Endoscopy 2006; 38: E30-E31
DOI: 10.1055/s-2006-944865
Unusual cases and technical notes

© Georg Thieme Verlag KG Stuttgart · New York

Esophageal duplication cyst presenting as a submucosal tumor: diagnosis by endoscopic ultrasound-guided fine-needle aspiration

T.-Y. Cheng1, 2 , J.-H. Chen3 , I.-S. Jan1 , C.-C. Chen2 , H.-P. Wang4 , J.-T. Lin2
  • 1Department of Laboratory Medicine, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan
  • 2Department of Internal Medicine, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan
  • 3Department of Internal Medicine, Tzu-Chi General Hospital, Taipei Branch, Taiwan
  • 4Department of Emergency Medicine, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan
Further Information

Publication History

Publication Date:
11 January 2007 (online)

A 44-year-old woman presented with symptoms of intermittent epigastric pain and chest discomfort which she had suffered for more than 5 years. She had noticed progressive discomfort on swallowing in the past 1 month. The episodic attacks were not related to meals, respiration, or exercise. She underwent esophagogastroduodenoscopy at her local hospital and this revealed a suspicious-looking region of external compression over the lower esophagus. Chest computed tomography showed a 3.4-cm mediastinal tumor that was adhering to the lower esophagus. She was then referred to our hospital for further evaluation.

An upper gastrointestinal series showed a smooth, wide-based indentation of the outline at the level of the lower esophagus (Figure [1]), and repeat esophagogastroduodenoscopy showed a submucosal tumor with normal-looking overlying mucosa (Figure [2]). Endoscopic ultrasound (EUS) was performed with an Olympus UC2000P echo endoscope (Olympus, Tokyo, Japan) in an attempt to clarify the character of the submucosal tumor. The EUS image revealed a 3.4-cm, anechoic lesion with a thick wall in the third layer of the lower esophagus. Subsequent EUS-guided fine-needle aspiration using a 22-gauge Olympus MAJ-919 needle yielded a large volume of dark-yellowish mucoid material (Figure [3]). On-site cytology after staining with Hemacolor stain (Merck, Darmstadt, Germany) showed groups of ciliated columnar cells on a mucoid cystic background (Figure [4]). There were no lymphocytes or polymorphonuclear leukocytes. These findings were consistent with a diagnosis of esophageal duplication cyst. The patient eventually underwent a surgical resection procedure for symptomatic relief, and the histopathologic examination of the resection specimen confirmed the diagnosis.

Figure 1 An upper gastrointestinal series revealed a smooth, wide-based indentation of the outline at the level of the lower esophagus.

Figure 2 Esophagogastroduodenoscopic view showed a submucosal tumor with normal-looking overlying mucosa in the lower esophagus.

Figure 3 The endoscopic ultrasound (EUS) image revealed a 3.4-cm anechoic lesion with a thick wall in the third layer of lower esophagus. EUS-guided fine-needle aspiration (EUS-FNA) (arrow) yielded a large volume of dark-yellowish mucoid material.

Figure 4 EUS-FNA cytology showed groups of ciliated columnar cells against a mucoid, cystic background (Hemacolor stain, original magnification × 400).

This case demonstrates that EUS with fine-needle aspiration can provide a quick, accurate, and minimally invasive method for the diagnosis of esophageal duplication cyst.

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Endoscopy_UCTN_Code_CCL_1AB_2AC_3AH

    H.-P. Wang, M. D.

    Department of Emergency Medicine

    National Taiwan University Hospital
    7 Chung-Shan South Road
    Taipei
    Taiwan

    Fax: +886-2-23947899

    Email: whp@ha.mc.ntu.edu.tw