Gastric Duplication Cyst Revealed After an Endoscopic Ultrasound-Guided Fine-Needle Aspiration of a Suspected Mucinous Cystadenoma of the Pancreas

Abstract

Gastrointestinal duplication is a rare congenital anomaly of the gastrointestinal tract. Gastric duplication cysts (GDCs) are uncommon in adults, and most cases are discovered incidentally. Here, we report a fortuitous discovery of a rare case of an asymptomatic noncommunicating GDC in an adult revealed after an endoscopic ultrasound-guided fine-needle aspiration of a suspected mucinous cystadenoma of the pancreas. A 34-year-old female presented with renal colic. Her abdominal examination was normal. She presented a cystic image at the left lumbar discovered fortuitously during ultrasonography. On uro-computed tomography, there was a suspicion of a pancreatic cystadenoma. Magnetic resonance imaging of the pancreas suggested a mucinous cystadenoma of the pancreatic tail. The endoscopic ultrasound showed a cystic thick-walled formation in the tail of the pancreas. After guided fine-needle aspiration, a split aspect of the gastric wall appeared evoking a GDC. The cytology showed epithelial cells without mucin. Three years later, the patient does not have any gastrointestinal symptoms. GDCs are a rare anomaly, and accurate diagnosis of these cysts is difficult. Surgical resection can offer a definitive diagnosis. The mainstay of treatment is surgery to avoid the risk of malignancy.

Gastric Duplication in an Adult Female: A Challenging Diagnosis

“…Endoscopic ultrasound-guided fine-needle aspiration (EUS-FNA) is also used in order to rule out malignancy, however, its use remains controversial, as elevated levels of carcinoembryonic antigen (CEA) and cancer antigen (CA) 19-9 have been found in samples of benign lesions [9,10]. The differential diagnosis includes gastrointestinal stromal tumors, neuroendocrine tumors, pancreatic heterotopia, pancreatic cystic lesions, and mesenteric cysts among others [9,[11][12][13]. In a retrospective review, which analyzed data from 319 patients, the rate of misdiagnosis was 72.14% [3].…”

Uncommon Presentation of Gastric Duplication Cyst with Left-Sided Portal Hypertension: A Case Report and Literature Review

“…The current advances in imaging enable an improved ability to make the correct diagnosis and ensure better case management. One of the most advanced methods remains echo-endoscopy, an interventional echography, which can accurately diagnose duplication cysts by describing the mass characteristics, invasion into other organs, presence of adenopathy or vascular invasion [11][12][13].…”