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Ronkainen E, Barner-Rasmussen N, Volmonen K, Färkkilä M, Arkkila P, Tenca A. Comparison of Endoscopic Ultrasound and CT Scan in the Diagnosis of Esophageal Duplication Cysts. Dig Dis Sci 2024:10.1007/s10620-024-08655-8. [PMID: 39384711 DOI: 10.1007/s10620-024-08655-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2024] [Accepted: 09/18/2024] [Indexed: 10/11/2024]
Abstract
BACKGROUND AND AIM Esophageal duplication cysts (EDCs) are rare congenital malformations, often discovered incidentally during endoscopy or on computed tomography (CT) scans. The role of endoscopic ultrasound (EUS) and CT scan in the diagnosis of these lesions and indications for surgical treatment are underreported. The aim of this study was to investigate these topics in a cohort of patients. MATERIALS AND METHODS Between January 2001 and October 2020, 82 patients had a suspicion of esophageal duplication cyst on endoscopic ultrasound. Thirty four of these patients were referred for surgical enucleation of the lesion, but three patients were lost to follow-up. At the end, 31 patients, who underwent surgical treatment for their suspected EDC were included in this study. Clinical features, EUS findings, CT images, surgical treatment, and outcome were collected from hospital health records. CT images were re-evaluated by a chest radiologist. Type of surgery, surgical complications, and final histological diagnosis were reported. RESULTS AND CONCLUSION The patients referred for surgery were younger (p = 0.0001) and had larger lesions (> 2 cm; p = 0.005) than the patients who had non-operative follow-up. From thirty-one operated patients, eighteen (58%) had post-operative histological diagnosis of duplication cyst. On EUS the final histological diagnosis was correct in 58% (18/31) of all the operated cases and on CT scan 57% (17/30). CT scan misdiagnosed three of the EDCs but found two leiomyomas correctly. None of these patients developed malignancy. According to this study, neither EUS without fine-needle biopsy nor CT scan alone can differentiate EDCs from other mediastinal masses.
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Affiliation(s)
- Eve Ronkainen
- Department of Gastroenterology, Abdominal Centre, Helsinki University Hospital HUS, University of Helsinki, POB 340, 00029 HUS, Helsinki, Finland.
| | - Nina Barner-Rasmussen
- Department of Gastroenterology, Abdominal Centre, Helsinki University Hospital HUS, University of Helsinki, POB 340, 00029 HUS, Helsinki, Finland
| | - Kirsi Volmonen
- Radiology, Diagnostic Centre, Helsinki University Hospital HUS, University of Helsinki, Helsinki, Finland
| | - Martti Färkkilä
- Department of Gastroenterology, Abdominal Centre, Helsinki University Hospital HUS, University of Helsinki, POB 340, 00029 HUS, Helsinki, Finland
| | - Perttu Arkkila
- Department of Gastroenterology, Abdominal Centre, Helsinki University Hospital HUS, University of Helsinki, POB 340, 00029 HUS, Helsinki, Finland
| | - Andrea Tenca
- Department of Gastroenterology, Abdominal Centre, Helsinki University Hospital HUS, University of Helsinki, POB 340, 00029 HUS, Helsinki, Finland
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Madhusudan M, Chandra T, Potti P, Jingade ST. Role of esophageal ultrasound with a bronchoscope (EUS-B) with fine needle aspiration in the diagnosis of mediastinal Bronchogenic cyst. Pediatr Pulmonol 2023; 58:3612-3614. [PMID: 37701980 DOI: 10.1002/ppul.26675] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2023] [Revised: 08/16/2023] [Accepted: 09/01/2023] [Indexed: 09/14/2023]
Abstract
A 12-year-old adolescent boy presented with complaints of persisting dry cough and exertional dyspnea. A CT chest revealed a cystic lesion posterior to the trachea and a flexible bronchoscopy revealed extrinsic compression of the posterior trachea and partial obstruction of the left main bronchus. He underwent an Endoscopic Ultrasound with a Bronchoscope. A Hypoechoic cystic lesion was seen just in front of the esophagus. Fine needle aspiration yielded thick mucoid aspirate and cytology revealed ciliated columnar epithelium, confirming the diagnosis of a Bronchogenic cyst.
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Affiliation(s)
- Manoj Madhusudan
- Department of Pediatric Pulmonology, Interventional Pulmonology and Sleep Medicine, Aster RV Hospital, Bengaluru, India
| | - Tejaswi Chandra
- Department of Pediatric Pulmonology, Interventional Pulmonology and Sleep Medicine, Aster RV Hospital, Bengaluru, India
| | - Priyanka Potti
- Department of Pediatric Pulmonology, Interventional Pulmonology and Sleep Medicine, Aster RV Hospital, Bengaluru, India
| | - Srikanta T Jingade
- Department of Pediatric Pulmonology, Interventional Pulmonology and Sleep Medicine, Aster RV Hospital, Bengaluru, India
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Kundu U, Gan Q, Donthi D, Sneige N. The Utility of Fine Needle Aspiration (FNA) Biopsy in the Diagnosis of Mediastinal Lesions. Diagnostics (Basel) 2023; 13:2400. [PMID: 37510144 PMCID: PMC10378189 DOI: 10.3390/diagnostics13142400] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2023] [Revised: 06/22/2023] [Accepted: 07/04/2023] [Indexed: 07/30/2023] Open
Abstract
Fine needle aspiration is a minimally invasive, low-morbidity, and cost-efficient technique for the sampling of mediastinal lesions. Additionally, ancillary testing on FNA samples can be used for the refinement of diagnoses and for treatment-related purposes (flow cytometry, cytogenetics, immunohistochemistry, and molecular diagnostics). Mediastinal lesions, however, can show a variety of lineages and morphologic features, giving rise to diagnostic dilemmas. As a result, the differential diagnosis can vary widely and becomes especially challenging due to the smaller sample size on FNA and the variability in component sampling. For appropriate patient management and to determine the correct treatment strategies, accurate pathologic diagnoses are paramount. In this review, we present the cytomorphologic features together with the immunophenotypic findings of mediastinal lesions, with emphasis on the diagnostic challenges and pitfalls in FNA cytology samples, including smears and cell block sections.
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Affiliation(s)
- Uma Kundu
- Section of Cytopathology, Department of Pathology, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
| | - Qiong Gan
- Section of Cytopathology, Department of Pathology, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
| | - Deepak Donthi
- Section of Cytopathology, Department of Pathology, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
| | - Nour Sneige
- Section of Cytopathology, Department of Pathology, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
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Adachi K, Tashiro T, Kato M, Ito T, Kato A, Takayama M, Kato S, Ono S, Yoshimine H, Koshino A, Nagao K, Kobayashi Y, Ebi M, Ogasawara N, Sasaki M, Kasugai K. A case report of contrast-enhanced harmonic ultrasonography for the diagnosis of an esophageal duplication cyst. DEN OPEN 2023; 3:e218. [PMID: 36942054 PMCID: PMC10023831 DOI: 10.1002/deo2.218] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/09/2023] [Revised: 02/07/2023] [Accepted: 02/15/2023] [Indexed: 03/19/2023]
Abstract
A 54-year-old man was referred to our hospital because of a suspected esophageal submucosal tumor on upper gastrointestinal radiography. Contrast-enhanced computed tomography showed a 52 mm homogeneous mass attached to the lower thoracic esophagus. Esophagogastroduodenoscopy revealed a 50 mm submucosal tumor in the lower esophagus, and endoscopic ultrasonography (EUS) showed a continuous hypoechoic lesion in the esophageal muscularis propria. Contrast-enhanced harmonic EUS revealed a non-echogenic area. T1 and T2 magnetic resonance imaging revealed a high-signal lesion. Based on imaging studies, an esophageal duplication cyst was diagnosed. Although asymptomatic, the patient underwent video-assisted thoracic surgery because of the possibility of rupture and the appearance of symptoms due to a future infection or enlargement, although this was not noted before. In our case, the esophageal duplication cyst appeared as a hypoechoic mass, requiring differentiation from submucosal tumor other than the cyst. Histologically, the cyst was covered by two layers of muscle covered by the chorioepithelial columnar epithelium. EUS fine-needle aspiration is effective in diagnosing submucosal tumor but also carries the risk of infection. Contrast-enhanced ultrasonography was used in this case to observe the interior and reach a preoperative diagnosis. Contrast-enhanced harmonic EUS appears to be effective in examining the interior of submucosal tumor lesions noninvasively.
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Affiliation(s)
- Kazunori Adachi
- Department of GastroenterologyAichi Medical University HospitalAichiJapan
| | - Takashi Tashiro
- Department of GastroenterologyAichi Medical University HospitalAichiJapan
| | - Makiko Kato
- Department of GastroenterologyAichi Medical University HospitalAichiJapan
| | - Takanori Ito
- Department of Surgical PathologyAichi Medical University HospitalAichiJapan
| | - Aya Kato
- Department of GastroenterologyAichi Medical University HospitalAichiJapan
| | - Masaaki Takayama
- Department of GastroenterologyAichi Medical University HospitalAichiJapan
| | - Shunsuke Kato
- Department of GastroenterologyAichi Medical University HospitalAichiJapan
| | - Satoshi Ono
- Department of GastroenterologyAichi Medical University HospitalAichiJapan
| | - Hisako Yoshimine
- Department of GastroenterologyAichi Medical University HospitalAichiJapan
| | - Akira Koshino
- Department of GastroenterologyAichi Medical University HospitalAichiJapan
| | - Kazuhiro Nagao
- Department of GastroenterologyAichi Medical University HospitalAichiJapan
| | - Yuji Kobayashi
- Department of GastroenterologyAichi Medical University HospitalAichiJapan
| | - Masahide Ebi
- Department of GastroenterologyAichi Medical University HospitalAichiJapan
| | - Naotaka Ogasawara
- Department of GastroenterologyAichi Medical University HospitalAichiJapan
| | - Makoto Sasaki
- Department of GastroenterologyAichi Medical University HospitalAichiJapan
| | - Kunio Kasugai
- Department of GastroenterologyAichi Medical University HospitalAichiJapan
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Streptococcus pyogenes infection of a mediastinal cyst after endoscopic ultrasound-guided fine-needle aspiration. Heliyon 2022; 8:e11900. [PMID: 36561704 PMCID: PMC9763743 DOI: 10.1016/j.heliyon.2022.e11900] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2022] [Revised: 07/08/2022] [Accepted: 11/17/2022] [Indexed: 11/26/2022] Open
Abstract
Mediastinal masses are uncommon and difficult to diagnose. Endoscopic ultrasound with fine-needle aspiration (EUS-FNA) is a minimally invasive technique for diagnosis of mediastinal lesions with few complications. Our report described a mediastinal bronchogenic cyst with soft tissue density infected by Streptococcus pyogenes (S. pyogenes) after EUS-FNA, accompanied by respiratory cardiac arrest and superior vena cava syndrome. The patient underwent cardiopulmonary resuscitation to gain the chance for emergency surgery and recovered. Clinicians should be aware that mediastinal mass with soft tissue density shown on imaging may be mediastinal cyst containing high density mucin, FNA should be avoided if cystic masses cannot be ruled out.
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Massidda M, Rocchi C, Tomassini G, Vadalà di Prampero SF, Cossu Rocca P, Tondolo V, Manzoni G, Bulajic M. Gastric duplication cyst: a challenging EUS differential diagnosis between subepithelial gastric lesion and exophytic pancreatic cystic neoplasm-a case report and a literature review. Clin J Gastroenterol 2022; 15:560-567. [PMID: 35294725 DOI: 10.1007/s12328-022-01619-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2021] [Accepted: 02/28/2022] [Indexed: 11/26/2022]
Abstract
Gastric duplication cysts are rare congenital malformation with a potential neoplastic progression and they may represent a challenge in differential diagnosis with exophytic pancreatic cyst neoplasm. We describe a case of a 38-year old man, complaining of recurrent epigastric pain due to a large abdominal mass, referred to our Hospital for EUS evaluation. Differential diagnosis was between gastric duplication cyst and exophytic pancreatic cyst because of FNA pointed out amylase 1280 UI/L and CEA 593.33 ng/mL. Despite antibiotic prophylaxis, an overinfection of the lesion occurred after the FNA, likely due to the technical failure to drain the cyst completely. Afterwards, the patient was referred to surgery and the pathologist confirmed the diagnosis of gastric duplication cyst. In this setting, EUS procedure has gained a leading play, complementary to traditional imaging tests, although its role has been not yet standardized in the reported literature. Here, we describe and discuss our demanding case, and we propose an algorithm to simplify and standardize the diagnostic workup.
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Affiliation(s)
- Marco Massidda
- Gastroenterology and Endoscopy Unit, Mater Olbia Hospital, SS 125 Orientale Sarda, 07026, Olbia, Italy.
| | - Chiara Rocchi
- Gastroenterology and Endoscopy Unit, Mater Olbia Hospital, SS 125 Orientale Sarda, 07026, Olbia, Italy
| | - Giulia Tomassini
- Clinica Medica, Dipartimento di Scienze Mediche, Chirurgiche e Sperimentali, University of Sassari, Viale San Pietro 43, 07100, Sassari, Italy
| | | | - Paolo Cossu Rocca
- Department of Diagnostic Services, Pathology Unit, ASL Gallura, Via Bazzoni Sircana, 07026, Olbia, Italy
| | - Vincenzo Tondolo
- General Surgery Unit, Mater Olbia Hospital, SS 125 Orientale Sarda, 07026, Olbia, Italy
| | - Gabriella Manzoni
- Radiology Unit, Mater Olbia Hospital, SS 125 Orientale Sarda, 07026, Olbia, Italy
| | - Milutin Bulajic
- Gastroenterology and Endoscopy Unit, Mater Olbia Hospital, SS 125 Orientale Sarda, 07026, Olbia, Italy
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Gandhi D, Garg T, Shah J, Sawhney H, Crowder BJ, Nagar A. Gastrointestinal duplication cysts: what a radiologist needs to know. Abdom Radiol (NY) 2022; 47:13-27. [PMID: 34417830 DOI: 10.1007/s00261-021-03239-w] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2021] [Revised: 08/02/2021] [Accepted: 08/03/2021] [Indexed: 12/13/2022]
Abstract
Gastrointestinal tract duplication cysts are rare congenital malformations which can be diagnosed as early as the prenatal period but are frequently found in infancy or incidentally in adulthood. They can be seen throughout the alimentary tract with the most common involving the distal ileum and second most common the esophagus. Many duplication cysts are asymptomatic and thus discovered as an incidental imaging finding, though they can also be symptomatic with an array of clinical presentations dependent largely on their location. The vast majority of duplication cysts are benign; however, there are rare instances of malignant transformation reported. The aim of this review is to show how multimodality imaging can help in the diagnosis of duplication cysts at various anatomical locations. Duplication cyst can become symptomatic and in rare cases undergo malignant transformation; therefore, they are typically managed with surgical excision, particularly if found prenatally or during infancy. Given the diversity of anatomic locations, multiple differential diagnoses, and the need for surgical intervention, it is valuable to comprehend the role of multimodality imaging role in diagnosing duplication cysts.
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Affiliation(s)
- Darshan Gandhi
- Department of Radiology, Northwestern Memorial Hospital, Northwestern University Feinberg School of Medicine, 676 N St. Clair St, Suite 800, Chicago, IL, 60611, USA.
| | - Tushar Garg
- Department of Radiology, Seth GS Medical College & KEM Hospital, Acharya Donde Marg, Parel East, Parel, Mumbai, Maharashtra, 400012, India
| | - Jignesh Shah
- Department of Pediatric Radiology, University of Tennessee Health Science Center, Memphis, TN, 38103, USA
| | - Harpreet Sawhney
- Department of Radiology, Bridgeport Hospital at Yale New Haven Health, 167 Grant St, Bridgeport, CT, 06610, USA
| | - Benjamin James Crowder
- Department of Radiology, The Ohio State University Wexner Medical Center, 395W, 12th Av, 4th Floor, Columbus, OH, 43210, USA
| | - Arpit Nagar
- Department of Radiology, The Ohio State University Wexner Medical Center, 395W, 12th Av, 4th Floor, Columbus, OH, 43210, USA
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Abstract
Patient and procedural factors can increase the risk of infectious adverse events during endoscopy. Prophylactic antibiotic use must be judicious and individualized in the era of antibiotic resistance. New and emerging procedures require high-quality studies to elucidate appropriate risk profiles.
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Affiliation(s)
- Brian P H Chan
- Division of Gastroenterology, Center for Advanced Endoscopy, Beth Israel Deaconess Medical Center, Harvard Medical School, 330 Brookline Avenue, Boston, MA 02215, USA
| | - Tyler M Berzin
- Division of Gastroenterology, Center for Advanced Endoscopy, Beth Israel Deaconess Medical Center, Harvard Medical School, 330 Brookline Avenue, Boston, MA 02215, USA.
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Seo WY, Kim GH, I H. An Esophageal Leiomyoma Mistaken as an Esophageal Duplication Cyst. THE KOREAN JOURNAL OF HELICOBACTER AND UPPER GASTROINTESTINAL RESEARCH 2020. [DOI: 10.7704/kjhugr.2020.0039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
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Colán-Hernández J, Sendino O, Loras C, Pardo A, Gornals JB, Concepción M, Sánchez-Montes C, Murzi M, Andujar X, Velasquez-Rodriguez J, Rodriguez de Miguel C, Fernández-Esparrach G, Ginés A, Guarner-Argente C. Antibiotic Prophylaxis Is Not Required for Endoscopic Ultrasonography-Guided Fine-Needle Aspiration of Pancreatic Cystic Lesions, Based on a Randomized Trial. Gastroenterology 2020; 158:1642-1649.e1. [PMID: 31972236 DOI: 10.1053/j.gastro.2020.01.025] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2019] [Revised: 01/08/2020] [Accepted: 01/11/2020] [Indexed: 12/17/2022]
Abstract
BACKGROUND & AIMS Guidelines recommend routine antibiotic prophylaxis for patients undergoing endoscopic ultrasonography-guided fine needle aspiration (EUS-FNA) of pancreatic cysts, but there is conflicting evidence for its necessity. We investigated whether performing the procedure without antimicrobial prophylaxis increases the incidence of infection. METHODS We performed a multicenter, randomized, noninferiority trial to compare prophylaxis with ciprofloxacin vs placebo in patients with a pancreatic cyst requiring EUS-FNA at multiple centers in Spain. From September 2014 to June 2018, patients were randomly assigned to groups that received the prophylaxis with ciprofloxacin (n = 112) or saline solution (n = 114, placebo). We recorded patients' demographic data, lesion characteristics, and procedure data and followed patients for 21 days. A total of 205 patients completed the trial (90.7%), receiving ciprofloxacin or the control, with no statistically significant differences in demographics, baseline data, or procedure characteristics between groups. The primary outcome was FNA-related infection. Secondary outcomes were incidence of fever, procedure complications, and medication-related adverse events. RESULTS The only case of FNA-related infection (0.44%) occurred in a patient in the placebo group (0.87%); this patient developed acute pancreatitis and bacteremia after the procedure. Prevention of infection was not inferior in the control group; the difference between proportions was 0.87% (95% confidence interval, -0.84% to 2.59%). There were no differences between groups in fever (2 patients in each group: 1.78% vs 1.76%; P = 1.00) or other adverse events. CONCLUSIONS In a randomized trial of patients undergoing EUS-FNA for pancreatic cyst evaluation, we found the risk of infection to be low. The incidence of infections did not differ significantly with vs without ciprofloxacin prophylaxis. (ClinicalTrials.gov, Number: NCT02261896).
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Affiliation(s)
- Juan Colán-Hernández
- Department of Gastroenterology, Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona, Spain
| | - Oriol Sendino
- Hospital Clínic, Universitat de Barcelona, Spain; Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas, CIBERehd Spain; Institut d'Investigació Biomèdica August Pi i Sunyer, Barcelona
| | - Carme Loras
- Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas, CIBERehd Spain; Department of Gastroenterology, Hospital Universitari Mútua Terrassa, Fundació per la Recerca Mútua Terrassa, Terrassa, Spain
| | | | - Joan B Gornals
- Hospital de Bellvitge-Institut d'Investigació Biomèdica de Bellvitge, Barcelona, Barcelona, Spain
| | - Mar Concepción
- Department of Gastroenterology, Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona, Spain
| | | | - Marianette Murzi
- Department of Gastroenterology, Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona, Spain
| | - Xavier Andujar
- Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas, CIBERehd Spain; Department of Gastroenterology, Hospital Universitari Mútua Terrassa, Fundació per la Recerca Mútua Terrassa, Terrassa, Spain
| | | | | | - Gloria Fernández-Esparrach
- Hospital Clínic, Universitat de Barcelona, Spain; Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas, CIBERehd Spain; Institut d'Investigació Biomèdica August Pi i Sunyer, Barcelona
| | - Angels Ginés
- Hospital Clínic, Universitat de Barcelona, Spain; Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas, CIBERehd Spain; Institut d'Investigació Biomèdica August Pi i Sunyer, Barcelona
| | - Carlos Guarner-Argente
- Department of Gastroenterology, Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona, Spain.
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He WT, Deng JY, Liang H, Xiao JY, Cao FL. Bronchogenic cyst of the stomach: A case report. World J Clin Cases 2020; 8:1525-1531. [PMID: 32368546 PMCID: PMC7190944 DOI: 10.12998/wjcc.v8.i8.1525] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/29/2019] [Revised: 03/27/2020] [Accepted: 04/09/2020] [Indexed: 02/05/2023] Open
Abstract
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.
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Affiliation(s)
- Wen-Ting He
- Department of Gastroenterology, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Key Laboratory of Cancer Prevention and Therapy, Tianjin, and Tianjin’s Clinical Research Center for Cancer, Tianjin 300060, China
| | - Jing-Yu Deng
- Department of Gastroenterology, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Key Laboratory of Cancer Prevention and Therapy, Tianjin, and Tianjin’s Clinical Research Center for Cancer, Tianjin 300060, China
| | - Han Liang
- Department of Gastroenterology, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Key Laboratory of Cancer Prevention and Therapy, Tianjin, and Tianjin’s Clinical Research Center for Cancer, Tianjin 300060, China
| | - Jian-Yu Xiao
- Department of Radiology, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Key Laboratory of Cancer Prevention and Therapy, Tianjin, and Tianjin’s Clinical Research Center for Cancer, Tianjin 300060, China
| | - Fu-Liang Cao
- Department of Endoscopy, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Key Laboratory of Cancer Prevention and Therapy, Tianjin, and Tianjin’s Clinical Research Center for Cancer, Tianjin 300060, China
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Zhao Y, Wang R, Wang Y, Chen Q, Chen L, Hou W, Liu L, Gao W, Cheng B. Application of endoscopic ultrasound-guided-fine needle aspiration combined with cyst fluid analysis for the diagnosis of mediastinal cystic lesions. Thorac Cancer 2018; 10:156-162. [PMID: 30480367 PMCID: PMC6360264 DOI: 10.1111/1759-7714.12924] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2018] [Revised: 11/01/2018] [Accepted: 11/03/2018] [Indexed: 12/26/2022] Open
Abstract
BACKGROUND Mediastinal cystic lesions account for approximately 15-20% of all mediastinal masses and are difficult to differentiate because of similar imaging manifestation. The aim of this study was to differentiate mediastinum cystic lesions through endoscopic ultrasound-guided-fine needle aspiration (EUS-FNA) and parameters from cyst-fluid analysis. METHODS Over a period of eight years, 37 patients suspected with mediastinal cystic lesions were assessed. Cyst fluid was collected via EUS-FNA and further examined using cytological and biochemical techniques. Definitive diagnosis was established based on cytology, surgical pathology, and/or clinical follow-up. RESULTS Based on the final pathological reports or long-term follow-up, 19 patients were diagnosed with benign cysts, 14 with benign or malignant tumors, 2 with tuberculosis, 1 with an abscess, and 1 with a pancreatic pseudocyst. Computed tomography or magnetic resonance imaging mistakenly distinguished eight cases as solid masses (27.03%), but EUS revealed cystic characteristics. Carcinoembryonic antigen and lactate dehydrogenase (LDH) were evaluated from the cyst fluid obtained by EUS-FNA. There was no statistically significant difference in carcinoembryonic antigen values between benign and malignant cysts; however the average LDH value in the malignancy group was significantly higher than in the benign group. CONCLUSION EUS-FNA showed great potential for differentiating mediastinal lesions by combining imaging manifestation and cytological examination. The elevated LDH value from cyst fluid chemical analysis could be used as an auxiliary indicator for diagnosing malignancy.
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Affiliation(s)
- Yuchong Zhao
- Department of Gastroenterology and Hepatology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology (HUST), Wuhan, China
| | - Ronghua Wang
- Department of Gastroenterology and Hepatology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology (HUST), Wuhan, China
| | - Yun Wang
- Department of Gastroenterology and Hepatology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology (HUST), Wuhan, China
| | - Qian Chen
- Department of Gastroenterology and Hepatology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology (HUST), Wuhan, China
| | - Liangkai Chen
- Department of Epidemiology and Biostatistics, School of Public Health, Tongji Medical College, HUST, Wuhan, China
| | - Wei Hou
- Department of Gastroenterology and Hepatology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology (HUST), Wuhan, China
| | - Limin Liu
- Unit of Cytopathology Unit, Department of Surgery, Tongji Hospital, Tongji Medical College, HUST, Wuhan, China
| | - Wei Gao
- Department of Anesthesia, Xiangya Hospital, Central South University, Changsha, China
| | - Bin Cheng
- Department of Gastroenterology and Hepatology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology (HUST), Wuhan, China
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Caballero Díaz Y, Centeno Haro M, Turégano García Á, Hernández Hernández JR. Adult gastric duplication: an unknown condition within the spectrum of gastric submucosal lesions. REVISTA ESPANOLA DE ENFERMEDADES DIGESTIVAS 2017. [PMID: 28625071 DOI: 10.17235/reed.2017.4851/2017] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
BACKGROUND Gastric duplication is an uncommon condition in adults representing only 4-8% of all gastrointestinal duplications. It develops as a cystic growth within the thick gastric wall that is surrounded by a layer of smooth muscle and lined with gastric mucosa. It is usually asymptomatic but may present with nonspecific abdominal symptoms as well as cyst-related complications such as gastrointestinal (GI) bleeding, ulceration and even pancreatitis. They are difficult to distinguish from other gastric submucosal lesions and may also mimic a gastrointestinal tumor (GIST) or mucinous cyst of the pancreas. Endoscopic ultrasound (EUS) is the most widely used diagnostic procedure and histology provides a definitive diagnosis. CASE REPORT We report the case of a 36-year-old female patient with a history of a "contained" perforated gastric ulcer that was managed conservatively. The patient was diagnosed with a gastric GIST which prompted a laparoscopic subtotal gastrectomy and Roux-en-Y reconstruction with a good postoperative outcome. DISCUSSION The definitive histological diagnosis was gastric duplication. Thus, the previous diagnosis of a "contained" perforated gastric ulcer was in fact a complication of the gastric duplication itself.
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Affiliation(s)
- Yurena Caballero Díaz
- Servicio de Cirugía General y del Aparat Digestivo, Complejo Hospitalario Universitario Insular Matern, España
| | - Macarena Centeno Haro
- Servicio de Anatomía Patológica, Complejo Hospitalario Universitario Insular Materno-Infantil de Gran Canaria, España
| | - Ángel Turégano García
- Servicio de Cirugía General y Digestiva, Complejo Hospitalario Universitario Insular-Materno Infantil de Gran Canaria
| | - Juan Ramón Hernández Hernández
- Servicio de Cirugía General y del Aparato Digestiv, Complejo Hospitalario Universitario Insular Materno-Infantil de Gran Canaria, España
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Valli PV, Gubler C, Bauerfeind P. Severe Infectious Complications after Endoscopic Ultrasound-Guided Fine Needle Aspiration of Suspected Mediastinal Duplication Cysts: A Case Series. Inflamm Intest Dis 2017; 1:165-171. [PMID: 29922673 DOI: 10.1159/000464327] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2016] [Accepted: 02/19/2017] [Indexed: 01/19/2023] Open
Abstract
Background and Study Aims The role of cyst cytology to diagnose mediastinal duplication cysts remains controversial. Since endoscopic ultrasound (EUS)-guided fine needle aspiration (FNA) of duplication cysts has been considered as safe so far, there are only a few case reports of infections following FNA. Case Summary We report a case series of all patients at our institution undergoing EUS evaluation for suspected mediastinal duplication cysts (n = 5) in the last 15 years. The mediastinal lesion in 4 patients did not feature typical EUS features for duplication cysts, wherefore we did perform EUS-guided FNA in order to rule out malignancy. In 3 out of 4 patients, a duplication cyst was confirmed. The fourth lesion turned out to be a sarcoma. All 4 patients developed severe FNA-induced cyst infection causing mediastinitis and the need for surgical debridement. Despite an immediate review of the FNA by the on-site cytopathologist with establishing the diagnosis of a duplication cyst, peri-interventional broad-spectrum antibiotics could not prevent severe infections of the lesions. Conclusions Given the potentially high rate of infectious complications, we advocate a very restrictive indication for diagnostic FNA in mediastinal masses. Yet, in unclear cases, FNA might be indispensable despite the potential adverse events in order to rule out hypoechogenic, mediastinal malignancy.
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Affiliation(s)
- Piero V Valli
- Division of Gastroenterology and Hepatology, University Hospital Zürich, Zurich, Switzerland
| | - Christoph Gubler
- Division of Gastroenterology and Hepatology, University Hospital Zürich, Zurich, Switzerland
| | - Peter Bauerfeind
- Division of Gastroenterology and Hepatology, University Hospital Zürich, Zurich, Switzerland
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Efficacy and Safety of Transbronchial Needle Aspiration in Diagnosis and Treatment of Mediastinal Bronchogenic Cysts: Systematic Review of Case Reports. J Bronchology Interv Pulmonol 2016; 22:195-203. [PMID: 26165889 DOI: 10.1097/lbr.0000000000000174] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Although surgical resection of mediastinal bronchogenic cysts is considered the treatment of choice, there is increasing interest in minimally invasive approaches of management. The purpose of this study was to review the literature on the role of transbronchial needle aspiration (TBNA), either conventional or endobronchial ultrasound (EBUS)-guided, in the diagnosis and management of bronchogenic cysts. METHODS We systematically searched the PubMed and EmBase databases for studies (until July 2014) reporting TBNA of bronchogenic cysts. Data were recorded on a standard data extraction form and is presented in a descriptive manner. RESULTS Our search yielded 26 studies (32 patients). The median age of the patients was 43 years. Most were men (n=15), symptomatic at presentation (n=19), and had cysts in the paratracheal location (n=14). Endosonography was performed on 16 patients. The EBUS appearance of the lesion was hypoechoic and anechoic in 11 and 5 patients, respectively. Thirty-one patients underwent TBNA (conventional: 16; EBUS-guided: 15). The intent of TBNA was therapeutic in 19 patients and diagnostic or symptomatic palliation in the others. Complications were reported in 5 (16.1%) patients [infective (n=4), bradycardia (n=1)] after TBNA; there were no deaths. The median duration of follow-up was 14 months and no recurrences were detected during the follow-up period. CONCLUSIONS Bronchoscopy is a useful tool in the diagnosis of bronchogenic cysts, both for confirmation of the cystic nature of the lesion by EBUS and diagnosis by TBNA (preferably EBUS-guided) of the cyst fluid. Therapeutic aspiration of the cyst may be an alternative to surgery in adults with mediastinal bronchogenic cysts.
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Tu C, Zhu J, Shao C, Mao W, Zhou X, Lin Q, Li Z, Zhang J, Zhou Q, Chen W. Gastric bronchogenic cysts: A case report and literature review. Exp Ther Med 2016; 11:1265-1270. [PMID: 27073434 PMCID: PMC4812213 DOI: 10.3892/etm.2016.3067] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2014] [Accepted: 01/29/2016] [Indexed: 12/11/2022] Open
Abstract
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.
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Affiliation(s)
- Chaoyong Tu
- Department of General Surgery, Lishui Central Hospital, Lishui, Zhejiang 323000, P.R. China
| | - Jingde Zhu
- Department of General Surgery, Lishui Central Hospital, Lishui, Zhejiang 323000, P.R. China
| | - Chuxiao Shao
- Department of General Surgery, Lishui Central Hospital, Lishui, Zhejiang 323000, P.R. China
| | - Weibo Mao
- Department of Pathology, Lishui Central Hospital, Lishui, Zhejiang 323000, P.R. China
| | - Xingmu Zhou
- Department of Pathology, Lishui Central Hospital, Lishui, Zhejiang 323000, P.R. China
| | - Qiaomei Lin
- Department of General Surgery, Lishui Central Hospital, Lishui, Zhejiang 323000, P.R. China
| | - Zhukai Li
- Department of General Surgery, Lishui Central Hospital, Lishui, Zhejiang 323000, P.R. China
| | - Jie Zhang
- Department of General Surgery, Lishui Central Hospital, Lishui, Zhejiang 323000, P.R. China
| | - Qingyue Zhou
- Department of General Surgery, Lishui Central Hospital, Lishui, Zhejiang 323000, P.R. China
| | - Wei Chen
- Department of Hepatobiliary and Pancreatic Surgery, Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang 310009, P.R. China
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EUS-guided tissue acquisition: an evidence-based approach (with videos). Gastrointest Endosc 2014; 80:939-59.e7. [PMID: 25434654 DOI: 10.1016/j.gie.2014.07.066] [Citation(s) in RCA: 93] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2014] [Accepted: 07/17/2014] [Indexed: 02/08/2023]
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20
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Liu R, Adler DG. Duplication cysts: Diagnosis, management, and the role of endoscopic ultrasound. Endosc Ultrasound 2014; 3:152-60. [PMID: 25184121 PMCID: PMC4145475 DOI: 10.4103/2303-9027.138783] [Citation(s) in RCA: 109] [Impact Index Per Article: 10.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2014] [Accepted: 01/29/2014] [Indexed: 02/06/2023] Open
Abstract
Gastrointestinal tract duplication cysts are rare congenital gastrointestinal malformation in young patients and adults. They consist of foregut duplication cysts, small bowel duplication cysts, and large bowel duplication cysts. Endoscopic ultrasound (EUS) has been widely used as a modality for the evaluation and diagnosis of duplication cysts. EUS is the diagnostic tool of choice to investigate duplication cysts since it can distinguish between solid and cystic lesions. The question of whether or not to perform EUS-fine needle aspiration (EUS-FNA) on a lesion suspected of being a duplication cyst is controversial as these lesions can become infected with significant consequences, although EUS-FNA is often required to obtain a definitive diagnosis and to rule out more ominous lesions. This manuscript will review the literature on duplication cysts throughout the body and will also focus on the role of EUS and FNA with regards to these lesions.
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Affiliation(s)
- Roy Liu
- Department of Gastroenterology and Hepatology, University of Utah School of Medicine, Huntsman Cancer Center, Salt Lake City, Utah, USA
| | - Douglas G Adler
- Department of Gastroenterology and Hepatology, University of Utah School of Medicine, Huntsman Cancer Center, Salt Lake City, Utah, USA
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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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Traibi A, El Hammoumi M, El Oueriachi F, Arsalane A, Kabiri EH. [Benign cysts of the mediastinum: series of 28 cases]. Rev Mal Respir 2012. [PMID: 23200583 DOI: 10.1016/j.rmr.2011.09.053] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
INTRODUCTION Benign cystic mediastinal mass form a group of heterogeneous and uncommon lesions. Surgical resection is the gold standard in these conditions. We reported our institutional experience in management of these benign tumours. In this review, cardiac and ganglionary benign mass were excluded. METHODS We retrospectively reviewed the records of 28 patients with benign cysts of the mediastinum, who are operated in our department between January 2003 and December 2009 (7years period). RESULTS There were 13 females (46.4%) and 15 males (53.5%), with a mean age of 36.8years (range: 13-63years). Most lesions (n=22) were equally in the anterior and middle mediastinum, only six were in the posterior mediastinum. Seventeen patients (60.7%) were symptomatic, with chest pain and cough as the most common symptoms. The diagnosis of mediastinal cyst was fortuitous in 11 patients with the waning of an assessment made for another reason. Surgery was indicated in all patients in order to both diagnostic and therapeutic. Posterolateral thoracotomy incision is the most common. Complete resection of the cyst was possible only in 18 cases (64.3%), whereas in ten (35. 7%) other cases part of the cyst was left in place due to tight adhesions to vital structures. After histological study, there were: nine bronchogenic cysts (32.1%), seven hydatid cysts (25%), four cystic lymphangiomas (14.3%), three mature cystic teratomas (10.7%) and three pleuropericardial cysts, one thymic cyst and one parathyroid cyst. The postoperative course was uneventful and no recurrence has been observed until now. CONCLUSION The benign cysts of the mediastinum is a rare entity, the hydatid etiology remains common in our context. Surgical treatment remains the treatment of choice for mediastinal cysts, when the patient is operable, to save the risk of complications or degeneration.
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Affiliation(s)
- A Traibi
- Service de chirurgie thoracique, faculté de médecine et de pharmacie de Rabat, université Mohamed V Souissi, hôpital militaire d'instruction Mohamed V, Hay Riad, Rabat, Morocco
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Jenssen C, Alvarez-Sánchez MV, Napoléon B, Faiss S. Diagnostic endoscopic ultrasonography: Assessment of safety and prevention of complications. World J Gastroenterol 2012; 18:4659-76. [PMID: 23002335 PMCID: PMC3442204 DOI: 10.3748/wjg.v18.i34.4659] [Citation(s) in RCA: 76] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2012] [Revised: 07/06/2012] [Accepted: 07/18/2012] [Indexed: 02/06/2023] Open
Abstract
Endoscopic ultrasonography (EUS) has gained wide acceptance as an important, minimally invasive diagnostic tool in gastroenterology, pulmonology, visceral surgery and oncology. This review focuses on data regarding risks and complications of non-interventional diagnostic EUS and EUS-guided fine-needle biopsy (EUS-FNB). Measures to improve the safety of EUS und EUS-FNB will be discussed. Due to the specific mechanical properties of echoendoscopes in EUS, there is a low but noteworthy risk of perforation. To minimize this risk, endoscopists should be familiar with the specific features of their equipment and their patients’ specific anatomical situations (e.g., tumor stenosis, diverticula). Most diagnostic EUS complications occur during EUS-FNB. Pain, acute pancreatitis, infection and bleeding are the primary adverse effects, occurring in 1% to 2% of patients. Only a few cases of needle tract seeding and peritoneal dissemination have been reported. The mortality associated with EUS and EUS-FNB is 0.02%. The risks associated with EUS-FNB are affected by endoscopist experience and target lesion. EUS-FNB of cystic lesions is associated with an increased risk of infection and hemorrhage. Peri-interventional antibiotics are recommended to prevent cyst infection. Adequate education and training, as well consideration of contraindications, are essential to minimize the risks of EUS and EUS-FNB. Restricting EUS-FNB only to patients in whom the cytopathological results may be expected to change the course of management is the best way of reducing the number of complications.
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Fusaroli P, Caletti G. Case 10-2012: a boy with epigastric pain and a mediastinal mass. N Engl J Med 2012; 366:2529; author reply 2529-30. [PMID: 22738113 DOI: 10.1056/nejmc1204963] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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25
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Kelleher CM, Forcione DG, Gee MS, Mino-Kenudson M. Case records of the Massachusetts General Hospital. Case 10-2012. A 16-year-old boy with epigastric pain and a mediastinal mass. N Engl J Med 2012; 366:1241-9. [PMID: 22455419 DOI: 10.1056/nejmcpc1110055] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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26
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Liu JF, Liu G, Xu B. Acute respiratory distress caused by esophageal duplication canceration in an adult. Gen Thorac Cardiovasc Surg 2012; 60:316-20. [PMID: 22453545 DOI: 10.1007/s11748-010-0731-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2010] [Accepted: 09/18/2010] [Indexed: 01/07/2023]
Abstract
Esophageal duplication (ED) in adults is rare, and ED canceration is very rare. We report a case of acute respiratory embarrassment caused by ED with squamous carcinoma in a 39-year-old man and a review of the literature.
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Affiliation(s)
- Ji-fu Liu
- Department of Thoracic Surgery, General Hospital of Beijing, Unit 5, Nan Men Cang, District of Dong Cheng, Beijing, 100700, PR China.
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27
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Guarner-Argente C, Shah P, Buchner A, Ahmad NA, Kochman ML, Ginsberg GG. Use of antimicrobials for EUS-guided FNA of pancreatic cysts: a retrospective, comparative analysis. Gastrointest Endosc 2011; 74:81-6. [PMID: 21704808 DOI: 10.1016/j.gie.2011.03.1244] [Citation(s) in RCA: 74] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2011] [Accepted: 03/25/2011] [Indexed: 12/13/2022]
Abstract
BACKGROUND Pancreatic cystic lesions present a challenge for patients and physicians alike. Morphology alone is inaccurate in discriminating lesion pathology, and use of EUS-guided FNA (EUS-FNA) improves accuracy. Current American Society for Gastrointestinal Endoscopy guidelines recommend prophylactic antibiotics during FNA of cystic lesions to minimize infection risk. However, evidence pertaining to infection risk has been conflicting. The use of prophylactic antibiotics might not be free of other adverse events and might not prevent infection. OBJECTIVE To assess the impact of antimicrobial therapy for prophylaxis during EUS-FNA of pancreatic cysts. DESIGN Retrospective cohort study. PATIENTS This study involved all patients who underwent EUS-FNA of pancreatic cysts at one institution from May 2007 to April 2010. INTERVENTION Antibiotic prophylaxis for EUS-FNA. MAIN OUTCOME MEASUREMENTS Infection of a pancreatic cyst, fever, or bacteremia after EUS-FNA. Secondary variables included other complications of the procedure related to the use of prophylaxis (ie, allergic reactions, secondary infections). RESULTS EUS-FNA was performed on 253 patients in 266 procedures. Antibiotics were used in 88 endoscopy cases (ATB group), whereas no antibiotics were used in 178 cases (NATB group). There were no differences in patient or cyst characteristics between groups. There were 4 major complications in the NATB group (localized bleeding, 2; pancreatitis, 1; bile leakage, 1) and 2 in the ATB group (possible cyst infection, 1; bile leakage, 1) (P = 1.0). Eight mild adverse events were observed in the NATB group and 6 in the ATB group (P = .56). Infections and antibiotic-related complications occurred in 1 (0.6%) (transient fever) in the NATB group and 4 (4.5%) in the ATB group (local allergic reaction, 2; possible cyst infection, 1; Clostridium difficile diarrhea, 1) (P = .04). LIMITATIONS Retrospective analysis. CONCLUSION The incidence of infectious complications after EUS-FNA of pancreatic cystic lesions, with or without antibiotic prophylaxis, appears very low. We have not observed a protective effect from periprocedural prophylactic antibiotic administration.
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Affiliation(s)
- Carlos Guarner-Argente
- Department of Medicine, University of Pennsylvania School of Medicine, Philadelphia, PA, USA
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28
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Wang KX, Ben QW, Jin ZD, Du YQ, Zou DW, Liao Z, Li ZS. Assessment of morbidity and mortality associated with EUS-guided FNA: a systematic review. Gastrointest Endosc 2011; 73:283-90. [PMID: 21295642 DOI: 10.1016/j.gie.2010.10.045] [Citation(s) in RCA: 269] [Impact Index Per Article: 20.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2010] [Accepted: 10/21/2010] [Indexed: 12/12/2022]
Abstract
BACKGROUND EUS-guided FNA (EUS-FNA) permits both morphologic and cytologic analysis of lesions within or adjacent to the GI tract. Although previous studies have evaluated the accuracy of EUS-FNA, little is known about the complications of EUS-FNA. Moreover, the frequency and severity of complications may vary from center to center and may be related to differences in individual experience. OBJECTIVE To systematically review the morbidity and mortality associated with EUS-FNA. DESIGN MEDLINE and EMBASE were searched to identify relevant English-language articles. MAIN OUTCOME MEASUREMENTS EUS-FNA-specific morbidity and mortality rates. RESULTS We identified 51 articles with a total of 10,941 patients who met our inclusion and exclusion criteria; the overall rate of EUS-FNA-specific morbidity was 0.98% (107/10,941). In the small proportion of patients with complications of any kind, the rates of pancreatitis (36/8246; 0.44%) and postprocedure pain (37/10,941; 0.34%) were 33.64% (36/107) and 34.58% (37/107), respectively. The mortality rate attributable to EUS-FNA-specific morbidity was 0.02% (2/10,941). Subgroup analysis showed that the morbidity rate was 2.44% in prospective studies compared with 0.35% in retrospective studies for pancreatic mass lesions (P=.000), whereas it was 2.33% versus 5.07% for pancreatic cysts (P=.036). LIMITATIONS Few articles reported well-designed, prospective studies and few focused on overall complications after EUS-FNA. CONCLUSIONS EUS-FNA-related morbidity and mortality rates are relatively low, and most associated events are mild to moderate in severity.
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Affiliation(s)
- Kai-Xuan Wang
- Department of Gastroenterology, Changhai Hospital, Second Military Medical University, Shanghai, China
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29
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Infectious Risk Enhanced Because of Endobronchial Ultrasound-guided Transbronchial Needle Aspiration of Bronchogenic Cysts. J Bronchology Interv Pulmonol 2010; 17:283-4. [DOI: 10.1097/lbr.0b013e3181ead75c] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Le Pimpec-Barthes F, Cazes A, Bagan P, Badia A, Vlas C, Hernigou A, Pricopi C, Riquet M. [Mediastinal cysts: clinical approach and treatment]. REVUE DE PNEUMOLOGIE CLINIQUE 2010; 66:52-62. [PMID: 20207297 DOI: 10.1016/j.pneumo.2009.12.009] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/17/2009] [Accepted: 12/17/2009] [Indexed: 05/28/2023]
Abstract
Mediastinal cysts (MC), mainly from embryonic origin, are benign and rare malformative lesions, gathering several varieties according to tissue origin. Diagnosis is mostly obtained thanks to tomodensitometry performance and sometimes by magnetic resonance imaging. It may be more difficult in some atypical topographies and in case of bulky MC. The most frequent, springing from division abnormality from embryonic foregut ("foregut cysts" in English literature), are primarily bronchogenic cysts (50 to 60 % of MC), which are symptomatic in 30 to 80 % of cases. Coelomic cysts, lined by a mesothelium, result from embryologic abnormality by incomplete fusion of mesenchymal coelomic lacunae. Rarely symptomatic, excepted in cases of very large cysts, they are mainly pleuropericardic cysts (PPC) that represent 30 % of MC. Thymic cysts, around 15 % of MC, are most often asymptomatic. Cystic lymphangiomas (CL) are congenital lymphatic malformations more frequent and symptomatic in children. Diagnosed in older patients, they are most often acquired and asymptomatic. The only radical and definitive treatment is complete surgical resection of the cyst. It allows suppression of symptoms, procurement of a formal diagnosis and prevention of complications. This resection, generally indicated for all symptomatic cysts, large-sized even asymptomatic and in case of non formal diagnosis, is now recommended for all kinds of cysts except for asymptomatic PPC. This strategy is justified considering morbidity and mortality rising rates in patients treated by surgical resection at time of local complications of the cyst. Surgery is commonly performed by videothoracoscopy or by video-assisted mini-thoracotomy, mainly for PPC and CL. The more conventional thoracotomy is performed in surgery for cysts, which are adhesive to nearby structures. PPC just need a simple follow-up, and surgery is required only in case of symptoms and increasing size. In total, surgical indications for MC are large and accepted because of null postoperative mortality and very low rate of morbidity thanks to mini-invasive surgery. This militates for early surgery, without waiting for cystic complications leading to peroperative difficulties and increasing risks. This review presents the characteristics of those different cysts and the strategies currently acknowledged for the treatment.
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Affiliation(s)
- F Le Pimpec-Barthes
- Service de Chirurgie Thoracique, Hôpital Européen Georges-Pompidou, 20 rue Leblanc, 75908 Paris cedex 15, France.
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31
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Diehl DL, Cheruvattath R, Facktor MA, Go BD. Infection after endoscopic ultrasound-guided aspiration of mediastinal cysts. Interact Cardiovasc Thorac Surg 2009; 10:338-40. [PMID: 19917550 DOI: 10.1510/icvts.2009.217067] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Foregut duplication cysts are rare congenital anomalies of enteric origin that arise during early embryonic development. They are usually incidentally found on routine imaging studies. The diagnosis can usually be made by computed tomography (CT) and endoscopic ultrasound (EUS) appearance. On CT, cyst attenuation values usually measure 0+/-20 Hounsfield units (HU). Higher HU is possible with hemorrhage, proteinaceous material or septations. At EUS, characteristic location and anechoic as well as hypoechoic but not necessarily anechoic appearance may be suggestive of a foregut duplication cyst. EUS-guided fine needle aspiration (FNA) has been thought to provide a safe, minimally invasive approach to establish the diagnosis. The purpose of this report is to highlight the potential for infectious risk of EUS-FNA for these cysts, and to suggest CT and EUS features that can suggest this diagnosis without FNA. Three patients who underwent EUS-FNA for diagnosis of incidental mediastinal lesions developed cyst infection despite accepted techniques including prophylactic antibiotics. Combined CT and EUS appearance may be sufficient in making this diagnosis without FNA. IV antibiotics may not be completely protective against infectious complications of FNA of mediastinal duplication cysts.
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Affiliation(s)
- David L Diehl
- Department of Gastroenterology, Geisinger Medical Center, Danville, PA 17821, USA.
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Landi B, Palazzo L. The role of endosonography in submucosal tumours. Best Pract Res Clin Gastroenterol 2009; 23:679-701. [PMID: 19744633 DOI: 10.1016/j.bpg.2009.05.009] [Citation(s) in RCA: 43] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2009] [Accepted: 05/26/2009] [Indexed: 01/31/2023]
Abstract
Submucosal tumours (SMTs) are relatively common findings in patients undergoing endoscopy, especially in upper gastrointestinal (GI) tract. This term includes various non-neoplastic and neoplastic conditions. Endoscopic ultrasonography (EUS) is the best imaging procedure to characterise SMT and to determine the need for further explorations. In this review, the following issues will be addressed: the endosonographic features of SMT; the diagnostic accuracy of EUS; the ability of EUS to distinguish benign and malignant SMTs; the value of EUS-guided fine-needle aspiration (FNA); and the influence of EUS on clinical management.
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Affiliation(s)
- Bruno Landi
- Hôpital Européen Georges Pompidou, Paris, France
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Letters to the Editor. Am Surg 2009. [DOI: 10.1177/000313480907500416] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Banner K, Helft S, Kadam J, Miah A, Kaushik N. An unusual cause of dysphagia in a young woman: esophageal duplication cyst. Gastrointest Endosc 2008; 68:793-5. [PMID: 18513721 DOI: 10.1016/j.gie.2008.02.004] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2007] [Accepted: 02/05/2008] [Indexed: 12/10/2022]
Affiliation(s)
- Kenneth Banner
- Department of Medicine, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York 10467, USA
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Sarkar M, Wood R, Oh Y, Hecht TEH, Kaiser L, Wasserstein A, Kochman ML. Presentation and management of acute fistulization of a foregut duplication cyst. Gastrointest Endosc 2008; 68:804-6. [PMID: 18436220 DOI: 10.1016/j.gie.2007.12.054] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2007] [Accepted: 12/31/2007] [Indexed: 02/08/2023]
Affiliation(s)
- Monika Sarkar
- Department of Medicine, Gastroenterology Division, University of Pennsylvania Health System, Philadelphia, Pennsylvania 19104-4283, USA
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Gottlieb K, Elkharwily A. Endoscopic ultrasound evaluation of a cystic lymphangioma of the colon. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2007; 26:1803-1804. [PMID: 18029936 DOI: 10.7863/jum.2007.26.12.1803] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
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Siddiqui AA, Eloubeidi MA. Esophageal endoscopic ultrasound fine-needle aspiration as a diagnostic tool. EXPERT OPINION ON MEDICAL DIAGNOSTICS 2007; 1:423-431. [PMID: 23489360 DOI: 10.1517/17530059.1.3.423] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
Endoscopic ultrasound-guided fine-needle aspiration biopsy (EUS-FNA) may be employed for procurement of a tissue diagnosis in a minimally invasive fashion. In many cases, EUS-FNA excludes the need for more invasive diagnostic procedures when a tissue diagnosis is required. In patients with esophageal neoplasms, EUS-FNA is a safe and accurate tool for the preoperative diagnosis of metastatic spread to the paraesophageal and celiac lymph nodes. EUS-FNA is also increasingly recognized as an accurate, cost-effective and safe means of evaluating and staging patients with lung cancer. EUS-FNA is useful in providing tissue confirmation of cancer in cases in which bronchoscopy or computed tomography-guided approaches has been non-diagnostic. EUS-guided therapies are paving the way for therapeutic/interventional EUS. The interventional endoscopist will now play a more central role in the diagnosis and treatment of various gastrointestinal malignancies by delivering antitumor agents.
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Affiliation(s)
- Ali A Siddiqui
- The University of Texas Southwestern Medical School, Dallas Veterans Affairs Medical Center, Department of Internal Medicine, Dallas, TX, USA
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Eloubeidi MA. Endoscopic Ultrasound-Guided Fine-Needle Aspiration in the Staging and Diagnosis of Patients with Lung Cancer. Semin Thorac Cardiovasc Surg 2007; 19:206-11. [PMID: 17983946 DOI: 10.1053/j.semtcvs.2007.07.008] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/26/2007] [Indexed: 11/11/2022]
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40
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Espeso A, Verma S, Jani P, Sudhoff H. Mediastinal foregut duplication cyst presenting as a rare cause of breathing difficulties in an adult. Eur Arch Otorhinolaryngol 2007; 264:1357-60. [PMID: 17594109 DOI: 10.1007/s00405-007-0364-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2007] [Accepted: 05/23/2007] [Indexed: 12/29/2022]
Abstract
Foregut duplication cysts are rare congenital anomalies of enteric origin. The diagnosis is usually made in infancy. We report the unusual case of a 71-year-old female presenting to the ENT department with shortness of breath and stridor due to an oesophageal reduplication cyst. The presentation, diagnosis and management of this potential pitfall for the unwary are outlined.
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Affiliation(s)
- A Espeso
- Department of Otolaryngology and Skull Base Surgery, Addenbrooke's Hospital, Cambridge, UK.
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41
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Hall DA, Pu RT, Pang Y. Diagnosis of foregut and tailgut cysts by endosonographically guided fine-needle aspiration. Diagn Cytopathol 2007; 35:43-6. [PMID: 17173292 DOI: 10.1002/dc.20573] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Foregut, hindgut, and tailgut cysts are uncommon developmental anomalies. Clinical and radiological diagnosis can present many challenges, especially in adult patients or when the lesions are in unique locations. Thus, diagnosis has traditionally been provided upon surgical resection. We describe the diagnoses of a gastric foregut cyst and a retrorectal tailgut cyst by endosonographically guided fine-needle aspiration in two adults. The common cytologic features of the specimens are ciliated epithelial cells, proteinaceous material with degenerated debris, histiocytes, and benign appearing epithelium of squamous and/or gastrointestinal type that lack cytologic atypia. The identification of ciliated columnar cells is the key finding. Cytologic diagnosis via endosonographically guided fine-needle aspiration of foregut/hindgut cyst is accurate and less traumatic than surgical biopsies.
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Affiliation(s)
- Diane A Hall
- Department of Pathology, University of Michigan Medical Center, Ann Arbor, Michigan 48109, USA
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Shah JN, Muthusamy VR. Minimizing complications of endoscopic ultrasound and EUS-guided fine needle aspiration. Gastrointest Endosc Clin N Am 2007; 17:129-43, vii-viii. [PMID: 17397780 DOI: 10.1016/j.giec.2006.10.002] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
Endoscopic ultrasound (EUS) and EUS-guided fine needle aspiration have become important tools in evaluation of patients who have various gastrointestinal and nongastrointestinal disorders, and are being increasingly utilized at many centers. With over 10 years of worldwide published clinical data, the collective experience suggests that EUS is a safe tool. There are various measures that may be undertaken to help minimize the risks. In light of ongoing advances in interventional techniques and recognition of new procedural indications, the safety of all types of procedures and efforts to minimize EUS-related complications need to be periodically reexamined.
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Affiliation(s)
- Janak N Shah
- Division of Gastroenterology, University of California, San Francisco, 4150 Clement Street, San Francisco, CA 94121, USA.
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Eloubeidi MA. Antibiotics are mandatory before EUS-guided FNA in cystic or semisolid lesions of the mediastinum and the pancreas. Gastrointest Endosc 2006; 63:890. [PMID: 16650573 DOI: 10.1016/j.gie.2005.12.029] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/26/2005] [Accepted: 12/29/2005] [Indexed: 12/10/2022]
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