The first case of intraperitoneal bronchogenic cyst in Korea.

Abstract

To the editor: We read with interest the article by Kim et al., first case of intraperitoneal bronchogenic cyst in Korea mimicking a gallbladder tumor on the June 2004 issue of J Korean Med Sci (1). In their report, they emphasized the case was the first case of intraperitoneal bronchogenic cyst in Korea. However, we found two other previously reported cases of intraperitoneal bronchogenic or foregut cyst through search of the Korean literature (2, 3) and a case of subphrenic bronchogenic cyst near the liver through a search of the English literature (4). Thus, it seems to be controversial whether the case of Kim et al. should be the first example of intraperitoneal bronchogenic cyst in Korea. Furthermore, they described, Among the cysts of foregut origin, those containing cartilage or seromucinous respiratory glands are designated as bronchogenic cysts; those containing two well-developed layers of smooth muscle without cartilage are designated as esophageal cysts; and those with none of these distinguishing features are classified as foregut cysts in their discussion. However, there was no mention whether their case contained cartilage or seromucinous respiratory glands. They only described Microscopically, the cyst is lined by a layer of pseudostratified ciliated columnar epithelial cells occasionally interspersed with goblet cells. Thus, the cyst was histologically diagnosed as a bronchogenic Considering these two sentences, the more appropriate diagnosis would have been a foregut cyst. Indeed, clear diagnostic criteria are required especially for the diagnosis of bronchogenic cysts in unusual locations (6), and the most reliable criterion is the presence of cartilage in the wall (7). Practically, however, it is often difficult to find. Therefore, the criteria referenced by Kim et al. (5) seem to be rational. Although Park et al. reported their case as a bronchogenic cyst, they also suggested that the diagnosis of their case was controversial because there was no cartilage or seromucinous glands (2). The case of Kim et al. (4) contained identifiable hyaline cartilage and therefore is supposed to be the subdiaphragmatic bronchogenic cyst according to well established histologic criteria.