Endoscopic ultrasound-guided fine-needle aspiration in the diagnosis of foregut duplication cysts: The value of demonstrating detached ciliary tufts in cyst fluid

Abstract

BACKGROUND The management of foregut duplication cysts is controversial, especially in asymptomatic patients. The safety and accuracy of endoscopic ultrasound (EUS) and EUS‐fine‐needle aspiration EUS‐FNA) in confirming the nature of cysts by using electron microscopy (EM) has not been reported. In this study, the authors describe the utility of demonstrating detached ciliary tufts (DCTs) in the diagnosis of foregut duplication cysts with EUS‐FNA. METHODS Consecutive patients with suspected mediastinal masses or mediastinal cysts on imaging studies were evaluated prospectively by EUS and EUS‐FNA. Cyst fluid was examined by routine cytologic techniques. In two patients, EM was performed to confirm the nature of DCTs. RESULTS Ten consecutive patients were evaluated with EUS and EUS‐FNA. Seventy percent of the cysts were characterized by computed tomography (CT) scans as solid masses. The mean greatest cyst dimension measured 34 mm × 48 mm by EUS. Microscopic examination of the cyst content revealed mucinous material, cellular debris, and DCTs. The latter were seen in routine cytologic preparations and by EM. Patients were followed up to a median of 321 days. Due to EUS‐FNA confirmatory diagnoses of foregut duplication cysts, none of the patients except 1 underwent surgical resection after developing pneumonia 6 months later. Histologic sections of the resected specimen confirmed the presence of (foregut cyst, bronchogenic type). All other patients were asymptomatic. Cysts size and nature did not change on repeated imaging studies. CONCLUSIONS EUS was superior compared with CT scanning in characterizing foregut duplication cysts. EUS‐FNA is safe and accurate in the diagnosis of foregut duplication cysts. The demonstration of DCTs in cyst fluid and the absence of malignant cells confirmed the benign nature of these lesions, allowing conservative and expectant management for these patients. Cancer (Cancer Cytopathol) 2004. © 2004 American Cancer Society.

Ultrasound-Guided Fine Needle Aspiration Cytology Diagnosis of a Foregut Cyst in the Thyroid

“…This case is also the first to be diagnosed by ultrasound-guided fine needle aspiration cytology, while all the other cases were diagnosed by histology after surgical excision. 5 In regard to clinical management, our patient did not require surgical intervention 6 months after the cytologic diagnosis, similar to most of the patients reported in a study by Eloubeidi et al 17 in which only 1 of 10 patients with foregut cysts involving various sites and diagnosed by fine needle aspiration underwent surgical resection because of complications. Although foregut cysts are rare, an awareness of this entity and accurate cytologic diagnosis will aid proper patient management and avoid unnecessary surgery.…”

“…It is the fifth case of such a lesion reported in the Englishlanguage literature. The presence of detached ciliary tufts (DCTs) as a diagnostic clue to foregut cysts was reported by Eloubeidi et al 17 In the current case, we highlight the diagnostic utility of these structures in the cytologic diagnosis of a foregut cyst in the thyroid gland.…”

“…18 Foregut cysts are usually asymptomatic and are mostly incidental findings in adults but can lead to symptoms like pain, breathing difficulties, cough and stridor. 17 Ciliocytophthoria is a term coined by Papanicolaou and originally applied to the anucleate cellular fragments that occur in specimens obtained from the airway tract. 20 These structures are remnants of ciliated columnar epithelium that result from detachment of the apical cytoplasm, terminal bar and cilia from columnar respiratory cells, dividing the ciliated columnar cell into 2, a part containing the degenerated nucleus enveloped by a thin rim of cytoplasm and a remnant with the remaining cytoplasm and cilia attached.…”

Rare Potential Pitfall in Endoscopic Ultrasound–Guided Fine Needle Aspiration Biopsy in Gastric Duplication Cyst

“…The cyst may contain amorphous debris, degenerated cells and mucinous materials, with rare gastric or esophageal cells that could be mucosal contamination. As indicated by Eloubeidi et al, 5 the presence of detached ciliary tufts (DCTs) is a diagnostic clue for foregut cysts cytologically, although DCTs are not specific for Mucin-producing cystic neoplasms and mucin-producing welldifferentiated adenocarcinoma of the pancreas or stomach may also mimic mucinous material in GDC.…”

“…[1][2][3][4] However, there are only 12 case reports regarding endoscopic ultrasound-guided fine needle aspiration biopsy (EUS-FNAB) finding. 1,5,6 FDCs can occur anywhere in the alimentary tract, from tongue to anus, but the ileum is the most common site. There are 3 types of FDCs-bronchogenic, intramural gastroesophageal and enteric.…”