Cystic intrathoracic derivatives of the foregut and their complications

Abstract

It is suggested that these lesions should be classified into three main categories based on embryology-bronchogenic cyst (resulting from a defect of lung budding), intramural oesophageal cyst (true duplication), and enteric cyst (resulting from the split notochord syndrome). A series of 41 patients is reported. Seven of our patients suffered complications, and in two cases these nearly resulted in the death of the patient. These complications are described and their serious import is used to emphasize the desirability of surgical removal of all these foregut derivatives before complications ensue.Cystic intrathoracic lesions of foregut origin are now well recognized and account for approximately 10% of lesions presenting as mediastinal tumours (Morrison, 1958). The terminology used to describe mediastinal endodermal cysts has been confused and sometimes ambiguous. The embryological derivation of these lesions has been the cause of much speculation. The purpose of this paper is to report a series of 41 intrathoracic foregut cysts, to show that they fall into three distinct categories on the basis of embryology, to emphasize the occurrence of serious complications, and, for this reason, to urge surgical removal of the lesions.

Bronchogenic cysts: clinicopathological presentation and treatment

“…MATZINGER et al [21] reported a case of intrapulmonary bronchogenic cyst in a 16 year old girl presenting with pneumothorax. Other reported complications are pleural effusion [22,23], arrhythmias [24], stenosis of the pulmonary artery [25], unilateral ventilation-perfusion defect [26], pericardial and cardiac tamponade [27], carcinomatous [28] or sarcomatous transformation [29], and giant tension bronchogenic cyst [30]. Intrapulmonary bronchogenic cysts generally present as one of three different patterns on the chest radiograph.…”

Adenocarcinoma arising from an enteric cyst of the posterior mediastinum

“…Kirwan et al (5) reported 41 patients with intrathoracic foregut cysts and classified them into three types: bronchogenic, esophageal, and enteric cysts. Bronchogenic cysts occur from extra lung buds, which develop from the primitive foregut.…”

“…Enteric cysts are often associated with vertebral anomalies and usually located in the posterior mediastinum with attachment to the dorsal vertebra, and have no connection with the esophagus. These cysts are lined by either gastric mucosa with parietal and chief cells; duodenal, small intestinal, or large intestinal mucosae; or squamous or ciliated columnar epithelium (5).…”

Tubular duplication of the oesophagus presenting with dysphagia

“…(9) Unlike cystic duplications, tubular duplications usually communicate with the normal oesophagus. The earliest known description of tubular duplication was made by Kirwan et al, (10) and the second patient was reported by Kathe in 1907. (11) Malignancies in patients with partial duplication have also been reported earlier.…”