Esophageal duplication cyst presenting as a submucosal tumor: diagnosis by endoscopic ultrasound-guided fine-needle aspiration

 

 Permissions and Reprints

A 44-year-old woman presented with symptoms of intermittent epigastric pain and chest discomfort which she had suffered for more than 5 years. She had noticed progressive discomfort on swallowing in the past 1 month. The episodic attacks were not related to meals, respiration, or exercise. She underwent esophagogastroduodenoscopy at her local hospital and this revealed a suspicious-looking region of external compression over the lower esophagus. Chest computed tomography showed a 3.4-cm mediastinal tumor that was adhering to the lower esophagus. She was then referred to our hospital for further evaluation.

An upper gastrointestinal series showed a smooth, wide-based indentation of the outline at the level of the lower esophagus (Figure [1]), and repeat esophagogastroduodenoscopy showed a submucosal tumor with normal-looking overlying mucosa (Figure [2]). Endoscopic ultrasound (EUS) was performed with an Olympus UC2000P echo endoscope (Olympus, Tokyo, Japan) in an attempt to clarify the character of the submucosal tumor. The EUS image revealed a 3.4-cm, anechoic lesion with a thick wall in the third layer of the lower esophagus. Subsequent EUS-guided fine-needle aspiration using a 22-gauge Olympus MAJ-919 needle yielded a large volume of dark-yellowish mucoid material (Figure [3]). On-site cytology after staining with Hemacolor stain (Merck, Darmstadt, Germany) showed groups of ciliated columnar cells on a mucoid cystic background (Figure [4]). There were no lymphocytes or polymorphonuclear leukocytes. These findings were consistent with a diagnosis of esophageal duplication cyst. The patient eventually underwent a surgical resection procedure for symptomatic relief, and the histopathologic examination of the resection specimen confirmed the diagnosis.

Figure 1 An upper gastrointestinal series revealed a smooth, wide-based indentation of the outline at the level of the lower esophagus.

Figure 2 Esophagogastroduodenoscopic view showed a submucosal tumor with normal-looking overlying mucosa in the lower esophagus.

Figure 3 The endoscopic ultrasound (EUS) image revealed a 3.4-cm anechoic lesion with a thick wall in the third layer of lower esophagus. EUS-guided fine-needle aspiration (EUS-FNA) (arrow) yielded a large volume of dark-yellowish mucoid material.

Figure 4 EUS-FNA cytology showed groups of ciliated columnar cells against a mucoid, cystic background (Hemacolor stain, original magnification × 400).

This case demonstrates that EUS with fine-needle aspiration can provide a quick, accurate, and minimally invasive method for the diagnosis of esophageal duplication cyst.

Endoscopy_UCTN_Code_CCL_1AF_2AB
Endoscopy_UCTN_Code_CCL_1AB_2AC_3AH

H.-P. Wang, M. D.

Department of Emergency Medicine

National Taiwan University Hospital
7 Chung-Shan South Road
Taipei
Taiwan

Fax: +886-2-23947899

Email: whp@ha.mc.ntu.edu.tw