Montemurro Severino, Cartanese Carmine, De Luca Raffaele, Zito Francesco Alfredo, Ranieri Girolamo, Ruggieri Eustachio
Department of Surgical Oncology, IRCCS National Cancer Centre "G. Paolo II", Bari, Italy.
Ann Ital Chir. 2011 Nov-Dec;82(6):487-91.
Gastrointestinal duplication is a congenital rare disease entity. Duplication cyst of the stomach with pseudo stratified columnar ciliated epithelium is extremely rare. The very appearance of a gastric duplication cyst in an adult can present a diagnostic dilemma. In majority of reported cases, the diagnosis is established during surgical exploration. We report on a 34 year-old female patient suffering from repeated episodes of epigastric pain and gastroesophageal reflux. Abdominal computed tomography and endoscopic ultrasound demonstrated a intramural lesion attached to the gastric fundus, suggestive of gastrointestinal stromal tumor (GIST). At exploratory laparotomy a non-communicating cyst, was found along the greater curvature of the stomach in the esophagogastric transition. The lesion was excised along with an adjacent sleeve of the stomach and esophagus wall because shared muscular layer with the stomach and esophagus. The final pathologic examination revealed that the inner wall of the cyst was lined by a pseudostratified columnar ciliated epithelium (respiratory type) and, in part, columnar and gastric foveolar epithelium. Even though a panel of imaging modalities is available, it is still difficult to obtain a preoperative diagnosis. Duplication cyst can be mistaken for a soft tissue tumor of the gastrointestinal tract. There is no therapeutic algorithm. Surgical treatment is recommended for symptomatic cases.
胃肠道重复畸形是一种先天性罕见疾病。胃重复囊肿伴假复层柱状纤毛上皮极为罕见。成人胃重复囊肿的表现可能会带来诊断难题。在大多数报道的病例中，诊断是在手术探查时确立的。我们报告一例34岁女性患者，反复出现上腹部疼痛和胃食管反流。腹部计算机断层扫描和内镜超声显示胃底有一个壁内病变，提示胃肠道间质瘤（GIST）。在剖腹探查术中，在食管胃交界处胃大弯处发现一个不与外界相通的囊肿。由于该病变与胃和食管壁共享肌层，故将其与胃和食管壁的相邻部分一并切除。最终病理检查显示囊肿内壁衬有假复层柱状纤毛上皮（呼吸型），部分为柱状上皮和胃小凹上皮。尽管有一系列影像学检查方法可用，但术前诊断仍很困难。重复囊肿可能被误诊为胃肠道软组织肿瘤。目前尚无治疗方案。对于有症状的病例，建议手术治疗。
