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  Table of Contents    
CASE REPORT  
Year : 2015  |  Volume : 58  |  Issue : 1  |  Page : 96-98
Bronchogenic cyst mimicking an adrenal mass in the retroperitoneal region: Report of a rare case


1 Department of Pathology, Faculty of Medicine, Yuzuncu Yil University, Van, Turkey
2 Department of Radiology, Van Research and Training Hospital, Van, Turkey
3 Department of General Surgery, Faculty of Medicine, Yuzuncu Yil University, Van, Turkey

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Date of Web Publication11-Feb-2015
 

   Abstract 

We report the surgical excision of a retroperitoneal bronchogenic cyst that presented as a nonfunctioning left adrenal mass in a 25-year-old woman with continuous pain in the left flank. Preoperative biochemical testing confirmed that the mass was nonfunctional. Bronchogenic cysts are mostly benign congenital abnormalities that originate from the remnants of the primitive foregut and typically occur in the lung. Subdiaphragmatic and especially, retroperitoneal locations are rare. Despite the rarity of this pathologic entity, bronchogenic cysts should be considered in the differential diagnosis of retroperitoneal cystic lesions. Diagnosis must be definitively confirmed by histology.

Keywords: Adrenal, bronchogenic cyst, retroperitoneal presentation

How to cite this article:
Bulut G, Bulut MD, Bahadır I, Kotan &. Bronchogenic cyst mimicking an adrenal mass in the retroperitoneal region: Report of a rare case. Indian J Pathol Microbiol 2015;58:96-8

How to cite this URL:
Bulut G, Bulut MD, Bahadır I, Kotan &. Bronchogenic cyst mimicking an adrenal mass in the retroperitoneal region: Report of a rare case. Indian J Pathol Microbiol [serial online] 2015 [cited 2020 Aug 11];58:96-8. Available from: http://www.ijpmonline.org/text.asp?2015/58/1/96/151200



   Introduction Top


Primary retroperitoneal cysts are rare. Bronchogenic cysts originate from the tracheobronchial bud that arises at the embryonic foregut. These lesions can be found in or near any organ derived from the embryonic foregut. Most frequently, they are encountered in the thoracic cavity, especially in the mediastinum, posterior to the carina, or embedded in the pulmonary parenchyma. More distant locations have been reported, including skin, left ventricle, abdomen and retroperitoneum. [1] A bronchogenic cyst located in the retroperitoneal region was first reported by Miller et al. in 1953. [2] There is no specific imaging method available for the preoperative diagnosis of retroperitoneal bronchogenic cysts. When a bronchogenic cyst is localized in the retroperitoneal region, it may be misdiagnosed as an adrenal tumor in preoperative imaging. [3]

Here, we report the case of a 25-year-old female patient with a bronchogenic cyst presenting as an adrenal mass.


   Case Report Top


The 25-year-old female patient had the complaint of an obscure pain in the left flank for approximately 1-month. It was evaluated as nonspecific abdominal pain during her physical examination. Computed tomography was performed after ultrasonography revealed a cystic mass in the left splenorenal and the left para-adrenal region. A well-demarcated, thin-walled, hypodense cystic mass lesion measuring 4 cm located adjacent to the upper pole of the left kidney was seen. The margins could not be clearly discriminated from the left adrenal gland at the left para-adrenal level. The mass was causing a mild pressure on surrounding structures. It was not contrasted after contrast medium injection and did not have septations observed on computed tomography [[Figure 1]a and b]. Radiologically, the cystic mass was considered to originate from the left adrenal gland.
Figure 1: (a and b) Computed tomography demonstrates a well demarcated, thin-walled, noncontrasting, low density cystic lesion in left splenorenal fossa


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The cystic mass was excised laparoscopically. Intraoperatively, the mass lesion was seen to not be associated with the left adrenal gland, but rather to be a well-demarcated 4 cm mass lesion between the adrenal gland and the kidney. The resected cystic lesion was a brown tissue piece measuring 4 cm × 2 cm × 1 cm. A dark grayish mucoid fluid was evacuated from the cystic lumen. The inner surface of the cyst was homogenous. On histopathological examination, the inner surface of the cyst was lined with respiratory type pseudo stratified, ciliated columnar epithelium. Seromucous gland regions were observed in the fibrous connective tissue, and smooth muscle fibers were seen in the wall of the cyst [Figure 2]. Pulmonary and teratomatous components were not observed. Respiratory epithelium and seromucous glands showed nuclear immunoreactivity for thyroid transcription factor-1 [Figure 3]. The lesion was evaluated as a bronchogenic cyst.
Figure 2: Microscopic view of the retroperitoneal bronchogenic cyst. Cystic spaces lined by respiratory-type epithelium, underlying lamina propria containing smooth muscle fibers, and sermucinous glands (H and E, ×100)


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Figure 3: A microscopic view of the retroperitoneal bronchogenic cyst: Spaces lined by epithelium showing nuclear immunoreactivity for the transcription factor thyroid transcription factor-1 (TTF-1) (nuclei showing as round Brown dots) (TTF-1, ×100)


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   Discussion Top


Most bronchogenic cysts originate in the mediastinum while other locations are rare. Subdiaphragmatic bronchogenic cysts are believed to result from bronchopulmonary foregut malformation and are usually found incidentally. Most reported subdiaphragmatic bronchogenic cysts are localized in the peritoneal cavity. [4]

Retroperitoneal bronchogenic cysts are seen in both genders equally and in any age range. [5] Most are located superior to the left adrenal gland and pancreas. These cysts are usually too small to be symptomatic (most reported cases are smaller than 5 cm) and are detected incidentally. When epigastric pain or back pain is present, the cysts are usually larger, measuring 7 cm or more. The largest reported cyst measured 10 cm. [6] Clinically and radiologically, retroperitoneal bronchogenic cysts may be easily confused with adrenal, cortical, or medullary tumors, pancreatic cysts, enteric cysts, and urothelial cysts. However, bronchogenic cysts are easily discriminated from other lesions histopathologically.

The differential diagnosis of retroperitoneal cysts lined with ciliated epithelium includes teratomas, bronchopulmonary sequestration, and cysts originating from foregut and urothelium. Foregut cysts are classified as bronchogenic cysts if they consist of cartilage or seromucinous respiratory glands; esophageal cysts if they consist of two layers of well-differentiated smooth muscle without cartilage; and as foregut cysts if they consist of neither. Cysts of urogenital origin may rarely be lined with pseudostratified ciliated epithelium; however submucosalseromucinous glands are never seen. [7] In our case, the cyst wall was lined with ciliated pseudostratified respiratory epithelium, thin smooth muscle bands, and seromucinous glands. Cartilage is not always seen in these cysts. [7] Our case did not contain cartilage.


   Conclusion Top


We diagnosed a rare retroperitoneal bronchogenic cyst in a 25-year-old female patient who had the complaint of left flank pain. Bronchogenic cysts must be considered in the diagnosis of cystic tumors located in the retroperitoneal region, particularly in left para-adrenal region.

 
   References Top

1.
Govaerts K, Van Eyken P, Verswijvel G, Van der Speeten K. A bronchogenic cyst, presenting as a retroperitoneal cystic mass. Rare Tumors 2012;4:e13.  Back to cited text no. 1
    
2.
Miller RF, Graub M, Pashuck ET. Bronchogenic cysts; anomalies resulting from maldevelopment of the primitive foregut and midgut. Am J Roentgenol Radium Ther Nucl Med 1953;70:771-85.  Back to cited text no. 2
    
3.
O'Neal PB, Moore FD, Gawande A, Cho NL, King EE, Moalem J, et al. Bronchogenic cyst masquerading as an adrenal tumor: A case of mistaken identity. Endocr Pract 2012;18:e102-5.  Back to cited text no. 3
    
4.
Ingu A, Watanabe A, Ichimiya Y, Saito T, Abe T. Retroperitoneal bronchogenic cyst: A case report. Chest 2002;121:1357-9.  Back to cited text no. 4
    
5.
Sumiyoshi K, Shimizu S, Enjoji M, Iwashita A, Kawakami K. Bronchogenic cyst in the abdomen. Virchows Arch A Pathol Anat Histopathol 1985;408:93-8.  Back to cited text no. 5
    
6.
Doggett RS, Carty SE, Clarke MR. Retroperitoneal bronchogenic cyst masquerading clinically and radiologically as a phaeochromocytoma. Virchows Arch 1997;431:73-6.  Back to cited text no. 6
    
7.
Itoh H, Shitamura T, Kataoka H, Ide H, Akiyama Y, Hamasuna R, et al. Retroperitoneal bronchogenic cyst: Report of a case and literature review. Pathol Int 1999;49:152-5.  Back to cited text no. 7
    

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Correspondence Address:
Dr. Gulay Bulut
Department of Pathology, School of Medicine, Yuzuncu Yil University, Van
Turkey
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0377-4929.151200

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  [Figure 1], [Figure 2], [Figure 3]



 

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    Abstract
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   Case Report
   Discussion
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    References
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