The role of endoscopic ultrasound and endoscopic ultrasound fine needle aspiration in the diagnosis and management of asymptomatic adult gastric bronchogenic cyst

Aim: This report demonstrates the role of Endoscopic Ultrasound Fine Needle Aspiration in the diagnosis and management of asymptomatic adult gastric bronchogenic cyst.

Introduction: Bronchogenic cysts are congenital foregut cysts. These cysts are rare and retrogastric bronchogenic cysts are even rarer. These cysts are usually asymptomatic but may present with pain due to bleeding or infection and signs of compression on adjacent organs. These cysts can be confused with tumoral lesions.

Preoperative diagnosis has often been difficult and the diagnosis of a bronchogenic cyst could be suspected on an EUS examination by demonstrating muscle layers at the cyst wall (which appear in just 50% of EUS examinations of the cysts) and cartilage elements inside the cyst. Final diagnosis and therapy were usually decided upon by surgical resection.

Methods & Results: A 61 year-old female who had a lumpectomy and chemotherapy due to breast cancer was asymptomatic. She underwent an abdominal Computerized Tomography (CT) as part of a routine follow-up. The CT disclosed a large avascular 4*6cm mass, adjacent to the cardia, above the pancreas and between the stomach and aorta. The differenzial diagnosis was a cystic tumor or a duplication cyst. A Magnetic Resonance Imaging (MRI) showed a retrocrural lesion above the pancreas, adjacent to the left crus of the diaphragm. The mass had a high signal on T2 weighted and a low signal on T1, characteristic of a viscous (protein-rich) cyst but not of cystic tumors.

An Endoscopic Ultrasound (EUS) showed a cystic hypoechoic mass with fine internal echoes, between the cardia and the aorta. On EUS-Fine Needle Aspiration, a brownish viscous material was obtained. A cytological examination showed degenerative tissue, erythrocytes, foamy macrophages and a few ciliated columnar epithelial cells. Our final diagnosis was a foregut cyst of the esophagus considering the presence of ciliated epithelial cells.

The cyst has remained the same size over the last 4 years and the patient is still asymptomatic.

Conclusion: Our case corroborates the few recent reports which show the role of EUS and EUS-FNA in the diagnosis of gastric bronchogenic cyst. Our case, in particular, emphasizes the importance of EUS-FINA in the conservative management of patients with asymptomatic adult gastric bronchogenic cyst who previously, in order to establish a precise and definite diagnosis, were operated on.