Esophageal Duplication Cyst -- A Guest Case in Robotic and Computer-Assisted Surgery From the University of Nebraska Medical Center

Chad Ringley, MD; Victor Bochkarev, MD; Dmitry Oleynikov, MDSeries Editors: Brant K. Oelschlager, MD; Carlos A. Pellegrini, MD

Disclosures

November 02, 2006

Introduction

The incidence of gastrointestinal tract duplication cysts is 1:100,000, with only about 160 cases described in adults.[1] The main locations of these duplication cysts are the ileum (50%), esophagus (25%), colon (15%), stomach (5%), duodenum (4%), and pancreas with biliary tree (< 1%).[1,2,3]

There are several anomalies of foregut duplication that can present as cystic masses in the chest. The esophageal duplication cyst represents one of the two most common types of bronchopulmonary foregut malformations.[4,5] The bronchogenic-type cyst occurs more frequently and is usually located in the mediastinum around the tracheobronchial tree, whereas esophageal duplication cysts are most frequently located in the right posterior inferior mediastinum.[5,6]

The primitive foregut gives rise to the pharynx and lower respiratory tract as well as to the upper gastrointestinal tract. Foregut cysts are lined by a ciliated epithelium, which lines both the early tracheobronchial tree and esophagus. Thus, from a pathology point of view, mediastinal cysts can be classified as esophageal duplications if they are close to the esophageal wall; are covered by 2 muscle layers; and if the lining is squamous, columnar, cuboid, pseudostratified, or ciliated epithelium.[4,6,7]

Esophageal duplication cysts become symptomatic in early childhood in 80% of cases.[4,8] In adults, esophageal duplication cysts are usually asymptomatic or cause mild dysphagia.[2,6,9] These cysts can be complicated by intracystic hemorrhage, cystic rupture, and infection, especially those with bronchial and esophageal communication.[10,11,12] Squamous metaplasia and malignant transformation have also been reported.[13,14]

The treatment of choice consists of open excision by thoracotomy or laparotomy and minimally invasive techniques.[6] Cases of esophageal duplication cyst removal by laparoscopic, thoracoscopic, and even transluminal (transesophageal) endoscopic approaches have been reported.[1,15,16,17]

This is the first case report of laparoscopic robotic-assisted transhiatal esophageal duplication cyst removal.

Which of the following mediastinal lesions can be represented as a cystic mass?

  1. Hodgkin's lymphoma

  2. Neuroma

  3. Germ cell tumor

  4. Thymoma

  5. All of the above

View the correct answer.

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