CASE 4159 Published on 11.10.2005

Gastric duplication cyst

Section

Abdominal imaging

Case Type

Clinical Cases

Authors

Albuquerque C, Vedor P, Beirão I

Patient

32 years, female

Clinical History
A 32- year- old women sought medical attention after the onset of, nausea, asthenia, anorexia and a weight loss. Physical examination revealed a large, fixed, painful mass in the right flank, with 10 cm.
Imaging Findings
A 32- year- old women sought medical attention after the onset of, nausea, asthenia, anorexia and a weight loss. Physical examination revealed a large, fixed, painful mass in the right flank, with 10 cm. Routine laboratory studies were within normal limits. US reveal either a sonolucent mass with good through transmission in right flank. The US was followed by a contrast barium enema study. It showed a large submucosal mass with mass effect extending in to the lumen of the greater curvature of the stomach. The mucosal surface was normal. CT with intravenous and oral contrast material was performed. There was a large, well- circumscribed, low- attenuation mass, with 9 cm in the anterior- posterior dimension lying close to the greater curvature of the stomach. The mass demonstrated peripheral enhancement and uniform central low attenuation of 10 HU. After these studies, the patient was taken to the operating room and underwent a laparotomy. The mass was resected. Gross pathologic examination of the resected specimen demonstrated a round submucosal mass. It was covered by normal gastric mucosa and pancreatic tissue. The gross and histologic finding indicated an enteric duplication cyst arising from the stomach.
Discussion
Gastrointestinal tract duplications are uncommon congenital abnormalities that may occur anywhere along the alimentary tract. Gastric duplication is extremely rare. Duplications of the stomach account for about 7% of gastrointestinal tract duplications. Most are noncommunicating, spheric or ovoid closed cysts, and the most common site is the greater curvature. The mucosal lining is usually gastric but pseudostratified respiratory epithelium and pancreatic tissue have been found. The clinical picture produced by gastric duplications depends on their size and location as well as the presence of communication with the rest of the alimentary tract. Most duplication is discovered in infants. Vomiting and abdominal pain is the predominant clinical findings, although patients are frequently asymptomatic. Radiography and barium studies usually show a paragastric mass displacing the stomach and bowel. US and CT show a well-defined cystic mass lying close to the greater curvature of the stomach. Complications include perforation, obstruction from adjacent pressure or mass effect, volvulus, and associated malignancy Differential diagnosis may include a submucosal mass such as a lipoma or gastrointestinal stromal tumor, and adjacent organ pathology such as a pancreatic mass or pseudocyst, a renal mass, splenomegaly, or a retroperitoneal sarcoma. Frequently, surgical exploration is needed to make the diagnosis. Complete resection is recommended to prevent both recurrent symptoms and malignant transformation of duplications.
Differential Diagnosis List
Gastric duplication cyst
Final Diagnosis
Gastric duplication cyst
Case information
URL: https://eurorad.org/case/4159
DOI: 10.1594/EURORAD/CASE.4159
ISSN: 1563-4086