Abstract
Gastric duplication cysts (GDCs) are a relatively rare congenital anomalies and are mostly diagnosed in the early years of life. Herein, we report a very rare surgical case of adenocarcinoma arising from a GDC with lymph node metastasis. A 78-year-old woman was referred to our hospital because of elevated serum levels of cancer antigen (CA) 19-9. Endoscopic ultrasound, contrast fistulography, and computed tomography showed a cystic lesion communicating with the lesser curvature of the stomach. The serum levels of CA 19-9 were high, and fluorine-18 fluorodeoxyglucose positron emission tomography/computed tomography (18F-FDG PET/CT) imaging demonstrated a slightly enlarged lymph node with high FDG uptake after four months. The size of the cyst was unchanged. It was diagnosed as a GDC. The enlarged lymph node was highly likely to be malignant. Hence, we performed a distal gastrectomy involving the origin of entry and whole body of the GDC with en bloc regional lymphadenectomy. The postoperative pathology was consistent with GDC with moderately differentiated adenocarcinoma and lymph node metastasis. Adjuvant chemotherapy with tegafur-gimeracil-oteracil potassium (S-1) was administered for 12 months. At present, the patient is alive, with no recurrence of the lesion even four years after the operation. GDCs in adults are rare and may predispose to malignancy. Early diagnosis and prompt surgical intervention are important for favorable outcomes.
Highlights
Gastric duplication cysts (GDCs) are relatively rare congenital anomalies that are mostly diagnosed in the early years of life
Diagnosis and prompt surgical intervention are important for favorable outcomes
Adenocarcinoma rarely arises from a GDC, and only 16 cases of malignancy have been reported to date [2,3,4,5,6,7,8,9,10,11,12,13,14,15,16]
Summary
Gastric duplication cysts (GDCs) are relatively rare congenital anomalies that are mostly diagnosed in the early years of life. A 78-year-old woman was referred to our hospital because of incidentally elevated serum levels of cancer antigen (CA) 19-9 by medical check including cancer screening with no significant clinical symptoms She had a history of hypertension, but she had no other significant past history nor family history of malignancy. Endoscopic ultrasound (EUS) and contrast fistulography through the hole showed a tubular lesion lined by a mucosal layer contiguous with that of the stomach, and the surrounding muscularis propria was visible in the root of the GDC (Figure 1B, 1C). Abdominal computed tomography (CT) showed a cystic lesion along the lesser curvature of the stomach and lymph node swelling. We followed up these lesions using CT because the patient did not report any discomfort. Differentiated adenocarcinoma confined to the mucosal layer is mainly observed in the proximal part of the duplication cyst (B); deep infiltration by the cancer cells; the layered structure of the cystic wall disappears in the distal part of the duplication cyst (C); vascular invasion (D)
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