Endoscope-Assisted Thoracoscopic Technique for Esophageal Bronchogenic Cyst Which Presented Elevated CA125

Abstract

A 26-year-old male was admitted to our hospital with a complaint of mild dysphagia. Preoperative examinations revealed a cystic lesion at the lower esophagus, thought to be a bronchogenic cyst. The patient underwent successful thoracoscopic tumor extirpation, assisted by endoscopy, without undergoing major thoracotomy. Thoracoscopic surgery is recommended for this entity, but the muscle layer is often injured. Endoscopic ultrasonography was very useful, as it could detect damage to the proper muscle layer of the esophagus near the tumor. Thus, we could predict preoperatively that the defect in the muscle layer, which must be closed, would be caused by the surgery. Additionally, endoscopy easily facilitated the detection of the regional defect and the border of the proper muscle layer, and also could be used as a stent during wall suturing. This technique enabled us to avoid postoperative stenosis of the esophagus. Furthermore, our case presented a high level of CA125. The preoperative serum CA125 value was 93.8 U/ml and intratumoral CA125 concentration was 1,690,000 U/ml. Serum CA125 decreased to 16.5 U/ml after surgery. In this paper, we present a new strategy of the treatment for bronchogenic cyst and a review the literature.

Stapled resection for bronchogenic cyst of the esophagus performed using video-assisted thoracic surgery

“…Our patient exhibited coughing and chest pain that were probably b Microscopic findings showed that the cyst wall was lined with ciliated mucinous columnar epithelial cells and squamous metaplasia, and contained intramural cartilage tissues and seromucinous glands Esophagus (2011) 8:191-195 193 associated with the expansion of the cyst itself. Elevated tumor marker levels, such as CA19-9 and CA125, have been found in some patients with esophageal cysts [6,7]. Positive immunohistochemical staining for CA19-9 has been observed for bronchial glands of the lung, and some previous reports have shown that the surface epithelium of esophageal bronchogenic cysts is stained by a monoclonal antibody against CA19-9 [7].…”

“…A literature search of the PubMed database was performed using esophagus, bronchogenic cyst, and thoracoscopic surgery as keywords and a publication range of between 1980 and 2010. Eight cases that underwent surgery for esophageal bronchogenic cyst via a thoracoscopic approach were identified, including our case (Table 1) [5,6,10,12,13]. The cysts were located in the middle and distal esophagus in four and four patients, respectively.…”

“…A thoracoscopic approach and enucleation are not always easy for esophageal bronchogenic cysts with a large size and severe adhesions [6,12]. Martinod et al [14] reported having to change from a thoracoscopic approach to an open thoracotomy in 7 out of 20 cases with mediastinal bronchogenic cysts because of major adhesion and bleeding.…”

“…This technique using endo-staplers enabled us not only to decrease the risk of mucosal damage, but also to close the muscle layer simultaneously. Furthermore, the intraoperative endoscope can itself act as a stent to avoid strictures of the esophagus [6].…”

Subdiaphragmatic bronchogenic cyst of the esophagus masquerading as a metastatic lymph node of coexisting advanced gastric cancer

“…Whereas bronchogenic cysts are lined with pseudostratified ciliated columnar or cuboidal epithelia that sit on a smooth muscle layer and must contain cartilage or bronchial mucous glands, duplication cysts do not contain cartilage or respiratory glands and are lined with two smooth muscle layers [8,9]. Some previous reports have described the presence of elevated levels of tumor marker such as CA19-9 and CA125, and positive staining with a monoclonal antibody against CA19-9 in the esophageal bronchogenic cyst [10][11][12]. Our patient had neither positive immunohistochemical staining for CA19-9 nor an elevated serum CA19-9 level.…”