Bronchogenic cyst of the gastric fundus presenting as a gastrointestinal stromal tumor

Young patient with a giant gastric bronchogenic cyst: A case report and review of literature

BACKGROUND

Gastric bronchogenic cysts (BCs) are extremely rare cystic masses caused by abnormal development of the respiratory system during the embryonic period. Gastric bronchial cysts are rare lesions that were first reported in 1956; as of 2023, only 33 cases are available in the PubMed online database. BCs usually have no clinical symptoms in the early stage, and imaging findings also lack specificity. Therefore, they are difficult to diagnose before histopathological examination.

CASE SUMMARY

A 34-year-old woman with respiratory distress presented at our hospital. Endoscopic ultrasound revealed an anechoic mass between the spleen, left kidney and gastric fundus, with hyperechogenic and soft elastography textures and with a size of approximately 6.5 cm × 4.0 cm. Furthermore, a computed tomography scan demonstrated high density between the posterior stomach and the spleen and the left kidney, with uniform internal density and a small amount of calcification. The maximum cross section was approximately 10.1 cm × 6.1 cm, and the possibility of a cyst was high. Because the imaging findings did not suggest a malignancy and because the patient required complete resection, she underwent laparotomy surgery. Intraoperatively, this cystic lesion was found to be located in the posterior wall of the large curvature of the fundus and was approximately 8 cm × 6 cm in size. Finally, the pathologists verified that the cyst in the fundus was a gastric BC. The patient recovered well, her symptoms of chest tightness disappeared, and the abdominal drain was removed on postoperative day 6, after which she was discharged on day 7 for 6 months of follow-up. She had no tumor recurrence or postoperative complications during the follow-up.

CONCLUSION

This is a valuable report as it describes an extremely rare case of gastric BC. Moreover, this was a very young patient with a large BC in the stomach.

Intramural bronchogenic cysts of the esophagus and gastroesophageal junction: A case report

Bronchogenic cyst is a relatively rare congenital malformation that is often identified in the mediastinum. The occurrence of bronchogenic cysts in the intramural esophagus and gastroesophageal junction is rare. The present report describes three cases of intramural bronchogenic cysts of the esophagus and gastroesophageal junction and reviews the clinicopathological features of these lesions. A 35-year-old Japanese male (Case 1), a 50-year-old Japanese woman (Case 2) and a 34-year-old Japanese man (Case 3) presented with dysphagia, pharyngeal pain and heartburn, respectively. Upper endoscopic examination revealed submucosal tumors in the esophagus (Case 1 and 2) and gastroesophageal junction (Case 3). Subsequent endoscopic examination revealed perforation of the cyst into the surface of the esophageal mucosa (Case 2). Surgical resection was performed in all cases. Histopathological examinations revealed that the submucosal cysts were covered by respiratory-type ciliated epithelium without atypia. Cartilage and bronchial glands were not observed in any of the cases. The present review of the clinicopathological characteristics of bronchogenic cysts of the esophagus and gastroesophageal junction revealed that males and females were equally affected. The median age of the patients was 34.5 years with a wide age distribution. The most common main complaint was dysphagia. A pre-operative diagnosis of bronchogenic cyst is difficult because no specific imaging features are present. As surgical resection is recommended for this lesion, recognition of the clinicopathological features of bronchogenic cysts is important for an accurate pre-operative diagnosis.

Bronchogenic cyst of the stomach: A case report

BACKGROUND

Gastric bronchogenic cysts (BCs) are extremely rare cystic masses caused by abnormal development of the respiratory system during the embryonic period. Gastric bronchial cysts are rare lesions first reported in 1956; as of 2019, only 37 cases are available in the MEDLINE/PubMed online databases. BCs usually have no clinical symptoms in the early stage, and their imaging findings also lack specificity. Therefore, they are difficult to diagnose before histopathological examination.

CASE SUMMARY

A 55-year-old woman presented at our hospital with intermittent epigastric pain. She had a slightly high level of serum carbohydrate antigen 72-4 (CA 72-4). Endoscopic ultrasound found that a cystic mass originated from the submucosa of the posterior gastric wall near the cardia, indicating a diagnosis of cystic hygroma of the stomach. Furthermore, a computed tomography scan demonstrated a quasi-circular cystic mass closely related to the lesser curvature of the gastric fundus with a low density. Because the imaging examinations did not suggest a malignancy and the patient required complete resection, she underwent laparoscopic surgery. As an intraoperative finding, this cystic lesion was located in the posterior wall of the fundus and contained some yellow viscous liquid. Finally, the pathologists verified that the cyst in the fundus was a gastric BC. The patient recovered well with normal CA 72-4 levels, and her course was uneventful at 10 mo.

CONCLUSION

This is a valuable report as it describes an extremely rare case of gastric BC. Moreover, this is the first case of BC to present with elevated CA 72-4 levels.

Adult Gastric Bronchogenic Cyst With Elevated Tumor Marker in Containing Fluid: A Case Report and Literature Review

Introduction:

Duplication cysts are rare malformations that exist in the alimentary tract, and the mucosa of gastric bronchogenic cyst lined by pseudostratified columnar ciliated epithelium (PCCE) is even more rare. We reviewed related literatures to depict this unique abnormality.

Case presentation:

Herein we report an abdominal mass that was found incidentally in a 52-year-old female. The biochemical test of contents revealed a high concentration of tumor markers unusually. A laparoscopic surgery was undertaken to remove the lesion. The cyst was found to originate from the stomach but did not show any anatomic communication with the stomach lumen. Pathologic examination confirmed the mucosa was lined by PCCE.

Conclusion:

The symptoms and radiologic presentations of GDC are nonspecific. It should be distinguished with other abdominal cystic masses. Surgery is advised in respective of malignancy.

Surgical treatment of an esophageal bronchogenic cyst with massive upper digestive tract hematoma without esophagectomy: a case report and the review of the literature

Esophageal bronchogenic cysts are extremely rare. Here we report a case of massive upper digestive tract hematoma and bronchogenic cyst mimicking aortic dissection that was safely removed without esophagectomy. A 30-year-old man was referred to our hospital for the treatment of a mediastinal cystic tumor located in the submucosa of the distal esophagus. His chief complaints were dysphagia > 1 week and severe persistent upper abdominal pain mimicking aortic dissection with constant vomiting for 1 day after gastroscopy examination. The serum level of carbohydrate antigen (CA)199 was > 1,000 U/mL and CA125 was 4,816 U/mL. Hemoglobin levels decreased from 122 g/L to 85 g/L in 5 days. Imaging examinations detected a huge hematoma of the gastric wall. Preoperative diagnosis was difficult. Although the pain indicated a possible aortic dissection, the abnormal levels of tumor biomarkers suggested malignancy. The patient underwent left thoracotomy. The cyst showed an exophytic lesion connected to the esophageal wall at the level of the gastroesophageal junction. Muddy brown contents were obtained by aspiration of the mass intraoperatively. Because enucleation could not be performed, esophageal myotomy in the distal esophagus and partial resection of the cyst were selected. Histopathological examination indicated a bronchogenic cyst of the esophagus. At a follow-up visit 3 months later, the patient had no signs of disease recurrence or any complaints. Postoperative tumor biomarkers returned to normal range. The present report summarizes the clinical details of the case and reviews the literature in order to improve the accuracy of diagnosis.

Bronchogenic cyst at esophagogastric junction treated by laparoscopic full-thickness resection and hand-sewn closure: a case report

Background

We herein report a case of a bronchogenic cyst arising from the esophagogastric junction treated by laparoscopic full-thickness extirpation. The full-thickness defect was closed by hand sewing a T-shaped line over the gastroendoscope as a bougie to prevent postoperative deformity or stenosis. Partial fundoplication (Toupet fundoplication) was added to prevent reflux.

Case presentation

A 32-year-old woman with a body mass index of 43 kg/m² was admitted for treatment of a cyst-forming submucosal tumor (60 mm in diameter) on the anterior wall of the esophagogastric junction, which was detected during screening endoscopy before bariatric surgery. The tumor was an extraluminal growing type but exhibited severe erosion at the mucosal site. A cystic tumor such as a duplication cyst, bronchogenic cyst, or cyst-forming gastrointestinal stromal tumor was suspected, and the abovementioned surgery was carried out. The postoperative course was uneventful. The pathological findings revealed the tumor to be a benign bronchogenic cyst. Endoscopic examination 3 months postoperatively showed no deformity or stenosis, and the patient complained of no reflux symptoms.

Conclusion

This procedure may be an efficient option for treatment of submucosal tumors on the esophagogastric junction to maintain function or avoid excessive surgery.

Gastric bronchogenic cysts: A case report and literature review

Gastric bronchogenic cysts are rare lesions, first described in 1956, with only 34 cases reported in the literature to date. The present study described a case of bronchogenic cyst of the stomach in a 17-year-old female who presented with periodic epigastric pain. In addition, the study analyzed the existing literature on these lesions. Gastric bronchogenic cysts are more common in females (female:male ratio, 21:14) and the median age of their development is 43 years. In total, 48.57% of the 34 previously reported cases were identified incidentally, and the remainder presented mainly with epigastric pain. Cyst sizes varied between 1.7 and 15 cm. In 3 cases, preoperative diagnosis was performed using needle biopsy, whereas several studies were initially misdiagnosed as stromal tumors. In 85% of the cases (31/35), cyst resection was performed, with laparoscopy used in 4 of the cases. The findings of the present study and literature review suggested that bronchogenic cysts of the stomach are rare, and surgical resection is warranted to treat symptoms and prevent malignant transformation.

Multiple Bronchogenic and Gastroenteric Cysts Arising from the Stomach in a Patient with Abdominal Pain

Bronchogenic cysts arising from the stomach are uncommon. We discuss a young female patient with presumed enteric duplication cysts who was found to have three bronchogenic and gastroenteric cysts upon pathologic review. We discuss the pathophysiology of bronchogenic cysts and their malignant potential.

Esophageal bronchogenic cyst and review of the literature

BACKGROUND

Bronchogenic cysts are rare foregut abnormalities that arise from aberrant budding of the tracheobronchial tree early in embryological development. These cysts predominantly appear in the mediastinum, where they may compress nearby structures. Intra-abdominal bronchogenic cysts are rare. We report an intra-abdominal bronchogenic cyst that was excised laparoscopically.

METHODS

A 40-year old female with a history of gastritis presented for evaluation of recurrent abdominal pain. A previous ultrasound showed cholelithiasis and a presumed portal cyst. Physical examination and laboratory findings were unremarkable. A CT scan with pancreatic protocol was performed and an intra-abdominal mass adherent to the esophagus was visualized. A laparascopic enucleation of the mass was performed. A 3-cm myotomy was made after circumferential dissection of the cyst and the decision was made intraoperatively to reapproximate the muscularis layer. A PubMed literature search on surgical management of esophageal bronchogenic cysts was subsequently performed.

RESULTS

The literature search performed on the subject of esophageal bronchogenic cysts found one review article focusing on intramural esophageal bronchogenic cysts in the mediastinum and five case reports of esophageal bronchogenic cysts. Of these, only one was both intraabdominal and managed laparascopically with simple closure of the resulting myotomy. The majority of the bronchogenic cysts mentioned in the literature were located mediastinally and were managed via open thoracotomy. Our findings confirm the rarity of this particular presentation and the unique means by which this cyst was surgically excised.

CONCLUSION

This case highlights the management of a rare entity and advocates for enucleation of noncommunicating, extraluminal esophageal bronchogenic cysts and closure of the esophageal muscular layers over intact mucosa as a viable surgical approach to this unusual pathology. Other cases of laparascopic enucleation of bronchogenic cysts have shown similarly uneventful postoperative courses and rapid recovery with no apparent return of symptoms.

Gastric foregut cystic developmental malformation: case series and literature review

Foregut cystic developmental malformation (FCDM) is a very rare lesion of the alimentary tract, especially in the stomach. We discuss the concepts of gastric duplication cyst, bronchogenic cysts, and FCDM. Nomenclature has been inconsistent and confusing, but, by some definitions, gastric duplication cysts involve gastric mucosa and submucosal glands, bronchogenic cysts involve respiratory mucosa with underlying cartilage and glands, and FCDM lacks gastric mucosa or underlying glands or cartilage but has pseudostratified ciliated columnar epithelium (PCCE). We searched our departmental case files from the past 15 years and identified 12 cases of FCDM in the alimentary tract. We summarize the features of these 12 cases including a report in detail on a 52-year-old man with a submucosal cyst lined with simple PCCE and irregular and stratified circular muscle layers that merged with gastric smooth muscle bundles near the lesser curvature of the gastric cardia. A literature review of cases with this histology yielded 25 cases. We propose the term gastric-FCDM for such cases. Our own series of 12 cases confirms that preoperative recognition of the entity is infrequent and problematic. The rarity of this developmental disorder, as well as a lack of understanding of its embryologic origins, may contribute to missing the diagnosis. Not appreciating the diagnosis preoperatively can lead to an inappropriate surgical approach. In contrast, presurgical recognition of the entity will contribute to a good outcome and reduced risk of complications.

Bronchogenic cyst of stomach: two cases report and review of the English literature

Bronchogenic cysts (BCs) are a rare clinical entity because of anomalism of foregut in the embryonic stage. They have been described mostly within the mediastinum and are uncommon reported arising from the stomach. In this article, we report two cases of BC of stomach identified by pathological examination after surgical resection. It is extremely difficult to make a definitive diagnosis preoperatively just based on imaging findings. Surgical resection may be indicated if malignancy is suspected, or the cyst is enlarging or infected or causing symptoms.

Foregut duplication of the stomach diagnosed by endoscopic ultrasound guided fine-needle aspiration cytology: case report and literature review

Gastric duplication cyst (GDC) with a pseudostratified columnar ciliated epithelium is an uncommon malformation supposed to originate from a respiratory diverticulum arising from the ventral foregut. Morphologic appearance of GDCs is variable, depending on the density of their contents. GDCs are often misdiagnosed as solid masses by imaging techniques, and as a consequence they may be wrongly overtreated. We report our case of a 56-year-old man with a 5 cm hypoechoic mass of the gastroesophageal junction, incidentally detected by transabdominal ultrasonography. Neither transabdominal ultrasonography nor magnetic resonance clearly outlined the features of the lesion. The patient underwent endoscopic ultrasound (EUS), which showed a hypoechoic mass arising from the fourth layer of the anterior gastric wall, just below the gastroesophageal junction. According to EUS features, a diagnosis of gastrointestinal stromal tumor was suggested. EUS-guided fine-needle aspiration cytology revealed a diagnosis of GDC with pseudostratified columnar ciliated epithelium. We therefore performed an endoscopically-assisted laparoscopic excision of the cyst.

In conclusion, whenever a subepithelial gastric mass is found in the upper part of the gastric wall, a duplication cyst, although rare, should be considered. In this case, EUS-guided fine-needle aspiration cytology could provide a cytological diagnosis useful to arrange in advance the more adequate surgical treatment.

A case of foregut gastric duplication cyst with pseudostratified columnar ciliated epithelium

Gastrointestinal duplication is a congenital rare disease. Duplication cyst of the stomach with pseudostratified columnar ciliated epithelium is extremely rare. A 44-year-old Japanese woman visited University of Yamanashi Hospital for evaluation of an abnormal tumor detected by abdominal ultrasonography at an annual general health examination. Abdominal computed tomography indicated a subserosal cystic lesion 6 cm in diameter on the posterior wall of the stomach. The cystic lesion was resected through partial resection of the stomach. Histopathology showed that the cyst did not communicate with the gastric lumen, was covered with gastric epithelium and pseudostratified columnar ciliated epithelium with circular muscle layers, and did not contain cartilaginous tissue. Consequently, the patient was diagnosed as having foregut duplication cyst of the stomach. Gastrointestinal duplication can occur in any region of the gastrointestinal tract, but foregut duplication cyst of the stomach is rare. The present case was a subserosal cyst on the greater curvature that did not communicate with the gastric lumen and was covered with gastric epithelium and pseudostratified columnar ciliated epithelium, suggesting a foregut cyst caused by an aberrant respiratory organ.

Splenic artery aneurysm presenting with clinical features of a bleeding gastric gastrointestinal stromal tumour

Gastrointestinal stromal tumours often present with insidious upper gastrointestinal symptoms. Initial definitive diagnosis can be difficult and therefore misdiagnosis is not infrequent. Here we report a case of upper GI bleeding caused by a splenic artery aneurysm that was misdiagnosed as a gastric GIST. This rare presentation of splenic artery aneurysm highlights the potential pitfalls of investigation in upper gastrointestinal disease.

Gastric duplication cyst lined by pseudostratified columnar ciliated epithelium: a case report and literature review

Gastric duplication cyst (GDC) lined by pseudostratified columnar ciliated epithelium (PCCE) is an uncommon lesion stemming from a foregut developmental malformation. Its clinical and radiological presentation is usually nonspecific. In this study, we reported a 76-year-old man who presented with an incidentally found perigastric mass. An exploratory laparotomy revealed a non-communicating cyst below the gastroesophageal junction, measuring 4 cm×4 cm in size. Microscopically, the gastric cyst was lined merely by PCCE. Although rare, GDC lined by PCCE should be included in the differential diagnosis of gastric wall masses. Surgical intervention is warranted in patients who have clinical symptoms, or who are aged more than 50 years.

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

Duplication cyst of the stomach with a pseudostratified columnar ciliated epithelium is extremely rare. We describe two cases of these cysts, with emphasis on their immunophenotype and embryogenesis. The first patient was a 29-year-old man who presented with cramping abdominal pain in his left lower quadrant. The second patient was a 26-year-old woman who had a history, over several years, of chronic epigastric abdominal pain radiating to her back. Both lesions were surgically removed. They showed the same histomorphology. The cysts were lined by a pseudostratified respiratory epithelium with ciliated cells. The first cyst was connected to the stomach, while the second cyst was not connected. Both cysts expressed thyroid transcription factor-1 (TTF-1) and surfactant. In this report, we explore the possible embryogenesis of these lesions in the light of TTF-1 and surfactant expression.

Intraabdominal bronchogenic cyst

INTRODUCTION

Bronchogenic cyst is pathology of the respiratory track. It consists of a defect during the embryological development of the tracheobronchial tree. Most common presentation is as a solid or cystic mass located in mediastinum, and it is usually diagnosed in relation to respiratory problems or recurrent infections in children. In adulthood, it is a rare pathology, and its diagnosis is usually incidental.

CASE REPORT

We present a case of a patient with a paraesophageal cystic mass suggestive of intraabdominal esophageal duplication cyst but, after the histopathological examination, was discovered to be a bronchogenic cyst, something extremely rare as in most cases of subdiaphragmatic location; bronchogenic cysts appear as retroperitoneal lesions.

DISCUSSION

After we review the current literature, surgical extirpation appears to be the treatment of choice due to potential complications, and laparoscopic approach is a feasibily and safe procedure for this pathology up to date.

Bronchogenic cyst of the stomach involved with gastric adenocarcinoma

Bronchogenic cyst, a congenital anomaly mostly found in the mediastinum, rarely arises in the stomach. A 43-year-old man had epigastric pain and was diagnosed as having gastric adenocarcinoma. Abdominal ultrasonography showed hepatic cyst, and computed tomography and magnetic resonance imaging revealed a cystic lesion near the stomach. At surgery, the cystic lesion was found to be located at the lesser curvature of the stomach where the cancer invasion was seen. Total gastrectomy with combined resection of the cystic lesion was performed. Pathologically, the cyst wall was lined by pseudostratified ciliated columnar epithelium, subepithelial mixed seromucinous glands and smooth muscle bundles. The pathological diagnosis was bronchogenic cyst of the stomach involved with gastric adenocarcinoma. Based on a similar association between gastric diffuse submucosal cysts and gastric cancer in the previous reports, it is possible that chronic inflammation from bronchogenic cysts to the gastric mucosa may cause adenocarcinoma in the stomach. At surgery, complete combined resection without rupture of the bronchogenic cyst involved with the gastric adenocarcinoma is needed for treatment of gastric cancer to prevent dissemination of cancer cells considering when cancer cells have invaded beyond the pseudostratified ciliated columnar epithelium and within the bronchogenic cyst.

Foregut duplication cyst of the stomach with pseudostratified columnar ciliated epithelium

Duplication cyst of the stomach with pseudostratified columnar ciliated epithelium is extremely rare. A 72-year-old Japanese woman visited Oomoto Hospital for examination of the stomach. Gastroendoscopy indicated a slightly depressed gastric cancer in the anterior wall of the middle third of the stomach. Adenocarcinoma was confirmed on endoscopic biopsy. Preoperative CT indicated a subserosal cystic lesion 2 cm in diameter on the lesser curvature of the stomach. The cystic lesion was resected through distal gastrectomy and systematic lymph node dissection. Histopathology showed that the cyst did not communicate with the gastric lumen, had pseudostratified columnar ciliated epithelium with circular muscle layers, and did not have gastric epithelium or cartilaginous tissue. The gastric cancer consisted of moderately differentiated adenocarcinoma with submucosal invasion and lymph node metastasis. Consequently, the present patient was diagnosed as having foregut duplication cyst of the stomach.

High-grade neuroendocrine carcinoma arising in a gastric duplication cyst: a case report with literature review

Gastric duplication cysts are rare congenital anomalies that are mostly discovered in children but can remain asymptomatic and undetected into adulthood. Malignant transformation in gastric duplications is extremely rare, with most reported cases being adenocarcinomas. Herein, the authors report the first case of a high-grade neuroendocrine carcinoma arising in a gastric duplication cyst in a 40-year-old Asian male. This case highlights that duplication cysts should be included in the differential diagnosis of cystic masses of the gastrointestinal tract in adult, as well as pediatric, patients and emphasizes the importance of complete surgical resection and meticulous pathologic examination of these congenital anomalies.

Paraesophageal bronchogenic cyst: first case reports in pediatric

We described for the first time a paraesophageal intra-abdominal bronchogenic cyst, first considered as hepatic tumor, in a young boy. Resection was successfully realized by laparoscopy. Abdominal bronchogenic cyst and differential diagnosis are discussed.