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• W2017221936 abstract "Esophageal duplication cysts are benign, asymptomatic anomalies of foregut formation. We report a case of esophageal duplication cyst with esophageal squamous cancer. An upper endoscopy visualized with esophageal scan disclosed a stenotic lesion in the lower esophagus. Computed tomography images revealed a cystic mass in the inferior mediastinum, which was on the right wall of the esophagus. The postoperative pathology report confirmed the diagnosis of esophageal squamous cancer (ulcer type) and esophageal duplication cyst with calcification. Esophageal duplication cysts are benign, asymptomatic anomalies of foregut formation. We report a case of esophageal duplication cyst with esophageal squamous cancer. An upper endoscopy visualized with esophageal scan disclosed a stenotic lesion in the lower esophagus. Computed tomography images revealed a cystic mass in the inferior mediastinum, which was on the right wall of the esophagus. The postoperative pathology report confirmed the diagnosis of esophageal squamous cancer (ulcer type) and esophageal duplication cyst with calcification. Esophageal duplication cyst is a rare benign, congenital cystic mass. Most cases are discovered in children. In adults, almost all of the patients are asymptomatic, and the cysts are diagnosed accidentally during evaluation for other clinical problems. They are frequently located on the right side in the lower third of the esophagus [1Arbona J.L. Fazzi J.G. Mayoral J. Congenital esophageal cysts: case report and review of literature.Am J Gastroenterol. 1984; 79: 177-182PubMed Google Scholar]. Respiratory symptoms may be caused by proximal cysts, and distal cysts can cause dysphagia. Malignant degeneration of esophageal duplication is a very rare event [1Arbona J.L. Fazzi J.G. Mayoral J. Congenital esophageal cysts: case report and review of literature.Am J Gastroenterol. 1984; 79: 177-182PubMed Google Scholar, 2Lee M.Y. Jensen E. Kwak S. Larson R.A. Metastatic adenocarcinoma arising in a congenital foregut cyst of the esophagus: a case report with review of the literature.Am J Clin Oncol. 1998; 21: 64-66Crossref PubMed Scopus (56) Google Scholar, 3Singh S. Lal P. Sikora S.S. Datta N.R. Squamous cell carcinoma arising from a congenital duplication cyst of the esophagus in a young adult.Dis Esophagus. 2001; 14: 258-261Crossref PubMed Scopus (45) Google Scholar]. We report an interesting case of an esophageal duplication cyst with esophageal cancer in a 61-year-old man with difficulty in eating.A 61-year-old man with dysphagia to both liquids and solids for 2 months was referred for operation. The patient had lost 14 pounds over a 2-month period. His medical history was unremarkable. The results of physical examination were normal. Laboratory examination revealed elevated serum carcinoembryonic antigen (4.42 ng/mL) and cancer antigen-199 (42.72 U/mL). Upper endoscopy visualized with esophageal scanning disclosed a stenotic lesion in the lower esophagus (Fig 1). Computed tomography was performed to better assess the stenotic lesion, and it revealed a cystic mass in the inferior mediastinum, which was on the right wall of the esophagus (Fig 2). Because of the development of symptoms and the results of examination, the diagnosis of esophageal cancer and esophageal duplication cyst was considered but needed to be confirmed. The patient underwent a transthoracic surgical operation. This surgical approach was transthoracic through the left side of the seventh rib bed, open inferior pulmonary ligament to the level of the aortic arch. We could touch a lump about 5 cm × 5 cm on the wall of the proximal esophagus, surrounded by numerous swelling lymph nodes. Additionally, another lump was found on the esophagus in the right thoracic cavity, which is a part of the esophagus. The lesions were removed completely, and the pathology report confirmed the diagnosis of esophageal squamous cancer (ulcer type) and esophageal duplication cyst with calcification (Fig 3). During the next 12 months of follow-up we observed significant improvement, and the patient had a normal clinical course.Fig 2Computed tomography images demonstrating a round cystic mass 5.0 cm × 4.0 cm in the inferior mediastinum, on the right side of the esophagus (arrow). The esophageal lumen is compressed and thickened.View Large Image Figure ViewerDownload (PPT)Fig 3(A) Round deflated unilocular cystic mass. (B) Esophageal squamous cancer (ulcer type) in cross-section, esophageal cyst on reverse side. (C) Pseudostratified ciliate mucosa with occasional submucosal glands in the inner layer of the esophageal cyst. (Hematoxylin-phloxine-saffron, ×200.) (D) Esophageal squamous cancer. (Hematoxylin-phloxine-saffron, ×200.)View Large Image Figure ViewerDownload (PPT)CommentThe first description of esophageal duplication, in 1711, is credited to Blasius [1Arbona J.L. Fazzi J.G. Mayoral J. Congenital esophageal cysts: case report and review of literature.Am J Gastroenterol. 1984; 79: 177-182PubMed Google Scholar]. Although esophageal duplicationconstitutes only 0.5% to 2.5% of all esophageal tumors [4Whitaker J.A. Deffenbaugh L.D. Cooke A.R. Esophageal duplication cyst Case report.Am J Gastroenterol. 1980; 73: 329-332PubMed Google Scholar], it is the second most common duplication of the alimentary tract after ileal duplication. The complications include obstruction, infection, hemorrhage, malignancy, or mediastinitis caused by rupture.Esophageal duplication cysts are rare anomalies resulting from a foregut budding error during the third to the sixth week of embryonic development [5Cohen S.R. Geller K.A. Birns J.W. Thompson J.W. Meyer B.W. Lindesmith G.G. Foregut cysts in infants and children Diagnosis and management.Ann Otol Rhinol Laryngol. 1982; 91: 622-627PubMed Google Scholar]. Several imaging techniques have been used in the diagnosis of esophageal duplication, such as chest roentgenology, computed tomography, magnetic resonance imaging, and barium examination [6Jeung M.Y. Gasser B. Gangi A. et al.Imaging of cystic masses of the mediastinum.Radiographics. 2002; 22: S79-S93Crossref PubMed Scopus (264) Google Scholar].The preferred treatment for esophageal duplication cysts is complete surgical resection [7Hazelrigg S.R. Landreneau R.J. Mack M.J. Acuff T.E. Thoracoscopic resection of mediastinal cysts.Ann Thorac Surg. 1993; 56: 659-660Abstract Full Text PDF PubMed Scopus (91) Google Scholar]. the location of cysts determined our surgical approach (transthoracic or transabdominal). Cysts above the lower third of the esophagus may not be accessible to the laparoscopic approach. Now, in most cases, a minimally invasive approach, such as thoracoscopy and laparoscopy, is preferred because it provides excellent exposure, a short time in the hospital, minimal postoperative discomfort, and fast recovery.Although malignancy of esophageal cysts is extremely rare, we needed to pay it enough attention. Adenocarcinoma is the most common histologic characteristic of malignant transformation [8Jacob R. Hawkes N.D. Dallimore N. Butchart E.G. Thomas G.A. Maughan T.S. Case report: Squamous carcinoma in an oesophageal foregut cyst.Br J Radiol. 2003; 76: 343-346Crossref PubMed Scopus (14) Google Scholar]. In this case, no direct relationship could be found between esophageal cancer and esophageal duplication cyst, through the adjacent tissues and pathology report, But it is rare for both diseases occur simultaneously. Esophageal duplication cyst is a rare benign, congenital cystic mass. Most cases are discovered in children. In adults, almost all of the patients are asymptomatic, and the cysts are diagnosed accidentally during evaluation for other clinical problems. They are frequently located on the right side in the lower third of the esophagus [1Arbona J.L. Fazzi J.G. Mayoral J. Congenital esophageal cysts: case report and review of literature.Am J Gastroenterol. 1984; 79: 177-182PubMed Google Scholar]. Respiratory symptoms may be caused by proximal cysts, and distal cysts can cause dysphagia. Malignant degeneration of esophageal duplication is a very rare event [1Arbona J.L. Fazzi J.G. Mayoral J. Congenital esophageal cysts: case report and review of literature.Am J Gastroenterol. 1984; 79: 177-182PubMed Google Scholar, 2Lee M.Y. Jensen E. Kwak S. Larson R.A. Metastatic adenocarcinoma arising in a congenital foregut cyst of the esophagus: a case report with review of the literature.Am J Clin Oncol. 1998; 21: 64-66Crossref PubMed Scopus (56) Google Scholar, 3Singh S. Lal P. Sikora S.S. Datta N.R. Squamous cell carcinoma arising from a congenital duplication cyst of the esophagus in a young adult.Dis Esophagus. 2001; 14: 258-261Crossref PubMed Scopus (45) Google Scholar]. We report an interesting case of an esophageal duplication cyst with esophageal cancer in a 61-year-old man with difficulty in eating. A 61-year-old man with dysphagia to both liquids and solids for 2 months was referred for operation. The patient had lost 14 pounds over a 2-month period. His medical history was unremarkable. The results of physical examination were normal. Laboratory examination revealed elevated serum carcinoembryonic antigen (4.42 ng/mL) and cancer antigen-199 (42.72 U/mL). Upper endoscopy visualized with esophageal scanning disclosed a stenotic lesion in the lower esophagus (Fig 1). Computed tomography was performed to better assess the stenotic lesion, and it revealed a cystic mass in the inferior mediastinum, which was on the right wall of the esophagus (Fig 2). Because of the development of symptoms and the results of examination, the diagnosis of esophageal cancer and esophageal duplication cyst was considered but needed to be confirmed. The patient underwent a transthoracic surgical operation. This surgical approach was transthoracic through the left side of the seventh rib bed, open inferior pulmonary ligament to the level of the aortic arch. We could touch a lump about 5 cm × 5 cm on the wall of the proximal esophagus, surrounded by numerous swelling lymph nodes. Additionally, another lump was found on the esophagus in the right thoracic cavity, which is a part of the esophagus. The lesions were removed completely, and the pathology report confirmed the diagnosis of esophageal squamous cancer (ulcer type) and esophageal duplication cyst with calcification (Fig 3). During the next 12 months of follow-up we observed significant improvement, and the patient had a normal clinical course. CommentThe first description of esophageal duplication, in 1711, is credited to Blasius [1Arbona J.L. Fazzi J.G. Mayoral J. Congenital esophageal cysts: case report and review of literature.Am J Gastroenterol. 1984; 79: 177-182PubMed Google Scholar]. Although esophageal duplicationconstitutes only 0.5% to 2.5% of all esophageal tumors [4Whitaker J.A. Deffenbaugh L.D. Cooke A.R. Esophageal duplication cyst Case report.Am J Gastroenterol. 1980; 73: 329-332PubMed Google Scholar], it is the second most common duplication of the alimentary tract after ileal duplication. The complications include obstruction, infection, hemorrhage, malignancy, or mediastinitis caused by rupture.Esophageal duplication cysts are rare anomalies resulting from a foregut budding error during the third to the sixth week of embryonic development [5Cohen S.R. Geller K.A. Birns J.W. Thompson J.W. Meyer B.W. Lindesmith G.G. Foregut cysts in infants and children Diagnosis and management.Ann Otol Rhinol Laryngol. 1982; 91: 622-627PubMed Google Scholar]. Several imaging techniques have been used in the diagnosis of esophageal duplication, such as chest roentgenology, computed tomography, magnetic resonance imaging, and barium examination [6Jeung M.Y. Gasser B. Gangi A. et al.Imaging of cystic masses of the mediastinum.Radiographics. 2002; 22: S79-S93Crossref PubMed Scopus (264) Google Scholar].The preferred treatment for esophageal duplication cysts is complete surgical resection [7Hazelrigg S.R. Landreneau R.J. Mack M.J. Acuff T.E. Thoracoscopic resection of mediastinal cysts.Ann Thorac Surg. 1993; 56: 659-660Abstract Full Text PDF PubMed Scopus (91) Google Scholar]. the location of cysts determined our surgical approach (transthoracic or transabdominal). Cysts above the lower third of the esophagus may not be accessible to the laparoscopic approach. Now, in most cases, a minimally invasive approach, such as thoracoscopy and laparoscopy, is preferred because it provides excellent exposure, a short time in the hospital, minimal postoperative discomfort, and fast recovery.Although malignancy of esophageal cysts is extremely rare, we needed to pay it enough attention. Adenocarcinoma is the most common histologic characteristic of malignant transformation [8Jacob R. Hawkes N.D. Dallimore N. Butchart E.G. Thomas G.A. Maughan T.S. Case report: Squamous carcinoma in an oesophageal foregut cyst.Br J Radiol. 2003; 76: 343-346Crossref PubMed Scopus (14) Google Scholar]. In this case, no direct relationship could be found between esophageal cancer and esophageal duplication cyst, through the adjacent tissues and pathology report, But it is rare for both diseases occur simultaneously. The first description of esophageal duplication, in 1711, is credited to Blasius [1Arbona J.L. Fazzi J.G. Mayoral J. Congenital esophageal cysts: case report and review of literature.Am J Gastroenterol. 1984; 79: 177-182PubMed Google Scholar]. Although esophageal duplicationconstitutes only 0.5% to 2.5% of all esophageal tumors [4Whitaker J.A. Deffenbaugh L.D. Cooke A.R. Esophageal duplication cyst Case report.Am J Gastroenterol. 1980; 73: 329-332PubMed Google Scholar], it is the second most common duplication of the alimentary tract after ileal duplication. The complications include obstruction, infection, hemorrhage, malignancy, or mediastinitis caused by rupture. Esophageal duplication cysts are rare anomalies resulting from a foregut budding error during the third to the sixth week of embryonic development [5Cohen S.R. Geller K.A. Birns J.W. Thompson J.W. Meyer B.W. Lindesmith G.G. Foregut cysts in infants and children Diagnosis and management.Ann Otol Rhinol Laryngol. 1982; 91: 622-627PubMed Google Scholar]. Several imaging techniques have been used in the diagnosis of esophageal duplication, such as chest roentgenology, computed tomography, magnetic resonance imaging, and barium examination [6Jeung M.Y. Gasser B. Gangi A. et al.Imaging of cystic masses of the mediastinum.Radiographics. 2002; 22: S79-S93Crossref PubMed Scopus (264) Google Scholar]. The preferred treatment for esophageal duplication cysts is complete surgical resection [7Hazelrigg S.R. Landreneau R.J. Mack M.J. Acuff T.E. Thoracoscopic resection of mediastinal cysts.Ann Thorac Surg. 1993; 56: 659-660Abstract Full Text PDF PubMed Scopus (91) Google Scholar]. the location of cysts determined our surgical approach (transthoracic or transabdominal). Cysts above the lower third of the esophagus may not be accessible to the laparoscopic approach. Now, in most cases, a minimally invasive approach, such as thoracoscopy and laparoscopy, is preferred because it provides excellent exposure, a short time in the hospital, minimal postoperative discomfort, and fast recovery. Although malignancy of esophageal cysts is extremely rare, we needed to pay it enough attention. Adenocarcinoma is the most common histologic characteristic of malignant transformation [8Jacob R. Hawkes N.D. Dallimore N. Butchart E.G. Thomas G.A. Maughan T.S. Case report: Squamous carcinoma in an oesophageal foregut cyst.Br J Radiol. 2003; 76: 343-346Crossref PubMed Scopus (14) Google Scholar]. In this case, no direct relationship could be found between esophageal cancer and esophageal duplication cyst, through the adjacent tissues and pathology report, But it is rare for both diseases occur simultaneously." @default.
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