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Double esophageal duplication cysts, with ectopic gastric mucosa: a case report.

Zhang Z, Jin F, Wu H, Tan S, Tian Z, Cui Y - J Cardiothorac Surg (2013)

Bottom Line: The small (1-cm) esophageal cyst was left untreated based on a "wait-and-see" policy.This finding was consistent with a diagnosis of EDC, with ectopic gastric mucosa.The respiratory tract symptoms resolved immediately after the operation.

View Article: PubMed Central - HTML - PubMed

Affiliation: Department of Thoracic Surgery, The First Hospital of Jilin University, 71 Xinmin Street, Changchun 130021, China. doctorcyb@163.com.

ABSTRACT
Esophageal duplication cyst (EDC) is a congenital malformation of the posterior primitive foregut, which mainly occurs in the thoracic esophagus. Here, we describe a 3-year-old Han Chinese boy afflicted with intermittent fever of acute onset and dry cough. Thoracic computed tomography revealed an 10 cm × 5.4 cm × 5.8 cm oval-shaped, cyst-like tumor located in the extrapleural space, extending along the right paravertebral gutter and compressing the trachea forward. An additional small-sized, oval-shaped cyst was identified in the posterior mediastinum, between the esophagus and the spinal column, at the T1 level. During open thoracotomy, under general anesthesia, an opaque, thick-walled, esophageal cyst was revealed not to be in communication with the esophageal lumen or the trachea. This cyst was subsequently resected in an en bloc manner. The small (1-cm) esophageal cyst was left untreated based on a "wait-and-see" policy. Histological analysis showed that the resected cyst was walled by hyperplastic, fibrous tissues and locally lined with gastric mucosa inherent glands. This finding was consistent with a diagnosis of EDC, with ectopic gastric mucosa. The respiratory tract symptoms resolved immediately after the operation. Computed tomography obtained at the 6-month follow-up showed that no disease, residual or recurrence, was present after the resection of the large-sized cyst, and the small-sized cyst remained unchanged in size.

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Intraoperative findings of the large-sized esophageal duplication cyst. (A) A cystic mass was located in the right-sided posterior mediastinum; and (B) gross pathology of the resection specimen containing brownish cystic fluid.
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Figure 3: Intraoperative findings of the large-sized esophageal duplication cyst. (A) A cystic mass was located in the right-sided posterior mediastinum; and (B) gross pathology of the resection specimen containing brownish cystic fluid.

Mentions: Because the cysts were symptomatic and one of them was oversized, elective open thoracotomy was undertaken. A double-lumen endotracheal tube was used to deflate the right lung, and a right-sided thoracotomy was made along the sixth intercostal space. A 10 cm × 5.4 cm × 5.8 cm cyst originating from the right lateral wall of the esophagus at the level of the carina was identified (Figure 3). The cyst wall was approximately 0.3 cm in thickness and moderately adherent to the membranous part of the right main bronchus and the dorsal segment of the right lower lobe; however, it was not in communication with the esophageal lumen or the bronchopulmonary tree. The cyst was punctured and deflated using an 18-gauge needle. Roughly 200 ml of brownish, viscous fluid, suggestive of intracystic hemorrhage, was drained away. The thoracic duct, esophageal mucosa, and vagus nerve were all well-preserved, and the cyst was mobilized and removed in an en bloc manner. The small esophageal cyst was left untreated based on a “wait-and-see” policy. This cyst was located at the thoracic entrance (the junction between the cervical portion and the thoracic portion of the esophagus) and was not easily accessible through the sixth intercostal space incision.


Double esophageal duplication cysts, with ectopic gastric mucosa: a case report.

Zhang Z, Jin F, Wu H, Tan S, Tian Z, Cui Y - J Cardiothorac Surg (2013)

Intraoperative findings of the large-sized esophageal duplication cyst. (A) A cystic mass was located in the right-sided posterior mediastinum; and (B) gross pathology of the resection specimen containing brownish cystic fluid.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4222059&req=5

Figure 3: Intraoperative findings of the large-sized esophageal duplication cyst. (A) A cystic mass was located in the right-sided posterior mediastinum; and (B) gross pathology of the resection specimen containing brownish cystic fluid.
Mentions: Because the cysts were symptomatic and one of them was oversized, elective open thoracotomy was undertaken. A double-lumen endotracheal tube was used to deflate the right lung, and a right-sided thoracotomy was made along the sixth intercostal space. A 10 cm × 5.4 cm × 5.8 cm cyst originating from the right lateral wall of the esophagus at the level of the carina was identified (Figure 3). The cyst wall was approximately 0.3 cm in thickness and moderately adherent to the membranous part of the right main bronchus and the dorsal segment of the right lower lobe; however, it was not in communication with the esophageal lumen or the bronchopulmonary tree. The cyst was punctured and deflated using an 18-gauge needle. Roughly 200 ml of brownish, viscous fluid, suggestive of intracystic hemorrhage, was drained away. The thoracic duct, esophageal mucosa, and vagus nerve were all well-preserved, and the cyst was mobilized and removed in an en bloc manner. The small esophageal cyst was left untreated based on a “wait-and-see” policy. This cyst was located at the thoracic entrance (the junction between the cervical portion and the thoracic portion of the esophagus) and was not easily accessible through the sixth intercostal space incision.

Bottom Line: The small (1-cm) esophageal cyst was left untreated based on a "wait-and-see" policy.This finding was consistent with a diagnosis of EDC, with ectopic gastric mucosa.The respiratory tract symptoms resolved immediately after the operation.

View Article: PubMed Central - HTML - PubMed

Affiliation: Department of Thoracic Surgery, The First Hospital of Jilin University, 71 Xinmin Street, Changchun 130021, China. doctorcyb@163.com.

ABSTRACT
Esophageal duplication cyst (EDC) is a congenital malformation of the posterior primitive foregut, which mainly occurs in the thoracic esophagus. Here, we describe a 3-year-old Han Chinese boy afflicted with intermittent fever of acute onset and dry cough. Thoracic computed tomography revealed an 10 cm × 5.4 cm × 5.8 cm oval-shaped, cyst-like tumor located in the extrapleural space, extending along the right paravertebral gutter and compressing the trachea forward. An additional small-sized, oval-shaped cyst was identified in the posterior mediastinum, between the esophagus and the spinal column, at the T1 level. During open thoracotomy, under general anesthesia, an opaque, thick-walled, esophageal cyst was revealed not to be in communication with the esophageal lumen or the trachea. This cyst was subsequently resected in an en bloc manner. The small (1-cm) esophageal cyst was left untreated based on a "wait-and-see" policy. Histological analysis showed that the resected cyst was walled by hyperplastic, fibrous tissues and locally lined with gastric mucosa inherent glands. This finding was consistent with a diagnosis of EDC, with ectopic gastric mucosa. The respiratory tract symptoms resolved immediately after the operation. Computed tomography obtained at the 6-month follow-up showed that no disease, residual or recurrence, was present after the resection of the large-sized cyst, and the small-sized cyst remained unchanged in size.

Show MeSH
Related in: MedlinePlus