Gastroenterology and Endoscopy Unit, Mater Olbia Hospital, SS 125 Orientale Sarda, 07026, Olbia, Italy.
Clinica Medica, Dipartimento di Scienze Mediche, Chirurgiche e Sperimentali, University of Sassari, Viale San Pietro 43, 07100, Sassari, Italy.
Clin J Gastroenterol. 2022 Jun;15(3):560-567. doi: 10.1007/s12328-022-01619-3. Epub 2022 Mar 16.
Gastric duplication cysts are rare congenital malformation with a potential neoplastic progression and they may represent a challenge in differential diagnosis with exophytic pancreatic cyst neoplasm. We describe a case of a 38-year old man, complaining of recurrent epigastric pain due to a large abdominal mass, referred to our Hospital for EUS evaluation. Differential diagnosis was between gastric duplication cyst and exophytic pancreatic cyst because of FNA pointed out amylase 1280 UI/L and CEA 593.33 ng/mL. Despite antibiotic prophylaxis, an overinfection of the lesion occurred after the FNA, likely due to the technical failure to drain the cyst completely. Afterwards, the patient was referred to surgery and the pathologist confirmed the diagnosis of gastric duplication cyst. In this setting, EUS procedure has gained a leading play, complementary to traditional imaging tests, although its role has been not yet standardized in the reported literature. Here, we describe and discuss our demanding case, and we propose an algorithm to simplify and standardize the diagnostic workup.
胃重复囊肿是一种罕见的先天性畸形，具有潜在的肿瘤进展，在与外生胰腺囊性肿瘤的鉴别诊断中可能具有挑战性。我们描述了一个 38 岁男性的病例，该男性因腹部巨大肿块反复出现上腹痛，被转介至我们医院进行 EUS 评估。由于 FNA 指出淀粉酶为 1280 UI/L，癌胚抗原为 593.33 ng/mL，因此鉴别诊断为胃重复囊肿和外生胰腺囊性肿瘤。尽管进行了抗生素预防，但 FNA 后病变发生了过度感染，可能是由于未能完全引流囊肿导致的技术失败。随后，患者转至外科手术，病理学家证实了胃重复囊肿的诊断。在这种情况下，EUS 检查发挥了主导作用，补充了传统的影像学检查，尽管其在报告的文献中的作用尚未标准化。在这里，我们描述并讨论了我们的高难度病例，并提出了一种简化和标准化诊断工作流程的算法。
