Bronchogenic cyst of the stomach: A case report

Abstract

Background: Gastric bronchogenic cysts (BCs) are extremely rare cystic masses caused by abnormal development of the respiratory system during the embryonic period. Gastric bronchial cysts are rare lesions first reported in 1956; as of 2019, only 37 cases are available in the MEDLINE/PubMed online databases. BCs usually have no clinical symptoms in the early stage, and their imaging findings also lack specificity. Therefore, they are difficult to diagnose before histopathological examination.

Case summary: A 55-year-old woman presented at our hospital with intermittent epigastric pain. She had a slightly high level of serum carbohydrate antigen 72-4 (CA 72-4). Endoscopic ultrasound found that a cystic mass originated from the submucosa of the posterior gastric wall near the cardia, indicating a diagnosis of cystic hygroma of the stomach. Furthermore, a computed tomography scan demonstrated a quasi-circular cystic mass closely related to the lesser curvature of the gastric fundus with a low density. Because the imaging examinations did not suggest a malignancy and the patient required complete resection, she underwent laparoscopic surgery. As an intraoperative finding, this cystic lesion was located in the posterior wall of the fundus and contained some yellow viscous liquid. Finally, the pathologists verified that the cyst in the fundus was a gastric BC. The patient recovered well with normal CA 72-4 levels, and her course was uneventful at 10 mo.

Conclusion: This is a valuable report as it describes an extremely rare case of gastric BC. Moreover, this is the first case of BC to present with elevated CA 72-4 levels.

Keywords: Bronchogenic cyst; Case report; Endoscopic ultrasound-guided fine needle aspiration; Endosonography; Stomach; Submucosal lesion.

Figure 1

Imaging at admission. An endoscopic ultrasound examination showed a 45 mm × 49 mm single cyst originating from the gastric submucosa (arrow). It also revealed that the cyst, without any echoes or color flow signals, was located in the posterior wall of the fundus close to the cardia. These results indicated the possibility of cystic hygroma of the stomach.

Figure 2

Imaging at admission. A plain computed tomography scan demonstrated a 52 mm × 43 mm quasi-circular mass (arrow). It appeared to have a low density of 29 HU and was closely related to the lesser curvature of the gastric fundus, which also showed an extraluminal growth pattern with an obvious border.

Figure 3

Postoperative histopathology. Microscopically, pseudostratified ciliated columnar epithelial cells could be observed in the cyst wall, and the structure of these cells was the same as that of the bronchus. Combined with immunohistochemical staining for CK7 (+), CK20 (-), TTF1 (-), and S-100 (-), the pathologists ultimately verified that this cystic mass of the fundus was a gastric bronchogenic cyst (×100).

Figure 4

Imaging during operation. Intraoperative findings of this cystic mass showed that it was a smooth single-port cyst originating from the submucosa of the posterior gastric wall close to the cardia (arrow). Then, the cystic mass was curatively resected from the stomach, and the surgeons paid attention to avoiding cyst rupture simultaneously.