Retroperitoneal bronchogenic cyst masquerading as an adrenal incidentaloma

We present three cases of retroperitoneal bronchogenic cysts resembling adrenal tumors in adults. Three cases were asymptomatic, and all were located on the left side. There was no significant enhancement of the cyst walls on contrast-enhanced computed tomography. Two cases presented with typical multilocular sacs and scattered calcification on radiology, whereas the other one showed unilocular sacs, without calcification, and elevation of serum carbohydrate antigen (CA) 19-9 and CA 24-2. Three cases underwent retroperitoneal laparoscopic surgeries. Histopathologic examination confirmed the diagnosis of retroperitoneal bronchogenic cysts. There was no recurrence of the three cases during follow-up. A retroperitoneal bronchogenic cyst is mostly asymptomatic. It can be found in adults with variable findings in computed tomography. It can be likely ignored and misdiagnosed as an adrenal tumor. The tests of CA 19-9 and CA 24-2 could help diagnose retroperitoneal bronchogenic cysts. Retroperitoneal laparoscopic surgery is recommended for the treatment of retroperitoneal bronchogenic cysts with a favorable prognosis.

Retroperitoneal bronchogenic cyst, typically situated in the subdiaphragmatic region, is a rare congenital benign developmental abnormality arising from dysplasia of the foregut and abnormal budding of the tracheobronchial tree. Due to its low incidence, there are limited reports regarding this condition. Four retroperitoneal bronchogenic cysts near the left adrenal gland were identified without accompanying clinical symptoms. One case was misdiagnosed as an adrenal tumor prior to surgery, while the others were diagnosed as retroperitoneal cysts of uncertain origin. All cases underwent surgical resection, with three being performed laparoscopically and one utilizing robot-assisted techniques. Pathological reports confirmed the diagnosis of bronchogenic cyst in each instance. The prognosis was favorable for all four patients, with no complications or recurrences observed. Additionally, a literature review was conducted, encompassing 82 cases, which revealed similar characteristics and radiological manifestations in the majority of cases. Although retroperitoneal bronchogenic cysts are rare developmental malformations lacking distinctive clinical and radiological features, reported cases exhibit similarities in certain clinical and imaging characteristics. This report offers additional insights into the diagnosis and management of this rare disease. Future reports are essential to enhance understanding of this disease.

Pancreatic bronchogenic cyst: Easily hidden, difficult to identify

Retroperitoneal Bronchogenic Cyst Managed With Retroperitoneoscopic Surgery

Rationale:Retroperitoneal bronchogenic cysts without specific clinical manifestations are extremely rare and difficult to diagnose preoperatively and are easily misdiagnosed as left adrenal or pancreatic tumors.Patient concerns:A 48-year-old woman with the chief complaint of obscure epigastric pain for 1 month and with no other gastrointestinal symptoms and no significant medical history. The patient had signed informed consent for publication of this case report.Diagnosis:The serum level of carbohydrate antigen 19-9 (CA 19-9) in the patient was >1200 U/mL, which far exceeded the normal level of <37 U/mL. Computed tomography (CT) initially suggested the presence of an adrenal tumor. However, endoscopic ultrasound (EUS) showed that the adrenal gland had an intact capsule and that the mass originated in the retroperitoneal space and did not involve the paranephros.Interventions:Surgical resection was performed on the patient.Outcomes:Histopathological examination demonstrated that the mass was a retroperitoneal bronchogenic cyst. At the 2-month postoperative follow-up, the level of CA 19-9 had returned to normal.Lessons:EUS appears to be superior to CT because it clearly delineated the mass from the surrounding structures of the retroperitoneal region. EUS-fine needle aspiration can be used for diagnosis or determining whether the mass is malignant or benign. To the best of our knowledge, retroperitoneal bronchogenic cysts with significantly elevated serum CA 19-9 have not been reported. Measurement of serum CA 19-9 may be helpful in the diagnosis of retroperitoneal bronchogenic cysts. However, this was a rare case, and the mechanism behind CA 19-9 elevation is not clear and needs further investigation.

Retroperitoneal Bronchogenic Cyst Mimicking Pancreatic Cystic Lesion

A case report- retroperitoneal bronchogenic cyst in relation to the hindgut

Bronchogenic cysts are mostly benign, congenital abnormalities originating from the remnants of the primitive foregut. A retroperitoneal location is rare. Due to the mostly asymptomatic behavior and the historical confusion regarding histology, an exact prevalence is not known. We present here a case report of a retroperitoneal bronchogenic cyst. A literature review was performed for cases of retroperitoneal bronchogenic cysts written in English. Anatomopathological criteria for inclusion were pseudo stratified, ciliated, columnar epithelium together with the presence of at least one of the following: cartilage, smooth muscle or seromucous glands. In addition, the embryology, pathogenesis, radiological, clinical and suggested treatment modalities are reviewed. We report the surgical excision of a retroperitoneal bronchogenic cyst that presented as a non-functioning left adrenal mass. Our review of literature revealed only 62 potential cases of retroperitoneal bronchogenic cysts. After applying the strict anatomopathological criteria, only 30 cases of true retroperitoneal bronchogenic cysts could be identified. Retroperitoneal location of a bronchogenic cyst is rare. Despite the rarity of this pathologic entity, bronchogenic cysts should be considered in the differential diagnosis of retroperitoneal cystic lesions. Only histology can confirm definitive diagnosis. Surgery remains the recommended treatment of choice.

A 32-year-old woman was referred to our hospital for consultation with a suspected left adrenal tumor detected by ultrasonography at a health check. Computed tomography and magnetic resonance imaging revealed a 3×1×4 cm multilocular cystic mass arising from the diaphragmatic crura, suggesting a retroperitoneal bronchogenic cyst. The patient underwent excision of the cyst and adjacent diaphragm using a retroperitoneoscopic approach. Retroperitoneal bronchogenic cysts are rare. We review the cases of 26 patients who underwent laparoscopic resection of a retroperitoneal bronchogenic cyst.

Retroperitoneal bronchogenic cysts are extremely rare congenital anomalies that represent malformations of the embryonic foregut and are morphologically expressed as maldevelopments of the respiratory system. Because of the low prevalence of these tumors, their imaging features have seldom been described. We present the computed tomographic and magnetic resonance imaging findings of a case of retroperitoneal bronchogenic cyst.

Subdiaphragmatic bronchogenic cyst masquerading as an "adrenal incidentaloma".

Bronchogenic cyst is a benign lesion with congenital dysplasia. Although the occurrence of this type of cyst is rare in the retroperitoneum, the presence of fluid-fluid levels is an even rarer phenomenon in bronchogenic cysts. Therefore, it can be easily misdiagnosed due to the lack of a universal guideline of specific imaging manifestations. The present report describes the case of a patient with a bronchogenic cyst with fluid-fluid levels whilst also performing a brief literature review to summarize the findings of previous reports on this condition. A 48-year-old male individual presented with severe lower back pain without any obvious causes. A CT scan revealed a low-density cystic mass of ~3x4x6 cm in the left front of the T12-L2 area, which originated from the left crus of the diaphragm. MRI revealed a fluid-fluid level in the cyst. Anterior thoracolumbar surgery was performed to completely resect the mass. During the surgery, it was confirmed that the cyst originated from the left crus of the diaphragm and the lesion was diagnosed to be a bronchogenic cyst by pathological analysis. The patient's symptoms improved after the surgery and no recurrence of the cyst was observed during the 3-year follow-up period. The presence of a fluid-fluid level in a retroperitoneal bronchogenic cyst is rare, particularly in the abdominal aorta and paravertebral regions, rendering it easily misdiagnosed. It may be associated with protein, hemorrhage and calcium-containing mucus deposition in the cysts. In the present study, a rare case of fluid-fluid level in bronchogenic cyst was reported and a literature review was provided.

Bronchogenic cyst is considered to be a benign morphological abnormality in the development of the primitive foregut, which usually occurs in the thorax, particularly in the mediastinum. Subdiaphragmatic and retroperitoneal locations in particular are unusual. It is usually asymptomatic. Clinical presentations are related to complicated forms (infection, haemorrhage and extrinsic compression). Imaging rarely contributes to the diagnosis. Only histopathological examination allows a definitive diagnosis of retroperitoneal bronchogenic cyst. Surgical resection is the therapeutic strategy of choice. We report a peculiar presentation of a symptomatic retroperitoneal bronchogenic cyst that can be confused with adrenal masses. Keywords: bronchogenic cyst; retroperitoneum; adrenal gland; surgical resection.

A Retroperitoneal Bronchogenic Cyst Treated With Laparoscopic Surgery

Retroperitoneal bronchogenic cysts (RBCs) are regarded as a rare type of congenital dysplasia disease that stems from the primitive foregut. Thus far, the exact pathogenesis of RBCs remains unknown. Due to an atypical clinical manifestation, RBCs are often incidentally detected and diagnosed by imaging modalities, such as computed tomography and magnetic resonance imaging. However, they are easily misdiagnosed due to their non-specific imaging features. Additionally, the most appropriate treatment strategy for an RBC is considered to be surgical resection. The present study reports the rare case of a 36-year-old female with a large RBC containing fatty fluid that was previously misdiagnosed as liposarcoma or cystic teratoma. Following a complex surgical resection, pathological findings confirmed a diagnosis of RBC. The follow-up examination showed that the patient was in good health at 16 months post-surgery, with no evidence of recurrence. Although rare, bronchogenic cysts must be considered in the differential diagnosis of retroperitoneal teratoma, and surgical resection should be pursued for symptom resolution and to establish a definitive histology.