Peritoneal metastatic adenocarcinoma possibly due to a gastric duplication cyst: a case report and literature review

Abstract

BackgroundGastric duplication cysts are rare congenital abnormalities, and malignant transformation of these duplications is also thought to be rare.Case presentationDuring a routine health checkup, a 28-year-old man underwent abdominal sonography followed by computed tomography (CT) with contrast agent, which revealed a cystic lesion with no enhancement. Laparoscopic surgery showed a 10 × 10 cm cyst adhering to the gastric corpus. However, attempts to remove the lesion en bloc were unsuccessful, and the ruptured cyst had contaminated the peritoneal cavity. Gastric duplication was diagnosed from microscopic examination of the cyst. Seven months later, the patient suffered a progressive increase in ascites, and repeated cytological analysis showed small nests of adenocarcinoma cells, with primary lesion unknown. Diagnostic laparoscopy showed multiple white nodules scattered over the surface of the liver, greater omentum, and peritoneum. Biopsy of the omental nodules confirmed adenocarcinoma, while carcinomatosis was diagnosed in the peritoneum.ConclusionsClinical presentation and chronological developments indicated that the malignancy probably originated from the gastric duplication cyst. This case highlights the importance of accurate preoperative diagnosis and optimal surgical management for gastric duplication as well as considering the potential existence of malignant transformation during surgical evaluation of adult patients with gastric duplication cysts.

An uncommon cause of acute abdomen: gastric duplication cyst

“…In differential diagnosis gastric tumors, pancreatic mucinous and cystic tumors, pancreatic psodocysts, cystic masses of adjacent organs, gastrointestinal stromal tumors and neuroendocrine tumors should be considered (5,8). GDCs are sometimes diagnosed incorrectly as adrenal masses due to the anatomical proximity of the adrenal glands (5,11).…”

“…GDCs are sometimes diagnosed incorrectly as adrenal masses due to the anatomical proximity of the adrenal glands (5,11).…”

“…CT is helpful in determining the size of the cyst and the relationship with the neighboring organs (5). CT indicates the GDC as in oval or round shaped, smooth bordered, water or soft tissue density, homogeneous and low density lesion.…”

Duplicación quística intestinal. Caso clínico

“…La presencia de tejido gástrico ectópico en 20-30% de los quistes puede provocar ulceración, sangrado o perforación a medio o largo plazo e, incluso, malignización en la edad adulta. 10,14 Su tratamiento es la resección quirúrgica electiva, de manera preferente, con técnicas mínimamente invasivas. En pacientes asintomáticos, se aconseja el seguimiento clínico y con estudios de imagen.…”

An Adult Gastric Duplication Cyst Mimicking a Gastrointestinal Stromal Tumor

“…Liu et al described the clinicopathological diagnosis for cases of malignancy arising from GDCs. Adenocarcinoma is likely the most common histologic type of gastric duplication cyst reported (5). In the present case, we selected surgical treatment for the following reasons: 1) the patient presented with outlet obstruction due to BVS by the GDC and 2) because the endoscopeguided FNA cytology was class III, malignancy could not be excluded.…”