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IMAGES Table of Contents   
Year : 2010  |  Volume : 53  |  Issue : 4  |  Page : 829-830
Foregut duplication cysts of stomach masquerading as leiomyoma


1 Department of Pathology, Indira Gandhi Medical College, Shimla, India
2 Department of Anatomy, Indira Gandhi Medical College, Shimla, India

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Date of Web Publication27-Oct-2010
 

How to cite this article:
Mardi K, Kaushal V, Gupta S. Foregut duplication cysts of stomach masquerading as leiomyoma. Indian J Pathol Microbiol 2010;53:829-30

How to cite this URL:
Mardi K, Kaushal V, Gupta S. Foregut duplication cysts of stomach masquerading as leiomyoma. Indian J Pathol Microbiol [serial online] 2010 [cited 2019 Dec 7];53:829-30. Available from: http://www.ijpmonline.org/text.asp?2010/53/4/829/72064


Foregut duplication cysts are rare but are well documented. Even more exceptional are those occurring in the stomach. [1] These malformations are believed to be congenital and are formed before differentiation of the lining epithelium; therefore, named for the organs with which they are associated. [2] In majority of reported cases, the diagnosis is established during surgical exploration. [3] We report a case of foregut duplication cyst arising from the stomach in a 42-year-old male which clinically and radiologically mimicked leiomyoma.

Our patient presented with pain in the left lumbar region. Abdominal examination and routine laboratory tests were normal. Upper gastrointestinal endoscopy revealed an extrinsic compression at lower end of esophagus without any mucosal abnormalities. Abdominal computed tomography (CT) revealed a 4.5 to 5.2cm sized, well defined soft tissue density with mild contrast enhancement situated adjacent to anterior aspect of gastrointestinal junction and cardia of the stomach [Figure 1]. Radiologically it was diagnosed as gastric leiomyoma. An exploratory laparotomy was performed and complete excision of the mass lesion was performed. Per-operatively there was a cystic lesion at the lesser curvature of the stomach compressing the gastrointestinal junction. Other parts of the stomach were normal. Postoperative course was uneventful and the patient has been asymptomatic since then. Gross examination of the surgical specimen revealed a unilocular cyst measuring 2.5cm in diameter with a grey-white, rubbery wall. Histopathological examination showed a cyst lined by pseudo-stratified, ciliated, columnar epithelium with a complete lining of smooth muscle bundles [Figure 2].
Figure 1: CT scan showing well defined soft tissue density situated adjacent to anterior aspect of gastrointestinal junction and cardia of stomach

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Figure 2: Photomicrograph showing cystwall lined by pseudo stratified, ciliated, columnar epithelium. (H and E, ×400)

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The term ''gastric duplication'' implies the presence of gastrointestinal mucosa (usually gastric, but may be small intestinal or colonic), whereas the term ''foregut duplication'' is preferred when pseudo stratified ciliated epithelium predominates. Duplication cyst of the stomach with pseudo stratified columnar ciliated epithelium is extremely rare. [4]

There is a controversy over the embryological origin of these anomalies. Foregut duplications are considered to be due to abnormal canalization of the gastrointestinal tract and may be communicating or non-communicating, cystic or tubular. Duplications of the stomach are typically single, non-communicating with the gut, less than 12 cm in diameter and located on the greater curvature or anterior/posterior gastric wall. [2] It has been seen that in 80% of the cases, gastric duplication cysts do not communicate with the gastric lumen. [1]

However, foregut duplication cysts of the stomach are usually diagnosed intraoperatively in adults. [1] The clinical presentation of a foregut duplication cyst of stomach can be highly variable and nonspecific, ranging from vague abdominal complaints, nausea, vomiting, epigastric fullness, weight loss, anemia, dysphagia, dyspepsia. Therefore a foregut duplication cyst can easily be misdiagnosed. The upper gastrointestinal series in cases of foregut duplication cysts demonstrates external pressure on the stomach and because of that can be mistaken for a soft tissue tumor at the gastro esophageal junction. Due to the risk of malignant transformation and the report of gastric cancer arising in duplications of the stomach, surgical excision is considered the best treatment. [5]

In conclusion, foregut duplication cyst of stomach can easily be mistaken for a soft tissue tumor of the gastrointestinal tract and the clinician as well as radiologist must maintain a high degree of suspicion. Although these lesions are very rare, gastric bronchogenic cyst should be included in the differential diagnosis of gastric wall mass.

 
   References Top

1.Theodosopoulos T, Marinis A, Karapanos K, Vassilikostas G, Dafnios N, Samanides L, et al. Foregut duplication cysts of the stomach with respiratory epithelium. World J Gastroenterol 2007;13:1279-81.  Back to cited text no. 1
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2.Cunningham SC, Hansel DE, Fishman EK, Cameron JL. Foregut duplication cyst of the stomach. J Gastrointest Surg 2006;10:620-1.   Back to cited text no. 2
[PUBMED]  [FULLTEXT]  
3.Perek A, Perek S, Kapan M, Goksoy E. Gastric duplication cyst. Dig Surg 2000;17:634-6.  Back to cited text no. 3
    
4.Murakami S, Isozaki H, Shou T, Sakai K, Toyota H. Foregut duplication cyst of the stomach with pseudostratified columnar ciliated epithelium. Pathol Int 2008;58:187-90.  Back to cited text no. 4
[PUBMED]  [FULLTEXT]  
5.Kuraoka K, Nakayama H, KagawaT, IchikawaT, Yasui W. Adenocarcinoma arising from a gastric duplication cyst with invasion to the stomach: a case report with literature review. J Clin Pathol 2004;57:428-31.  Back to cited text no. 5
    

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Correspondence Address:
Kavita Mardi
12-A, Type V Quarters, GAD Colony, Kasumpti, Shimla, H.P.
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0377-4929.72064

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