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World J Gastroenterol. Jan 14, 2015; 21(2): 432-438
Published online Jan 14, 2015. doi: 10.3748/wjg.v21.i2.432
Gastric foregut cystic developmental malformation: Case series and literature review
Yan-Hua Geng, Chang-Xing Wang, Jiang-Tao Li, Qing-Yu Chen, Xiu-Zhen Li, Hao Pan
Yan-Hua Geng, Xiu-Zhen Li, Hao Pan, Department of Pathology, Second Affiliated Hospital of Zhejiang University College of Medicine, Hangzhou 310009, Zhejiang Province, China
Chang-Xing Wang, Department of Osteology, Second Affiliated Hospital of Zhejiang University of Traditional Chinese Medicine, Hangzhou 310005, Zhejiang Province, China
Jiang-Tao Li, Department of Surgery, Second Affiliated Hospital of Zhejiang University College of Medicine, Hangzhou 310009, Zhejiang Province, China
Qing-Yu Chen, Department of Gastroenterology, Second Affiliated Hospital of Zhejiang University College of Medicine, Hangzhou 310009, Zhejiang Province, China
Author contributions: Geng YH and Wang CX designed the research and wrote the paper; Li JT, Chen QY, Li XZ and Pan H collected and analyzed the data.
Supported by The Science and Technology Project of Zhejiang Province, China, No. N20120675.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Geng Yan-Hua, Associate Chief Physician, Master of Medicine, Department of Pathology, Second Affiliated Hospital of Zhejiang University College of Medicine, Building 9, No. 88 Jie-Fang Road, Hangzhou 310009, Zhejiang Province, China. yhgeng@sina.cn
Telephone: +86-571-87767185 Fax: +86-571-87767185
Received: July 26, 2014
Peer-review started: July 27, 2014
First decision: August 15, 2014
Revised: September 4, 2014
Accepted: October 21, 2014
Article in press: October 21, 2014
Published online: January 14, 2015
Processing time: 175 Days and 21.2 Hours
Abstract

Foregut cystic developmental malformation (FCDM) is a very rare lesion of the alimentary tract, especially in the stomach. We discuss the concepts of gastric duplication cyst, bronchogenic cysts, and FCDM. Nomenclature has been inconsistent and confusing, but, by some definitions, gastric duplication cysts involve gastric mucosa and submucosal glands, bronchogenic cysts involve respiratory mucosa with underlying cartilage and glands, and FCDM lacks gastric mucosa or underlying glands or cartilage but has pseudostratified ciliated columnar epithelium (PCCE). We searched our departmental case files from the past 15 years and identified 12 cases of FCDM in the alimentary tract. We summarize the features of these 12 cases including a report in detail on a 52-year-old man with a submucosal cyst lined with simple PCCE and irregular and stratified circular muscle layers that merged with gastric smooth muscle bundles near the lesser curvature of the gastric cardia. A literature review of cases with this histology yielded 25 cases. We propose the term gastric-FCDM for such cases. Our own series of 12 cases confirms that preoperative recognition of the entity is infrequent and problematic. The rarity of this developmental disorder, as well as a lack of understanding of its embryologic origins, may contribute to missing the diagnosis. Not appreciating the diagnosis preoperatively can lead to an inappropriate surgical approach. In contrast, presurgical recognition of the entity will contribute to a good outcome and reduced risk of complications.

Keywords: Endoscopic ultrasound-guided fine-needle aspiration; Foregut duplication cyst; Gastric duplication cyst; Laparoscopic surgery; Pseudostratified columnar ciliated epithelium

Core tip: Gastric foregut cystic developmental malformation is a rare lesion that has been reported intermittently in recent decades. Its classification was inconsistent. It has often been misdiagnosed preoperatively. By missing the nature of the diagnosis, the surgical management was quite different. Through a review of the case series and literature concerning their clinical and radiologic features, and recognition of its embryologic and histological origin, we found that it is not an irregular disease and is an easily missed diagnosis. It can be cured by rational surgery, contributing to a good outcome and reduced risk of complications.