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.
Highlights
Duplications of the alimentary tract are relatively rare congenital anomalies
The structure of a gastric duplication cyst (GDC) consists of a smooth muscle coat lined by a mucous membrane, in most cases containing a typical gastric epithelium [2], a small intestinal or colonic mucosa may be present
We report a case of GDC with respiratory epithelium, misdiagnosed as a gastrointestinal stromal tumor (GIST) at endoscopic ultrasound (EUS)
Summary
Duplications of the alimentary tract are relatively rare congenital anomalies. Those located in the stomach are very uncommon, constituting between 4 and 9% of all intestinal duplications [1]. The structure of a gastric duplication cyst (GDC) consists of a smooth muscle coat lined by a mucous membrane, in most cases containing a typical gastric epithelium [2], a small intestinal or colonic mucosa may be present. They are single and do not communicate with gastric lumen. Epithelium with cardial glands but most of the cystic wall was lined by a pseudostratified columnar ciliated epithelium (Figure 3) These features were consistent with a diagnosis of foregut duplication cyst of the stomach
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