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Zhao T, Kwan M, Barrera CA, Shroff S, Oliva E. Retroperitoneal Foregut Duplication Cyst Containing Gastric, Respiratory, and Pancreatic Tissue Misinterpreted as an Adrenal Mass on Imaging: A Case Report and Review of the Literature. Int J Surg Pathol 2024; 32:780-786. [PMID: 37525554 DOI: 10.1177/10668969231188899] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/02/2023]
Abstract
Foregut duplication cyst is most commonly seen in the posterior mediastinum without communication with adjacent organs or presence of other malformations and typically shows ectopic gastric or respiratory epithelium. The finding of ectopic pancreatic tissue is extremely rare. A 15-year-old female patient presented with elevated blood pressure, intermittent right flank pain for 18 months. An abdominal MRI revealed a 4 cm right cystic retroperitoneal mass, initially thought to arise from the right adrenal gland. Intraoperatively, the mass was centered in the retroperitoneum between the right adrenal gland and kidney, without attachments to these organs and no communication with other structures, and it was completely excised. Gross examination revealed a 3.5 cm well-circumscribed solid and cystic mass with orange-white cut surface and cloudy fluid surrounded by variable amounts of adipose tissue. On microscopic examination, the cysts were lined by respiratory and gastric antral/oxyntic-type mucosa, surrounded by muscularis mucosae, submucosal tissue, muscularis propria, and perienteric tissue. Within the muscular propria, exocrine pancreatic tissue was also noted. The patient is well with 7-months of follow up. This case is the first one reporting gastric, respiratory, and pancreatic epithelia.
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Affiliation(s)
- Ting Zhao
- Department of Pathology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Melanie Kwan
- Department of Pathology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Christian A Barrera
- Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Stuti Shroff
- Department of Pathology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Esther Oliva
- Department of Pathology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
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Yoshikawa C, Migita K, Yamato I, Ueno M, Kashizuka H, Murakami K, Ishikawa H. Acute peritonitis caused by the acute pancreatitis of an ectopic pancreas in a jejunal duplication, in an adult with intestinal malrotation: a case report. Surg Case Rep 2023; 9:150. [PMID: 37638994 PMCID: PMC10462583 DOI: 10.1186/s40792-023-01736-2] [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: 06/20/2023] [Accepted: 08/21/2023] [Indexed: 08/29/2023] Open
Abstract
BACKGROUND Intestinal duplication and ectopic pancreas are two rare independent congenital anomalies. Few reports describe cases of patients with ectopic pancreas in an intestinal duplication causing acute peritonitis. CASE PRESENTATION A 31-year-old man was admitted to the hospital for epigastric pain. The patient was diagnosed with acute peritonitis caused by the acute pancreatitis of an ectopic pancreas in a jejunal duplication, with intestinal malrotation. The patient underwent the partial resection of the jejunum and Ladd's procedure. The histopathological findings indicated ectopic pancreatitis in the jejunal duplication. CONCLUSIONS We presented the case of acute peritonitis caused by the acute pancreatitis of an ectopic pancreas in a jejunal duplication in an adult with intestinal malrotation. Surgery is the primary treatment and is necessary for a definitive diagnosis.
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Affiliation(s)
- Chihiro Yoshikawa
- Department of Surgery, Nara Prefecture Seiwa Medical Center, 1-14-16 Mimuro Sango-Cho Ikoma-Gun, Nara, 636-0802, Japan.
| | - Kazuhiro Migita
- Department of Surgery, Nara Prefecture Seiwa Medical Center, 1-14-16 Mimuro Sango-Cho Ikoma-Gun, Nara, 636-0802, Japan
| | - Ichiro Yamato
- Department of Surgery, Nara Prefecture Seiwa Medical Center, 1-14-16 Mimuro Sango-Cho Ikoma-Gun, Nara, 636-0802, Japan
| | - Masato Ueno
- Department of Surgery, Nara Prefecture Seiwa Medical Center, 1-14-16 Mimuro Sango-Cho Ikoma-Gun, Nara, 636-0802, Japan
| | - Hisanori Kashizuka
- Department of Surgery, Nara Prefecture Seiwa Medical Center, 1-14-16 Mimuro Sango-Cho Ikoma-Gun, Nara, 636-0802, Japan
| | - Koichi Murakami
- Department of Surgery, Nara Prefecture Seiwa Medical Center, 1-14-16 Mimuro Sango-Cho Ikoma-Gun, Nara, 636-0802, Japan
| | - Hirofumi Ishikawa
- Department of Surgery, Nara Prefecture Seiwa Medical Center, 1-14-16 Mimuro Sango-Cho Ikoma-Gun, Nara, 636-0802, Japan
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An adult case of a retroperitoneal isolated enteric duplication cyst with the imaging changes over time. Surg Case Rep 2021; 7:258. [PMID: 34914020 PMCID: PMC8677869 DOI: 10.1186/s40792-021-01337-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2021] [Accepted: 11/24/2021] [Indexed: 11/23/2022] Open
Abstract
Background Adult cases of retroperitoneal isolated enteric duplication cyst (IEDC) are rare, with only 17 case reports in the relevant literature. We herein present a case, which was characterized by changes in intra-cystic density on computed tomography (CT), which was safely resected by laparoscopic surgery. Case presentation The patient was a 60-year-old male who received abdominal CT to investigate the cause of increased serum CA19-9 levels. CT revealed a unilocular cystic mass located in the lower right retroperitoneum. The size increased from 5 to 10 cm in three and a half years and the CT value decreased from 101 Hounsfield Units (HU) to 20 HU. We performed laparoscopic surgical resection, because the possibility that the enlargement of the lesion represented malignant transformation could not be denied. The large cystic mass firmly adhered to the appendix and its mesentery via the retroperitoneum, the appendix was resected en bloc with the cystic lesion. Microscopically, it had no communication with the appendix, and had an intestinal wall structure of muscularis mucosae and muscularis propria. The final pathological diagnosis was IEDC in the retroperitoneal space. There was no histological evidence of malignancy. Conclusion When we encounter a retroperitoneal cystic lesion, we should consider the possibility of malignancy to determine the treatment strategy and perform a careful operation without breaking the cyst wall, irrespective of the preoperative diagnosis.
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Sasaki N, Okamura M, Kanto S, Tatsumi K, Yasuda S, Kawabe A. Laparoscopic excision of a retroperitoneal completely isolated enteric duplication cyst in an adult male: A case report and review of literature. Int J Surg Case Rep 2018; 46:1-5. [PMID: 29626802 PMCID: PMC6000737 DOI: 10.1016/j.ijscr.2018.03.035] [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: 02/10/2018] [Accepted: 03/23/2018] [Indexed: 01/07/2023] Open
Abstract
INTRODUCTION Duplication cysts are very rare congenital malformations in adults. They are lined by gastrointestinal mucosa, connect to the digestive tract, and share smooth muscular layers and a common blood supply. In rare cases, duplication cysts are completely isolated from the digestive tract and have a proper blood supply. Completely isolated duplication cysts in the retroperitoneum are unusual so it is hard to diagnose them without a surgical resection. PRESENTATION OF CASE A 19-year-old male presented at our emergency department with sharp abdominal pain. Contrast-enhanced computed tomography detected a 5-cm multilocular cystic mass located in the retroperitoneum, caudal to the pancreatic body. The cystic mass was safely resected with laparoscopic surgery without any complication. The final pathological diagnosis was an epithelium-lined duplication cyst in the retroperitoneal space. There was no evidence of malignancy in the duplication cyst. Intracystic bleeding was assumed to be the cause of the abdominal pain. DISCUSSION The most common differential diagnoses of retroperitoneal cystic masses are pseudocysts related to pancreatitis, cysts from surrounding structures, and neoplasms. In this case, the cystic mass was diagnosed as completely isolated duplication cyst after surgical resection. It is very rarely observed in adults, but it should be listed on differential diagnoses because it has some possibility of malignancy. CONCLUSION A completely isolated duplication cyst is very rare but noteworthy because there is some possibility of malignancy, ulcerative bleeding, and perforation. A surgical resection is recommended for diagnostic treatment. Laparoscopic surgery is favorable for intraoperative inspection and it is minimally invasive.
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Affiliation(s)
- Naoya Sasaki
- Department of Surgery, Hikone Municipal Hospital, 1882 Hassaka-cho, Hikone-shi, Shiga Prefecture, Japan.
| | - Miru Okamura
- Department of Surgery, Hikone Municipal Hospital, 1882 Hassaka-cho, Hikone-shi, Shiga Prefecture, Japan.
| | - Satoshi Kanto
- Department of Surgery, Hikone Municipal Hospital, 1882 Hassaka-cho, Hikone-shi, Shiga Prefecture, Japan.
| | - Kentaro Tatsumi
- Department of Surgery, Hikone Municipal Hospital, 1882 Hassaka-cho, Hikone-shi, Shiga Prefecture, Japan.
| | - Seiichi Yasuda
- Department of Surgery, Hikone Municipal Hospital, 1882 Hassaka-cho, Hikone-shi, Shiga Prefecture, Japan.
| | - Atsushi Kawabe
- Department of Surgery, Hikone Municipal Hospital, 1882 Hassaka-cho, Hikone-shi, Shiga Prefecture, Japan.
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Juillerat A, Rougemont AL, Wildhaber BE. [Duplication of the gallbladder with heterotopic mucosa: A case report and proposal for a classification for gastrointestinal duplications]. Arch Pediatr 2016; 23:607-11. [PMID: 27021880 DOI: 10.1016/j.arcped.2016.02.014] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2015] [Revised: 10/18/2015] [Accepted: 02/19/2016] [Indexed: 12/24/2022]
Abstract
BACKGROUND Gastrointestinal duplications are rare congenital malformations that can occur anywhere between the mouth and the anus, including the digestive annexes. Numerous classifications of these malformations exist, varying from one author to another. This study describes a rare case of gallbladder duplication and suggests a unified classification of gastrointestinal duplications in order to merge epidemiological and clinical considerations. CASE REPORT A 13-year-old boy presented with acute abdominal pain. Investigations revealed a cystic structure located in the gallbladder combined with lithiasis. Following an elective laparoscopic cholecystectomy, the diagnosis of gallbladder duplication in association with heterotopic gastrointestinal mucosa and pancreatic micro-clusters was made. The patient is in excellent health 4 years after surgery. COMMENTARY AND CONCLUSION This atypical duplication is rare and can most likely be explained by the proximity between the pancreas and gastrointestinal tract during their development: the intestinal metaplasia and the development of the gastric mucosa may further represent congenital lesions due to aberrant migration of normal tissue, or could be secondary to a chronic inflammatory response in the gallbladder. The revised standardized classification we propose is based on the accurate identification, precise location and detailed histology of the lesions.
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Affiliation(s)
- A Juillerat
- Centre universitaire romand de chirurgie pédiatrique, service de chirurgie pédiatrique, département de pédiatrie, hôpitaux universitaires de Genève, rue Willy-Donzé 6, 1211 Genève 14, Suisse
| | - A-L Rougemont
- Service de pathologie clinique, département de médecine génétique et de laboratoire, hôpitaux universitaires de Genève, Genève, Suisse
| | - B E Wildhaber
- Centre universitaire romand de chirurgie pédiatrique, service de chirurgie pédiatrique, département de pédiatrie, hôpitaux universitaires de Genève, rue Willy-Donzé 6, 1211 Genève 14, Suisse.
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Ciliated pancreatic foregut cyst: MRI, EUS, and cytologic features. Clin Imaging 2016; 40:140-3. [DOI: 10.1016/j.clinimag.2015.10.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2015] [Revised: 09/21/2015] [Accepted: 10/08/2015] [Indexed: 11/20/2022]
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Abstract
A 21-day-old Thoroughbred colt was euthanized following a history of recurrent colic. A 4.5 cm in diameter, occlusive, submucosal cyst was identified in the duodenum at necropsy. Histologically, the cyst was surrounded by a smooth muscle wall and was lined by both squamous and attenuated cuboidal to columnar epithelium. A diagnosis of an esophageal cyst was made based on the gross and histologic findings.
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Affiliation(s)
- Alan T Loynachan
- 1Alan T. Loynachan, Veterinary Diagnostic Laboratory, University of Kentucky, 1490 Bull Lea Road, Lexington, KY 40511.
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Tsai SD, Sopha SC, Fishman EK. Isolated duodenal duplication cyst presenting as a complex solid and cystic mass in the upper abdomen. J Radiol Case Rep 2014; 7:32-7. [PMID: 24421928 DOI: 10.3941/jrcr.v7i11.1785] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Abstract
Duodenal duplication cysts are a rare subtype of gastrointestinal duplications cysts. Approximately 5% of gastrointestinal duplication cysts occur in the duodenum. An 18-year-old woman presented with epigastric pain and a subjective abdominal bulge. A computed tomography scan was subsequently performed and showed a solid and cystic mass with wall calcifications in the lesser sac of the upper abdomen. A duodenal duplication cyst was found unexpectedly on histopathologic analysis. This was also an unusual case as there was no evidence of malignancy. Four years after surgery, the patient remains asymptomatic. We present a brief literature review on duodenal duplication cysts and discuss its differential diagnosis.
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Affiliation(s)
- Salina D Tsai
- The Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins Medical Institutions, Baltimore, MD, USA
| | - Sabrina C Sopha
- Department of Pathology, Johns Hopkins Hospital, Baltimore, MD, USA
| | - Elliot K Fishman
- The Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins Medical Institutions, Baltimore, MD, USA
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Lopez MJ, Bradley TH, Harrison AJ, Alseidi AA. Perforated tubular duodenal duplication in a 79 year old woman: Case report and review of the literature. Int J Surg Case Rep 2013; 4:623-5. [DOI: 10.1016/j.ijscr.2013.03.030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2013] [Revised: 03/12/2013] [Accepted: 03/15/2013] [Indexed: 10/27/2022] Open
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