Wang Min, He Xu, Qiu Xia, Tian Chuan, Li Jian, Lv Mingnan
Department of Gastroenterology, The People's Hospital of Nanchuan, Chongqing Clinical Medical Experimental Teaching Center, School of Clinical Medicine, Chengdu Medical College, Chengdu, Sichuan Department of Nephrology, The People's Hospital of Nanchuan, Chongqing, China.
Medicine (Baltimore). 2017 Aug;96(31):e7678. doi: 10.1097/MD.0000000000007678.
Retroperitoneal bronchogenic cysts without specific clinical manifestations are extremely rare and difficult to diagnose preoperatively and are easily misdiagnosed as left adrenal or pancreatic tumors.
A 48-year-old woman with the chief complaint of obscure epigastric pain for 1 month and with no other gastrointestinal symptoms and no significant medical history. The patient had signed informed consent for publication of this case report.
The serum level of carbohydrate antigen 19-9 (CA 19-9) in the patient was >1200 U/mL, which far exceeded the normal level of <37 U/mL. Computed tomography (CT) initially suggested the presence of an adrenal tumor. However, endoscopic ultrasound (EUS) showed that the adrenal gland had an intact capsule and that the mass originated in the retroperitoneal space and did not involve the paranephros.
Surgical resection was performed on the patient.
Histopathological examination demonstrated that the mass was a retroperitoneal bronchogenic cyst. At the 2-month postoperative follow-up, the level of CA 19-9 had returned to normal.
EUS appears to be superior to CT because it clearly delineated the mass from the surrounding structures of the retroperitoneal region. EUS-fine needle aspiration can be used for diagnosis or determining whether the mass is malignant or benign. To the best of our knowledge, retroperitoneal bronchogenic cysts with significantly elevated serum CA 19-9 have not been reported. Measurement of serum CA 19-9 may be helpful in the diagnosis of retroperitoneal bronchogenic cysts. However, this was a rare case, and the mechanism behind CA 19-9 elevation is not clear and needs further investigation.
无特异性临床表现的腹膜后支气管源性囊肿极为罕见，术前难以诊断，易被误诊为左肾上腺或胰腺肿瘤。
一名48岁女性，主要诉求为上腹部隐痛1个月，无其他胃肠道症状，无重大病史。患者已签署本病例报告发表的知情同意书。
患者血清糖类抗原19-9（CA 19-9）水平>1200 U/mL，远超过正常水平<37 U/mL。计算机断层扫描（CT）最初提示存在肾上腺肿瘤。然而，内镜超声（EUS）显示肾上腺包膜完整，肿块起源于腹膜后间隙，未累及肾旁组织。
对患者进行了手术切除。
组织病理学检查显示肿块为腹膜后支气管源性囊肿。术后2个月随访时，CA 19-9水平已恢复正常。
EUS似乎优于CT，因为它能清晰地将肿块与腹膜后区域的周围结构区分开来。EUS细针穿刺可用于诊断或确定肿块是恶性还是良性。据我们所知，血清CA 19-9显著升高的腹膜后支气管源性囊肿尚未见报道。血清CA 19-9的检测可能有助于腹膜后支气管源性囊肿的诊断。然而，这是一个罕见病例，CA 19-9升高背后的机制尚不清楚，需要进一步研究。
