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Large bronchogenic cyst of stomach: A case report

View Article: PubMed Central - PubMed

ABSTRACT

Bronchogenic cysts of the stomach are rare congenital benign cysts arising as an abnormal budding from primitive tracheobronchial tree.

They are lined by pseudostratified columnar ciliated epithelium and contain smooth muscle fibers, mucous glands and/or cartilage in the cyst wall.

They are most frequently located close to the gastroesophageal junction or gastric cardia and misdiagnosed as gastrointestinal stromal tumor on preoperative imaging.

Surgical excision is the most preferred treatment as it helps in relieving the symptoms as well as confirms the diagnosis.

Surgical excision is the most preferred treatment as it helps in relieving the symptoms as well as confirms the diagnosis.

No MeSH data available.


Related in: MedlinePlus

Contrast enhanced computed tomography of abdomen showing a large gastric mass with heterogenous content and enhancing wall arising from the posterior wall of the gastric cardia and its relation with the esophagus, diaphragm and splenic hilum in the axial (a, b), coronal (b) and sagittal view (d).
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fig0005: Contrast enhanced computed tomography of abdomen showing a large gastric mass with heterogenous content and enhancing wall arising from the posterior wall of the gastric cardia and its relation with the esophagus, diaphragm and splenic hilum in the axial (a, b), coronal (b) and sagittal view (d).

Mentions: A 65-year-old lady presented with history of epigastric pain for 2 months. There was no history of associated vomiting, hematemesis or weight loss. She had previous history of total thyroidectomy for thyroid nodule and laparoscopic cholecystectomy for gallstones. On examination, there was no anemia, icterus or palpable abdominal lump. Routine blood investigations and tumor markers were within normal range. Abdominal ultrasound revealed a heterogenous lesion in the subdiaphragmmatic location close to the medial surface of spleen measuring 6 × 7 cm with echogenic center. Computed tomography (CT) showed a large mass of 7 × 8 cm in relation to the gastric cardia with regular outlines and heterogeneous enhancement (Fig. 1). Upper gastrointestinal endoscopy found large ulcerated fundic folds with a bulge in to the lumen suggestive of extrinsic compression. There was presence of congestive gastropathy. Esophagus was normal. Biopsy from fundic mucosa showed moderately active chronic gastritis with absence of intestinal metaplasia or H. pylori infection or malignancy in the samples examined. Based on the above findings, gastrointestinal stromal tumor was suspected and she was planned for tumor excision. On abdominal exploration, an exophytic mass measuring 8 × 7 cm was found arising from the gastric cardia adherent to the adjoining diaphragm and encroaching upon the splenic hilum (Fig. 2). After dissection, the mass could be separated from the diaphragm and splenic hilum. Because of the large size, total gastrectomy with Roux-en-Y esophagojejunal anastomosis was performed. The postoperative course was uneventful and patient was discharged on postoperative day 7. The cyst contained thick mucinous fluid. Histopathological examination of the resected specimen revealed a sub-mucosal cyst lined by PCCE without cellular atypia (Fig. 3). There was no communication between the cyst and the gastric lumen. The cystic wall consisted of smooth muscle fibers with focal mucous glands showing hemorrhagic remodeling with hemosiderin deposits (Fig. 3, Fig. 4). The gastric mucosa showed mild chronic gastritis with presence of H. pylori without intestinal metaplasia. Based on these findings, final diagnosis of bronchogenic cyst was made. On the last follow up at one year, she was symptom free with no evidence of recurrence.


Large bronchogenic cyst of stomach: A case report
Contrast enhanced computed tomography of abdomen showing a large gastric mass with heterogenous content and enhancing wall arising from the posterior wall of the gastric cardia and its relation with the esophagus, diaphragm and splenic hilum in the axial (a, b), coronal (b) and sagittal view (d).
© Copyright Policy - CC BY-NC-ND
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC5384289&req=5

fig0005: Contrast enhanced computed tomography of abdomen showing a large gastric mass with heterogenous content and enhancing wall arising from the posterior wall of the gastric cardia and its relation with the esophagus, diaphragm and splenic hilum in the axial (a, b), coronal (b) and sagittal view (d).
Mentions: A 65-year-old lady presented with history of epigastric pain for 2 months. There was no history of associated vomiting, hematemesis or weight loss. She had previous history of total thyroidectomy for thyroid nodule and laparoscopic cholecystectomy for gallstones. On examination, there was no anemia, icterus or palpable abdominal lump. Routine blood investigations and tumor markers were within normal range. Abdominal ultrasound revealed a heterogenous lesion in the subdiaphragmmatic location close to the medial surface of spleen measuring 6 × 7 cm with echogenic center. Computed tomography (CT) showed a large mass of 7 × 8 cm in relation to the gastric cardia with regular outlines and heterogeneous enhancement (Fig. 1). Upper gastrointestinal endoscopy found large ulcerated fundic folds with a bulge in to the lumen suggestive of extrinsic compression. There was presence of congestive gastropathy. Esophagus was normal. Biopsy from fundic mucosa showed moderately active chronic gastritis with absence of intestinal metaplasia or H. pylori infection or malignancy in the samples examined. Based on the above findings, gastrointestinal stromal tumor was suspected and she was planned for tumor excision. On abdominal exploration, an exophytic mass measuring 8 × 7 cm was found arising from the gastric cardia adherent to the adjoining diaphragm and encroaching upon the splenic hilum (Fig. 2). After dissection, the mass could be separated from the diaphragm and splenic hilum. Because of the large size, total gastrectomy with Roux-en-Y esophagojejunal anastomosis was performed. The postoperative course was uneventful and patient was discharged on postoperative day 7. The cyst contained thick mucinous fluid. Histopathological examination of the resected specimen revealed a sub-mucosal cyst lined by PCCE without cellular atypia (Fig. 3). There was no communication between the cyst and the gastric lumen. The cystic wall consisted of smooth muscle fibers with focal mucous glands showing hemorrhagic remodeling with hemosiderin deposits (Fig. 3, Fig. 4). The gastric mucosa showed mild chronic gastritis with presence of H. pylori without intestinal metaplasia. Based on these findings, final diagnosis of bronchogenic cyst was made. On the last follow up at one year, she was symptom free with no evidence of recurrence.

View Article: PubMed Central - PubMed

ABSTRACT

Bronchogenic cysts of the stomach are rare congenital benign cysts arising as an abnormal budding from primitive tracheobronchial tree.

They are lined by pseudostratified columnar ciliated epithelium and contain smooth muscle fibers, mucous glands and/or cartilage in the cyst wall.

They are most frequently located close to the gastroesophageal junction or gastric cardia and misdiagnosed as gastrointestinal stromal tumor on preoperative imaging.

Surgical excision is the most preferred treatment as it helps in relieving the symptoms as well as confirms the diagnosis.

Surgical excision is the most preferred treatment as it helps in relieving the symptoms as well as confirms the diagnosis.

No MeSH data available.


Related in: MedlinePlus