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Image of the Month—Diagnosis
Corresponding author: Clark J. Zeebregts, MD, Department of Surgery, University Hospital Groningen, PO Box 30001, 9700 RB Groningen, the Netherlands (e-mail: czeebregts{at}hotmail.com).
Arch Surg. 2004;139:688.
Answer: Gastric Duplication Cyst
Figure 1.
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Figure 1.A contrast-enhanced single-slice spiral computed tomographic scan of the abdomen demonstrating a 7 x 5-cm cystic lesion with serous fluid–filled appearance. The mass was located dorsal to the stomach.
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Figure 2.
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Figure 2.Histologic view of the septum between the stomach and duplication cyst. The stomach is lined with fundal mucosa (small arrow), and the duplication cyst is lined with antral mucosa (large arrow). Note the simplified appearance of the epithelium of the duplication cyst, with discrete, nonspecific signs of chronic inflammation (hematoxylin-eosin, original magnification x5.5).
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Gastric duplications are relatively rare, constituting approximately 4% to 10% of all gastrointestinal duplications and having a male-female ratio of 2:1.1-2 Several theories explain the embryonic development of gastric duplications, but no single theory adequately explains all types of duplications. In 1959, Rowling3 proposed 3 morphologic criteria for the correct diagnosis of gastric duplication cysts. First, the cyst must be attached to the stomach and contiguous with its wall. Second, the cyst must be surrounded by at least 1 coat of smooth muscle, fusing with the muscularis propria of the stomach. Third, the cyst must be lined with typical gastric mucosa. Most gastric duplications are noncommunicating, cystic in nature, and situated along the greater curvature.2 Because of the unspecific clinical symptoms, gastric duplications are usually diagnosed by surgical means. Nevertheless, preoperative imaging may be helpful in determining the diagnosis. Plain films and barium studies may suggest a mass by impression or displacement signs, but ultrasonography is needed to assess the nature and size of the mass.4 In the patient described, ultrasonography was also performed and showed a thick-walled cyst containing echogenic material. It was not clear, however, from which organ the cyst originated. As in other reports,4-5 our computed tomographic scan suggested duplication cyst of the stomach but could not exclude pancreatic pseudocyst or omental cyst. Magnetic resonance images were able to show the cyst as being separate from the pancreas, thereby raising the suspicion for gastric duplication cyst. The final diagnosis was based on a combination of preoperative imaging and surgical and histologic findings, for which all are requisite.
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REFERENCES
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1. Agha FP, Gabriele OF, Abdulla FH. Complete gastric duplication. AJR Am J Roentgenol. 1981;137:406-407.
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2. Macpherson RI. Gastrointestinal tract duplications: clinical, pathologic, etiologic, and radiologic considerations. Radiographics. 1993;13:1063-1080.
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3. Rowling JT. Some observations on gastric cysts. Br J Surg. 1959;46:441-445.
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4. Dittrich JR, Spottswood SE, Jolles PR. Gastric duplication cyst: scintigraphy and correlative imaging. Clin Nucl Med. 1997;22:93-96.
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5. Gupta AK, Berry M, Mitra DK. Gastric duplication cyst in children: report of two cases. Pediatr Radiol. 1994;24:346-347.
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SECTION EDITOR: GRACE S. ROZYCKI, MD
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Image of the Month—Quiz Case
Clark J. Zeebregts, Barry Slot, Mariël Brinkhuis, and Jos J. G. M. Gerritsen
Arch Surg. 2004;139(6):687-688.
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