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