two cases, a ciliated pseudostratified epithelium has been reported [3][4][5][6][7][8][9][10][11][12] .…”

“…Foregut duplications may or may not communicate with the gastrointestinal tract, and are usually diagnosed at a young age [2] . There have been relatively few case reports describing this entity [3][4][5][6][7][8][9][10][11][12] Adenocarcinoma has been reported in four cases of gastric duplication cyst, but not in cysts that have a ciliated epithelium [13][14][15][16] . Controversy exists concerning the embryological origin of these anomalies [11,17,18] .…”

Foregut duplication cysts in siblings: A case report

“…The mucosal lining of the cyst may or may not correspond to anatomic level. For example, gastric duplication cysts, as well as floor of mouth cysts such as the one in this report, have been noted to contain pseudostratified ciliated respiratorytype epithelial linings [5]. Cysts in the floor of mouth have also demonstrated gastric mucosa [6].…”

Gastric Duplication Treated by Laparoscopy in a Child

“…Even more exceptional are occurrences in the stomach. 1 These malformations are believed to be congenital and are formed before differentiation of the lining epithelium and are named for the organs with which they are associated. 2 Duplication cysts of the stomach represent 4% of all alimentary tract duplications.…”