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Open Access Case report

Foregut duplication of the stomach diagnosed by endoscopic ultrasound guided fine-needle aspiration cytology: case report and literature review

Vincenzo Napolitano1, Angelo M Pezzullo1, Pio Zeppa2, Pietro Schettino1, Maria D’Armiento2, Antonietta Palazzo1, Cristina Della Pietra1, Salvatore Napolitano1 and Giovanni Conzo1*

Author Affiliations

1 Department of General and Specialistic Surgery, School of Medicine, Second University of Naples, 5 S. Pansini Street, 80100, Naples, Italy

2 Department of Pathology, School of Medicine, Federico II University of Naples, 80100, Naples, Italy

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World Journal of Surgical Oncology 2013, 11:33  doi:10.1186/1477-7819-11-33

Published: 2 February 2013

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.

Keywords:
Gastric duplication cyst; Foregut duplication cysts; Pseudostratified columnar ciliated epithelium; Laparoscopic surgery; Endoscopic ultrasound-guided fine-needle aspiration cytology