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Napolitano V, Pezzullo AM, Zeppa P, Schettino P, D'Armiento M, Palazzo A, Della Pietra C, Napolitano S, Conzo G. Foregut duplication of the stomach diagnosed by endoscopic ultrasound guided fine-needle aspiration cytology: case report and literature review. World J Surg Oncol 2013; 11:33. [PMID: 23374143 PMCID: PMC3599514 DOI: 10.1186/1477-7819-11-33] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2012] [Accepted: 01/18/2013] [Indexed: 02/06/2023] Open
Abstract
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.
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Affiliation(s)
- Vincenzo Napolitano
- Department of General and Specialistic Surgery, School of Medicine, Second University of Naples, 5 S, Pansini Street, 80100, Naples, Italy
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Fazel A, Moezardalan K, Varadarajulu S, Draganov P, Dragonov P, Eloubeidi MA. The utility and the safety of EUS-guided FNA in the evaluation of duplication cysts. Gastrointest Endosc 2005; 62:575-80. [PMID: 16185972 DOI: 10.1016/j.gie.2005.06.014] [Citation(s) in RCA: 57] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2004] [Accepted: 06/03/2005] [Indexed: 02/08/2023]
Abstract
BACKGROUND Diagnosis of a foregut duplication cyst is of great clinical impact. A definitive diagnosis of a foregut duplication cyst can avert the need for major thoracic surgery in the otherwise asymptomatic individual. This study sought to evaluate the safety and the utility of EUS and EUS-guided FNA (EUS-FNA) in the diagnosis of foregut duplication cysts. METHODS Over a period of 4 years, 4771 patients underwent EUS for various indications at two EUS referral centers. EUS findings were consistent with a mediastinal cyst in 30 cases. EUS-FNA was performed in 22 patients. A definitive diagnosis was established based on cytology, surgical pathology, and/or clinical follow-up. FNA was done with 22-gauge needles and antibiotic prophylaxis. RESULTS The appearance of cyst contents on EUS ranged from completely anechoic (23 cases) to hypoechoic (7 cases). Hypoechoic cystic lesions contained echogenic foci. All anechoic lesions were confirmed as benign duplication cysts based on cytology, pathology, and clinical follow-up. Hypoechoic cystic lesions were confirmed to be benign duplication cysts in 4 cases. Three cases proved to be malignant or granulomatous necrotizing lymph nodes. No periprocedural complications occurred. CONCLUSIONS Variation exists in the EUS appearance of benign mediastinal cysts. EUS-FNA of mediastinal cysts with smaller-gauge needles, and antibiotic prophylaxis appears safe and can provide a definitive diagnosis in atypical mediastinal cystic lesions.
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Affiliation(s)
- Ali Fazel
- Division of Gastroenterology and Hepatology, University of Florida, Gainesville, Florida 32610-0214, USA
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Moulton MSJ, Moir C, Matsumoto J, Thompson DM. Esophageal duplication cyst: a rare cause of biphasic stridor and feeding difficulty. Int J Pediatr Otorhinolaryngol 2005; 69:1129-33. [PMID: 16005356 DOI: 10.1016/j.ijporl.2005.03.008] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/10/2004] [Accepted: 03/01/2005] [Indexed: 10/25/2022]
Affiliation(s)
- Marlene St Joan Moulton
- Department of Otorhinolaryngology Head and Neck Surgery, Mayo Clinic, 200 First Street, SW, Rochester, MN 55905, USA
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Accadia M, Ascione L, De Michele M, Saulino C, Alabiso ME, Tuccillo B. Esophageal Duplication Cyst: A Challenging Diagnosis of a Paracardiac Mass. Echocardiography 2004; 21:551-4. [PMID: 15298693 DOI: 10.1111/j.0742-2822.2004.03125.x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
We present a case of esophageal duplication cyst, echocardiographically appearing as a mass above the roof of the left atrium and behind the right pulmonary artery. The differential diagnosis and the management of such disease are discussed.
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Affiliation(s)
- Maria Accadia
- Division of Cardiology, S. Maria di Loreto Hospital, Naples, Italy
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José Fibla J, Carlos Penagos J, Farina C, Gómez G, Estrada G, León C. Quiste de duplicación esofágica. Cir Esp 2004. [DOI: 10.1016/s0009-739x(04)72339-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
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Sugiyama M, Izumisato Y, Abe N, Masaki T, Mori T, Atomi Y. Predictive factors for acute pancreatitis and hyperamylasemia after endoscopic papillary balloon dilation. Gastrointest Endosc 2003. [PMID: 12665764 DOI: 10.1067/s0016-5107(03)00009-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
BACKGROUND Although endoscopic papillary balloon dilation may result in acute pancreatitis or hyperamylasemia, the risk factors for these complications have not been well documented. Risk factors predictive of acute pancreatitis and hyperamylasemia after endoscopic papillary balloon dilation were retrospectively analyzed. METHODS In 118 patients who underwent endoscopic papillary balloon dilation for choledocholithiasis, postendoscopic papillary balloon dilation acute pancreatitis and hyperamylasemia (at least 3-fold elevation) were investigated. A multivariate analysis was conducted for 20 potential risk factors related to clinical and procedure characteristics. RESULTS Bile duct clearance was achieved in 113 patients. Early complications in the form of mild pancreatitis occurred in 7 patients (6%). Multivariate analysis identified history of acute pancreatitis as the only risk factor for postendoscopic papillary balloon dilation pancreatitis. Postendoscopic papillary balloon dilation hyperamylasemia occurred in 30 patients (25%). Multivariate analysis identified 4 independent risk factors for hyperamylasemia: an age of 60 years or less, previous pancreatitis, bile duct diameter 9 mm or less, and difficult bile duct cannulation. CONCLUSIONS Endoscopic papillary balloon dilation is associated with a relatively low occurrence (6%) of pancreatitis but a high frequency (25%) of hyperamylasemia. The latter may represent pancreatic irritation or latent pancreatic injury. Particular care is necessary when endoscopic papillary balloon dilation is performed in younger patients, those with a history of pancreatitis, patients with a nondilated bile duct, and when cannulation is difficult.
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Affiliation(s)
- Masanori Sugiyama
- The First Department of Surgery, Kyorin University School of Medicine, Tokyo, Japan
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Abstract
Diaphragmatic hernias are the most common abnormalities of gastrointestinal system especially in elderly patients. The radiographic findings of diaphragmatic hernias on esophagram are well known, but when incidentally found in an asymptomatic patient on axial computed tomography (CT) sections, the appearance of diaphragmatic hernia may mimic many other conditions. Our purpose is to present the CT findings of sliding hernia in an incidentally found asymptomatic patient, and to differentiate it from the other abnormalities that can be located in the distal paraesophageal area with the same appearance characteristics.
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Affiliation(s)
- P Polat
- Department of Radiology, Faculty of Medicine, Atatürk University, Erzurum, Turkey.
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Abstract
Benign tumors of the esophagus can be classified as mucosal or submucosal in origin. The most common mucosal lesions include squamous papillomas, adenomas arising in Barrett's mucosa, inflammatory esophagogastric polyps, and glycogenic acanthosis. These benign mucosal lesions can often be diagnosed on double-contrast esophagrams based on their characteristic radiographic findings. Major submucosal or intramural lesions include leiomyomas, leiomyomatosis, fibrovascular polyps, granular cell tumors, and duplication cysts. Despite their infrequency, these lesions also can often be diagnosed on esophagography and/or CT based on their characteristic radiographic findings. The purpose of this article is to review in some detail the radiographic features of these various benign tumors of the esophagus.
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Affiliation(s)
- Marc S Levine
- University of Pennsylvania School of Medicine, Gastrointestinal Radiology Section, Hospital of the University of Pennsylvania, Philadelphia, PA 19104, USA
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Cioffi U, Bonavina L, De Simone M, Santambrogio L, Pavoni G, Testori A, Peracchia A. Presentation and surgical management of bronchogenic and esophageal duplication cysts in adults. Chest 1998; 113:1492-6. [PMID: 9631783 DOI: 10.1378/chest.113.6.1492] [Citation(s) in RCA: 115] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
OBJECTIVE Bronchogenic and esophageal duplication cysts are congenital anomalies of the tracheobronchial tree and foregut that are often asymptomatic at initial presentation in adults. Surgery is always recommended, even for patients with asymptomatic disease, because of the possible development of symptoms and complications during the natural course of the disease and because definitive diagnosis can be established only on surgical specimen. METHODS Twenty-seven patients with bronchogenic and esophageal duplication cysts were treated in our institution over the last 2 decades. Ten patients (37%) were asymptomatic at initial presentation. Chest pain and dysphagia were the most common complaints in symptomatic patients affected by bronchogenic and duplication cysts, respectively. RESULTS A complete excision of the cyst was performed in 26 cases, whereas one patient with intrapulmonary cyst underwent a right upper pulmonary lobectomy. A posterolateral thoracotomy was performed in 23 patients, and a video-assisted thoracoscopy using a three-port technique was performed in the last 4 patients. No postoperative morbidity was recorded. All patients, except one, were asymptomatic at a median follow-up time of 4 years. CONCLUSIONS Surgery is the treatment of choice for bronchogenic and esophageal duplication cysts. Video-assisted thoracoscopy should represent the first-line approach in these patients.
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Affiliation(s)
- U Cioffi
- Department of General and Oncologic Surgery, Ospedale Maggiore Policlinico VIACCS, University of Milan, Italy
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Faigel DO, Burke A, Ginsberg GG, Stotland BR, Kadish SL, Kochman ML. The role of endoscopic ultrasound in the evaluation and management of foregut duplications. Gastrointest Endosc 1997; 45:99-103. [PMID: 9013183 DOI: 10.1016/s0016-5107(97)70315-8] [Citation(s) in RCA: 48] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Affiliation(s)
- D O Faigel
- Department of Medicine, University of Pennsylvania Health System, Philadelphia, USA
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Abstract
Many physicians believe that ultrasound has limited usefulness in chest disease. Our clinical experiences and a review of the literature in preparation for this monograph have convinced us that sonography can be a very useful and versatile tool for thoracic diagnosis and intervention. Although there are some limitations caused by interposed ribs and air-containing lung, almost all of the compartments of the chest can be evaluated with ultrasound, which gives unique and clinically useful information. Ultrasound guidance for biopsy and drainage does take some time to learn, but we feel that the effort is very worthwhile. The same advantages ultrasound enjoys for other body regions make it a modality that will see increased use in the chest as well. We hope that this monograph will stimulate our colleagues to explore and expand upon the techniques described.
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Affiliation(s)
- C L Sistrom
- Department of Radiology, University of Virginia, Charlottesville, USA
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Abstract
BACKGROUND & AIMS Foregut duplication cysts are rare congenital anomalies of enteric origin found most commonly in children and rarely in adults. They are usually found in adults on routine radiological studies and represent a challenging diagnostic problem. Conventional imaging tests do not lead to a conclusive diagnosis. With endoscopic ultrasonography, it is possible to distinguish between cystic and solid masses and to accurately establish the location of the cyst in relation to the gastrointestinal wall and to the mediastinum. METHODS Seven patients who had endoscopic ultrasonography performed because of differentiation between a cystic or solid mass lesion in the chest or abdomen could not be made with conventional radiological methods are described. RESULTS In all patients, a definite diagnosis was established by endoscopic ultrasonography. The diagnosis was confirmed in 2 patients after surgical excision. CONCLUSIONS Surgery can be avoided in patients with asymptomatic enteric duplication cysts diagnosed by endoscopic ultrasonography.
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Affiliation(s)
- A Geller
- Department of Internal Medicine, Mayo Clinic, Rochester, Minnesota, USA
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Affiliation(s)
- J L Buck
- Department of Radiologic Pathology, Armed Forces Institute of Pathology, Washington, DC 20306-6000
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Yang X, Partanen K, Seppä A, Berg E, Pasanen P. Paraesophageal bronchogenic cyst in the adult: can it be differentiated from intramural esophageal cyst by different imagings? Case report and review of the literature. Clin Imaging 1994; 18:68-71. [PMID: 8180865 DOI: 10.1016/0899-7071(94)90150-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Affiliation(s)
- X Yang
- Department of Clinical Radiology, Kuopio University Hospital, Finland
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