Best Cases from the AFIP

Enteric Duplication Cyst Containing Squamous and Respiratory Epithelium: An Interesting Case of a Typically Pediatric Entity Presenting in an Adult Patient

“…Such lesions are more likely to be associated with cases that present with GI bleeding and can be detected via Tc-99m pertechnetate radionuclide scan, the same study used to detect ectopic gastric tissue in Meckel's diverticulum. However, as only about 35% of enteric duplication cysts will contain detectable gastric mucosa [13], isotope studies are of only limited diagnostic utility [5, 6]. …”

“…Though conventional abdominal films rarely aid significantly in diagnosis, other imaging modalities, such as contrast studies, CT, or ultrasound (US), are helpful in the context of proper clinical correlation. US is currently the favored modality and will typically reveal a double-walled cyst appearing to have an echogenic inner mucosal layer and hypoechoic outer muscularis propria layer [5, 16]. The “double wall sign” can occasionally be mimicked by other GI or GU lesions, however, including Meckel's diverticulum, torsed ovarian cysts, and intestinal abscesses.…”

“…Confirmation of imaging with characteristic histology is still required for definitive diagnosis [17]. CT imaging of enteric duplication cysts is somewhat less informative, as the mass will appear simply as a nonenhancing or slightly enhancing cystic lesion [1, 5], as noted in this case. Upper GI and barium contrast studies may sometimes reveal a filling defect or abnormal communication of a cystic structure with the bowel wall at the site of the mass [1, 6, 13].…”

“…Duplication cysts can occur in the context of other congenital abnormalities, such as those of the vertebral bodies and genitourinary tract, though they most often are seen in patients without other developmental malformations [2–4]. The lesions are typically present in the first year of life (70% of cases) or early childhood, though they more rarely have been reported in older patients [5–7]. Initial symptomatology is dictated by the size and location of the lesion and most commonly includes obstruction, with or without vomiting, abdominal distension, dysphagia, palpable mass, or, more infrequently, urinary symptoms [4, 5, 8].…”

“…The lesions are typically present in the first year of life (70% of cases) or early childhood, though they more rarely have been reported in older patients [5–7]. Initial symptomatology is dictated by the size and location of the lesion and most commonly includes obstruction, with or without vomiting, abdominal distension, dysphagia, palpable mass, or, more infrequently, urinary symptoms [4, 5, 8]. We herein present a unique case of a young adult patient with an enteric duplication cyst lined by both respiratory and squamous epithelia, the latter of which we have only rarely seen previously reported in this clinical entity.…”