Isolated duodenal duplication cyst presenting as a complex solid and cystic mass in the upper abdomen

Abstract

Duodenal duplication cysts are a rare subtype of gastrointestinal duplications cysts. Approximately 5% of gastrointestinal duplication cysts occur in the duodenum. An 18-year-old woman presented with epigastric pain and a subjective abdominal bulge. A computed tomography scan was subsequently performed and showed a solid and cystic mass with wall calcifications in the lesser sac of the upper abdomen. A duodenal duplication cyst was found unexpectedly on histopathologic analysis. This was also an unusual case as there was no evidence of malignancy. Four years after surgery, the patient remains asymptomatic. We present a brief literature review on duodenal duplication cysts and discuss its differential diagnosis.

Keywords: Computed tomography; Duodenum; Duplication cyst; Gastrointestinal stromal tumor; Lesser sac.

Figure 1

18-year-old woman with a duodenal duplication cyst presenting with epigastric pain and abdominal bulge. Axial CT images in the arterial phase (A) and venous phase (B) of the upper abdomen show a 8.2 × 8.0 × 6.9 cm smoothly-marginated mass (arrow) in the lesser sac posterior to the stomach and medial to the first portion of the duodenum. (Protocol: Siemens CT scanner, 225 mA, 120kV, 5mm slice thickness, 100 cc IV Omnipaque 350).

Figure 2

18-year-old-woman with a duodenal duplication cyst presenting with epigastric pain and abdominal bulge. Coronal reformatted CT images of the upper abdomen in the arterial phase (A) and venous phase (B) show a 8.2 × 8.0 × 6.9 cm well-circumscribed mass (large arrow) that is mostly cystic superiorly but with some solid component in the inferior aspect. Coarse calcifications are present in the inferior wall of the mass (small arrow). (Protocol: Siemens CT scanner, 225 mA, 120kV, 5mm slice thickness, 100 cc IV Omnipaque 350).

Figure 3

18-year-old-woman with a duodenal duplication cyst. Photomicrographs of hematoxylin and eosin-stained tissue sections showing the normal complement of gastrointestinal wall layers (a, 40× magnification), with foci of Paneth cells (arrow in b, 100× magnification) supporting small bowel origin.