• A 27 year old male has a history of chronic back ache without any GI complaints
  • MRI dorsal spine–
  • incidental finding of 4 x 5 x 6 cm sized lesion in upper thoracic esophagus
  • partial luminal narrowing and extra luminal extension in to left Para tracheal location
  • benign soft tissue lesion/Leiomyoma
  • OGD Scopy- proximal esophageal submucosal lesion? GIST
  • EUS (Singapore) – Large cystic lesion and thick mucoid aspirate removed with 19 G needle.
  • Cytology – Pauci cellular mucoid aspirate
  • EUS – At Endoscopy Asia –
  • Large submucosal anechoic cystic lesion in the lower esophagus measuring 6 cm X 4 cm.
  • The cyst wall contained all the layers of the esophageal wall: Mucosa, muscularis mucosa, sub mucosa, Muscularis propria and adventitia
  • Diagnosis – Esophageal duplication cyst

EXPERT COMMENTS-

  • Esophageal duplication is an embryologic duplication of a portion of the muscle and submucosa of the esophagus without epithelial duplication
  • Maldevelopment of the posterior division of the primitive foregut is the embryologic defect responsible for esophageal cysts.
  • The lining of the cyst can vary and can include squamous columnar, cuboidal, pseudo stratified, ciliated, and gastric mucosa. Hemorrhage can be the presenting symptom if gastric mucosa is present in the cyst.
  • Video-assisted thoracoscopic surgery (VATS) is currently used to enucleate cysts and resects duplications

TAKE HOME MESSAGE –

  • Duplication cysts should never be aspirated in view of the risk of infection.
  • Asymptomatic lesions should not be intervened up on
  • Trans-oesophageal endoscopic marsupilisation of the cyst is a feasible option only in symptomatic cases.
Large submucosal lesion in mid esophagus

Large submucosal lesion in mid esophagus

NBI View

NBI View

 

 

 

 

 

 

 

 

 

A large submucosal anechoic cystic lesion

A large submucosal anechoic cystic lesion

An Esophageal duplication cyst

An Esophageal duplication cyst

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