Retroperitoneal bronchogenic cyst: A case report and review of literature

Abstract

BACKGROUND

Bronchogenic cysts are rare developmental anomalies that belong to the category of congenital enterogenous cysts. They arise from lung buds and are present at birth. The embryonic foregut is their origin. Typically, they are located within the chest cavity, particularly in the cavum mediastinale of the thoracic cavity or lodged in the pulmonary parenchyma, and are considered a type of lung bud malformation.

CASE SUMMARY

A 49-year-old male patient was admitted to the hospital due to the detection of a retroperitoneal mass during a physical examination. Two weeks before admission, the patient underwent a physical examination and routine laboratory tests, which revealed a space-occupying mass in the retroperitoneal region. The patient did not report any symptoms (such as abdominal pain, flatulence, nausea, vomiting, high fever, or chills). The computed tomography (CT) revealed a retroperitoneal space-occupying lesion with minimal enhancement and a CT value of approximately 36 Hounsfield units. The lesion was not delineated from the boundary of the pancreatic body and was closely related to the retroperitoneum locally.

CONCLUSION

Following a series of tests, an abdominal mass was identified, prompting the implementation of a laparoscopic retroperitoneal mass excision procedure. During the investigation, an 8 cm × 7 cm cystic round-shaped mass with a distinct demarcation was identified in the upper posterior region of the pancreas. Subsequently, full resection of the mass was performed. Postoperative pathological examination reveled a cystic mass characterized by a smooth inner wall. The cystic mass was found to contain a white, viscous liquid within its capsule.

Key Words: Bronchogenic cyst, Retroperitoneal space, Excision, Laparoscopic surgery, Case report

Core Tip: A 49-year-old male with no significant medical or family history was diagnosed with a retroperitoneal mass during a routine physical examination, despite showing no typical symptoms. The absence of common diseases such as hypertension or diabetes in his medical history, with normal physical examination and laboratory results, highlighted the unusual nature of this case. The mass, detected incidentally, underscoreds the importance of routine health checks in identifying potentially serious conditions in asymptomatic patients. This case emphasizes the critical role of comprehensive evaluations and the need for surgical intervention in managing unexpected findings, demonstrating the value of caution in routine medical examinations.

INTRODUCTION

Bronchogenic cysts originate from the foregut and are most commonly situated in the mediastinum, as noted previously[1,2]. However, these cystic anomalies have also been identified in less common locations, including the esophagus, as reported by Altieri et al[1] and near the diaphragm[3,4]. While often presenting without symptoms, these cysts may lead to clinical concerns through infection or by exerting pressure on adjacent anatomical structures, as described previously[2]. To mitigate such issues and avert further complications, surgical removal of the cysts is frequently advocated[2]. While these cysts are generally asymptomatic, they can become infected or exert compressive effects on adjacent tissues[2]. This case study describes a case involving a subdiaphragmatic retroperitoneal bronchogenic cyst, with a definitive diagnosis established through histopathological examination of the surgically excised specimen.

CASE PRESENTATION

Chief complaints

A retroperitoneal mass was identified during a routine physical examination. The mass was detected two weeks prior to his admission, through physical assessment and standard laboratory tests.

History of present illness

A 49-year-old male who was hospitalized following a routine physical examination unexpectedly revealed a retroperitoneal mass despite the absence of symptoms such as nausea, vomiting, fever, abdominal pain, or distension.

History of past illness

The patient's medical history was devoid of any conditions, including the absence of other diseases such as hypertension (HTN), diabetes mellitus (DM), heart disease, or tuberculosis (TB).

Personal and family history

The patient reported no family history of any disease or cancerous growth.

Physical examination

During the physical examination, the patient's abdominal area exhibited a flat and soft appearance, without any indications of gastrointestinal problems or peristaltic movements. Moreover, there were no signs of varices in the abdominal wall, tenderness, rebound pain, or muscle guarding. The liver and spleen displayed normal characteristics, and Murphy's sign elicited a negative response. No pain was elicited during percussion in the liver and kidney regions, and no anomalies were detected during digital rectal examination. The vital signs of the patient were recorded as follows: Body temperature of 36.2 ℃, arterial blood pressure of 130/65 mmHg, SpO₂ level of 95%, pulse rate of 105 beats per minute, and respiration rate of 19 breaths per minute. In general, the findings of the physical examination were within normal limits.

Laboratory examinations

Laboratory analyses revealed a C-reactive protein concentration of 24.0 mg/L, a white blood cell (WBC) count of 12.4 × 10⁹/L, and a neutrophil proportion of 77.6%. The results of the endocrine assessment conducted to evaluate excessive adrenal secretion revealed no abnormalities, as shown in Table 1. Blood biochemistry results fell within the normal range, and after comprehensive laboratory analyses and a thorough physical examination, there were no evident contraindications for the surgical extraction of the tumor.

Table 1 Results obtained from the preoperative laboratory tests.

Actual parameter	Amount of concentration	Reference values
Leukocyte (WBC), × 109/L	6.1	3.5-9.5
Neutrophils, × 109/L	2.6	1.8-6.3
Lymphocytes, × 109/L	2.6	1.1-3.2
Monocytes, × 109/L	0.7	0.1-0.6
Eosinophils, × 109/L	0.12	0.02-0.52
Basophil, × 109/L	0.07	0-0.06
CA19-9, U/mL	3.3	< 37.0
CEA, ng/mL	2.3	< 5.0
AFP, ng/mL	1.25	< 8.78
CA125, U/mL	6.1	< 35

WBC: White blood cell; AFP: Alpha-fetoprotein; CA: Carbohydrate antigen; CEA: Carcinoembryonic antigen.

Table 1 presents the results of a series of presurgery laboratory tests conducted on the patient. It provides the actual values of various measured parameters, their corresponding normal reference values, and the units of measurement. The first parameter in the table is the leukocyte or WBC count, which measures the total WBCs in the bloodstream. The patient's WBC count was determined to be 6.1 × 10⁹/L, and this value falls within the typical reference range of 3.5-9.5 × 10⁹/L. Additionally, the table includes various types of WBCs, such as neutrophils, lymphocytes, monocytes, eosinophils, and basophils. The patient's neutrophil count was slightly below the standard range, while the lymphocyte count was within the normal reference range. The counts of the other types of WBCs all fell within their respective normal ranges. Additionally, the table reports the values of four tumor markers: Carbohydrate antigen (CA)19-9, carcinoembryonic antigen (CEA), alpha-fetoprotein (AFP), and CA125. Tumor markers are substances produced either by cancer cells or by normal cells in response to cancer. They serve the purpose of detecting cancer, monitoring its progression, and evaluating treatment efficacy. In this particular case, all four tumor markers were within their normal reference ranges, signifying the absence of evidence for cancer.

Imaging examinations

Further diagnostic evaluations were undertaken through noncontrast computed tomography (CT) scans to characterize the retroperitoneal space-occupying lesion. Imaging revealed that the lesion demonstrated characteristics suggestive of limited enhancement, an observation attributable to the imaging technique employed. The cyst content was noted to have a uniform density, with CT values ranging between 17 and 36 Hounsfield units, which are indicative of the lesion composition. A notable finding was the increased thickness of the cyst wall, a feature that may suggest underlying contamination or inflammation. Figure 1 shows the anatomical location of an oval cystic lesion situated at the posterior lower aspect of the left lateral lobe of the liver, within the retroperitoneal space, adjacent to the right side of the spine, and to the left of the inferior vena cava. However, it is important to clarify that the figure predominantly shows a large cystic mass accompanied by scattered calcifications within the abdominal-pelvic cavity, without distinct demarcation of the specific lesion across the mentioned anatomical landmarks.

Figure 1 Abdominal noncontrast computed tomography scan depicting a sizable cystic formation. The scan also revealed scattered calcifications throughout the abdominal and pelvic regions.

Further diagnostic work-up

Upon identifying an unexpected retroperitoneal mass during a standard physical examination, the 49-year-old male was subjected to a noncontrast CT scan, which delineated a lesion with limited enhancement and a uniform density, alongside an increased cyst wall thickness, suggesting possible underlying issues. The decision for surgical intervention was made, leading to the laparoscopic resection of the mass. Intraoperatively, the lesion, located on the dorsal side of the upper pole of the left kidney, was noted for its soft, gray-yellow appearance with a smooth surface. The tumor was characterized as soft and gray-yellow and had a smooth surface, and it was successfully completely excised. Upon opening the mass, a thick, jelly like substance was found within, and the thickness of the capsule wall measured approximately 0.2 cm, as shown in Figure 2A. The resected specimen, measuring 8.8 cm × 7.2 cm × 2.6 cm, underwent histopathological examination, which confirmed the diagnosis of a retroperitoneal bronchogenic cyst (Figure 2B). This examination revealed a cystic mass with a smooth inner wall, containing white viscous fluid, and a capsule wall lined with pseudostratified ciliated columnar epithelium, inclusive of glands, cartilage, and smooth muscle. Immunohistochemical analysis was not detailed in the initial text but would typically be considered for further characterization of the tissue, especially in distinguishing the cyst's benign nature from potential malignancies, by assessing specific markers relevant to bronchogenic cysts.

Figure 2 Cystic-solid tumor. A: Relationship of cystic lesions with surrounding structures and their maximum diameter; B: Complete surgical removal of the cystic-solid tumor, measuring 8.8 cm in length, 7.2 cm in width, and 2.6 cm in depth.

FINAL DIAGNOSIS

Considering the patient's clinical presentation and subsequent investigative findings, the final diagnosis was determined to be a retroperitoneal bronchogenic cyst.

TREATMENT

The patient was treated through laparoscopic resection of the retroperitoneal lesion under general anesthesia, successfully excising the cystic lesion. Postoperative recovery was uneventful, leading to discharge five days after the procedure without any complications.

OUTCOME AND FOLLOW-UP

The surgical procedure was carried out successfully, and the patient was safely transferred to the hospital ward without any postoperative complaints. Subsequent laboratory results indicated a reduction in C-reactive protein levels and WBC count, with a recorded value of 6.1-9 mg/L, while the neutrophil percentage remained at 77.6%. The patient's condition remained stable, characterized by normal vital signs, satisfactory overall well-being, restful sleep, and a positive mental state. Examination of the abdomen did not reveal any tenderness, and bowel sounds were within the expected range. After a postoperative recovery period of five days, the patient exhibited excellent progress without any complications, which ultimately led to their discharge from the hospital.

DISCUSSION

Bronchogenic cysts are a type of congenital developmental anomaly that typically occurs in the mediastinum but can also occur in other areas, such as the abdominal cavity, skin, and diaphragm. Retroperitoneal bronchogenic cysts are frequently observed in the left adrenal region and frequently exhibit an absence of symptoms, hence contributing to the potential for misdiagnosis[5]. It is crucial to distinguish these cysts from other conditions, such as adrenal adenomas, renal cysts, and cystic teratomas. As a consequence of the initial findings, the patient was referred to the surgical department for further evaluation and medical intervention. Throughout the illness, the patient did not manifest any distressing symptoms, such as abdominal pain, abdominal distension, diarrhea, hematuria, urinary pain, frequent urination, cold sensitivity, fever, night sweats, cough, or hemoptysis. Both urinary and bowel functions were reported to be normal, and no significant recent weight loss was documented. Furthermore, the patient had no previous medical history of conditions such as HTN, DM, heart disease, or TB. This case report highlights the discovery of a retroperitoneal space-occupying lesion in a patient who exhibited no accompanying symptoms. Imaging findings suggested the presence of additional cystic lesions within the retroperitoneal region, necessitating further inquiries to establish an accurate diagnosis and develop a suitable course of treatment for this individual.

There were no indications of varices, tenderness, rebound pain, or muscle guarding. Both the liver and spleen appeared normal. Percussion in the liver and kidney areas did not elicit any pain, and digital rectal examination revealed no abnormalities. Overall, the physical examination findings were within normal parameters.

Laboratory tests showed a C-reactive protein level of 24.0 mg/L, a WBC count of 12.4 × 10⁹/L, and a neutrophil percentage of 77.6%. Endocrine evaluation for excessive adrenal secretion revealed no abnormalities (Table 1). A CT scan revealed a retroperitoneal mass without significant enhancement. While the diagnosis confirmed the presence of an abdominal mass, further pathological assessment was needed for precise characterization. Blood biochemistry results were normal. After thorough laboratory analyses and physical examination, there were no contraindications for surgical tumor removal. Surgery was scheduled following appropriate preoperative assessments.

Bronchogenic cysts can be categorized into three types based on their location: Intrapulmonary, mediastinal, and ectopic. The mediastinal type is the most prevalent and typically manifests as a clearly defined cystic structure in the posterior mediastinum. Ectopic variants, which can appear in locations such as the neck, brain, and spinal dura, are rare and may occasionally be found in the retroperitoneal area. Retroperitoneal bronchogenic cysts are exceedingly rare, with only sixty-two cases reported in the medical literature. Among these cases, approximately thirty were verified as genuine retroperitoneal bronchogenic cysts based on anatomical and pathological criteria[6]. Retroperitoneal bronchogenic cysts are an uncommon, accounting for only 0.03% of the tumor incidence. These cysts are thought to have their origins in the embryonic foregut and arise from a segment of the abnormally developed trachea and bronchial tree that takes shape in the early stages following the detachment and implantation of the plumule in the abdominal cavity[5,7]. The concept posits a potential correlation between the occurrence of retroperitoneal bronchogenic cysts on the left side of the body and the separation of the plumule from the left side after anterior bowel transposition. Retroperitoneal bronchogenic cysts are a rare clinical discovery, and most of these lesions typically cluster around the left adrenal gland. The peripancreatic area is the second most frequently affected site for these cysts and can occasionally be mistaken for adenomas during preoperative imaging[8,9]. We examined a patient with a congenital malformation in the posterior mediastinum, likely attributed to the abnormal development of the foregut. One of the retroperitoneal cysts initially appeared as a left adrenal cyst and was effectively excised using laparoscopic techniques. The cyst was definitively diagnosed as a bronchogenic cyst through pathological analysis, highlighting the need to consider bronchogenic cysts as a possible diagnosis for retroperitoneal cysts.

Retroperitoneal bronchogenic cysts generally remain asymptomatic unless complications such as infection or significant enlargement leading to the compression of neighboring organs arise. The usual indications may involve unexplained abdominal swelling and a sense of fullness before lunchtime. In certain instances, when the adrenal glands are compressed, symptoms resembling those associated with pheochromocytoma have been documented. Early diagnosis and prompt treatment are crucial for preventing potential complications, as elevated levels of hormones may be released if left untreated[10,11]. Retroperitoneal bronchogenic cysts exhibit a nearly equal distribution between genders, affecting both women and men. Approximately 82% of these cysts are observed to localize on the left side of the abdominal region[12]. Bronchogenic cysts situated in deep anatomical locations, such as the posterior pelvic peritoneum, pose significant challenges in preoperative identification and are commonly subject to misdiagnosis[13]. The patient underwent a laparoscopic resection procedure for the retro-abdominal lesion under general anesthesia. No ascites was detected in the pelvic cavity, and there were no apparent abnormalities in various abdominal organs, including the liver, stomach, lungs, glands, spleen, small intestine, large intestine, and pelvic cavity. During the operation, the tumor was located on the dorsal side of the upper pole of the left kidney, as illustrated in Figure 2A.

Symptoms such as sickness, vomiting, and stomach discomfort may be useful in obtaining a diagnosis through medical assessment if the lesions become substantial enough to compress neighboring organs. While CT and magnetic resonance imaging are valuable diagnostic modalities for retroperitoneal bronchogenic cysts, the process of establishing a definitive diagnosis can be complex due to various aspects, including the protein or calcium composition of the cysts, their dimensions, compaction, or the potential occurrence of infection[8,14,15]. The tumor was characterized as soft and gray-yellow and had a smooth surface, and it was successfully completely excised. Upon opening the mass, a thick, jelly like substance was found within, and the thickness of the capsule wall measured approximately 0.2 cm, as shown in Figure 2B.

The retroperitoneal bronchogenic cyst was established during the postoperative pathological examination. The mass exhibited a rounded shape, measuring approximately 8 cm × 7 cm, and had a soft consistency with an intact capsule. Microscopic examination of the specimen revealed a cystic mass with a smooth inner wall, containing white viscous fluid. The capsule wall was lined with pseudostratified ciliated columnar epithelium and included glands, cartilage, and smooth muscle. The pathological diagnosis confirmed tha the mass was as a bronchogenic cyst, as depicted in Figure 3.

Figure 3 Histopathological analysis showing a retroperitoneal mass identified as an ectopic bronchogenic cyst, featuring nodular tissue in shades of gray-white and yellow. The cystic portion contains a light yellow, soft, gelatinous substance, encased by a smooth, encapsulated surface.

Following a successful surgical procedure, the patient was transferred safely to the hospital ward without experiencing any postoperative issues. Subsequent laboratory results showed decreased C-reactive protein levels and WBC counts, with a recorded range of 6.1-9 mg/L, while the neutrophil percentage remained stable at 77.6%. The patient's condition remained stable, with normal vital signs, satisfactory overall well-being, restful sleep, and a positive mental state. Abdominal examination revealed no tenderness, and bowel sounds were normal. After a 5-d postoperative recovery period, the patient made excellent progress without complications, leading to discharge from the hospital. Surgical removal is typically the treatment of choice, and symptoms of this lesion type often improve following surgical intervention. Fifty percent of all retroperitoneal bronchogenic cysts are discovered incidentally[8].

During sonogram investigation, retroperitoneal cystic lesions typically present as anechoic lesions with or without echo fragmentation. Computerized axial tomography typically indicates a thin-walled, well-defined lesion with low water density and little enhancement, although these lesions may have high density due to protein content, hemorrhagic content, or sticky mucinous tissue. Fluid level and wall calcification may also beobserved[6]. Retroperitoneal cystic lesions have a wide range of possible causes, including adrenal cysts, pancreatic pseudocysts, teratomas, and cystic lymphangiomas. Bronchogenic cysts are treated surgically and have a very good long-term success rate[2,12].

The use of endoscopic ultrasound (EUS) seems to exhibit a higher level of effectiveness compared to CT in the identification and characterization of retroperitoneal cystic masses. This is mostly due to its ability to provide a clear depiction of the mass itself, as well as the surrounding structures within the posterior peritoneal region. EUS-guided fine-needle aspiration is a diagnostic procedure that can be employed to ascertain the malignancy or benign nature of a lesion. There have been recorded instances of retroperitoneal bronchogenic cysts with notably increased levels of serum CA19-9, while the underlying cause for this increase remains unclear and requires additional investigation[16]. The use of serum CA19-9 measurement has the potential to provide valuable diagnostic information for the identification of retroperitoneal bronchogenic cysts[17]. Retroperitoneal bronchogenic cysts were first described by Miller et al[18] in 1953 and are considered to be extremely rare. A thorough examination of the PubMed database has shown a total of 88 recorded cases of retroperitoneal bronchogenic cysts in the global English-language literature from 1991 to 2022. In the context of this study, a comprehensive analysis was conducted on a total of 40 publications, each presenting detailed information on 45 cases involving the laparoscopic extraction of red blood cells. The evaluation encompassed the entirety of the texts as well as the pathological findings associated with these cases. Table 2 provides a concise summary of the papers that are included for reference.

Table 2 A literature review on laparoscopic and robotic surgery for retroperitoneal bronchogenic cysts.

Country	Year	Age (yr)	Sex	Location	Size (cm)	Chief complaint	Surgical technique	First author	Ref.
Japan	1997	24	F	L adrenal gland	3	Asymptomatic	Laparoscopic	Tokuda N	[19]
Japan	1998	49	F	R adrenal gland	3.2 × 2.2	Asymptomatic	Laparoscopic	Yamamoto E	[23]
Australia	2002	15	M	L adrenal gland	5.5 × 3.5 × 1.2	L flank pain	Laparoscopic	McCrystal DJ	[24]
Australia	2002	8	F	L adrenal gland	4 × 3 × 2	Abdominal pain	Laparoscopic	McCrystal DJ	[24]
United States	2003	59	F	L adrenal gland	7 × 5	Asymptomatic	Laparoscopic	Hedayati N	[25]
Japan	2003	41	F	L adrenal gland	9.2	L flank pain	Laparoscopic	Ishikawa T	[26]
Japan	2004	36	M	L adrenal gland	5 × 3	Asymptomatic	Laparoscopic	Ishizuka O	[27]
United States	2007	75	F	L adrenal gland	5	Abdominal pain	Laparoscopic	Terry NE	[28]
China	2007	55	M	L adrenal gland	4 × 3	Asymptomatic	Laparoscopic	Chu PY	[29]
Japan	2007	39	M	L adrenal gland	3.5 × 3	Fever	Laparoscopic	Minei S	[30]
United States	2008	40	M	L adrenal gland	6.2	Asymptomatic	Laparoscopic	Roma A	[31]
Korea	2009	41	F	L adrenal gland	4.8 × 3.5 × 4.2	Asymptomatic	Laparoscopic	Chung JM	[12]
United States	2009	67	M	L upper-quadrant	3.9 × 3.7	Asymptomatic	Laparoscopic	Obando J	[32]
Portland	2010	44	M	L adrenal gland	3	Asymptomatic	Laparoscopic	El Youssef R	[33]
Japan	2010	64	F	Stomach posterior wall	3 × 4 × 2	Asymptomatic	Laparoscopic	Inaba K	[34]
Spain	2010	67	M	Gastro-esophageal junction	6	Low back pain	Laparoscopic	Díaz Nieto R	[35]
United States	2012	23	F	R adrenal gland	4	Asymptomatic	Robotic	Alguraan Z	[36]
United States	2012	23	F	L adrenal gland	5.2 × 4	Abdominal discomfort	Laparoscopic	O'Neal PB	[37]
Germany	2013	50	M	L adrenal gland	4	L flank pain	Laparoscopic	Jannasch O	[38]
China	2013	50	F	Pancreas posterior wall	3	L flank pain	Laparoscopic	Cai Y	[39]
Switzerland	2013	42	F	L adrenal gland	5 × 3.6 × 4	Epigastric pain	Laparoscopic	Runge T	[40]
Portugal	2013	36	F	L upper quadrant	8	Abdominal pain	Laparoscopic	Castro R	[41]
China	2014	30	F	L adrenal gland	1.5 × 2 × 2	Asymptomatic	Laparoscopic	Dong B	[42]
China	2014	51	M	L adrenal gland	4.5	Headache	Laparoscopic	Cao DH	[43]
Japan	2014	27	M	L adrenal gland	5.4 × 3.8	Asymptomatic	Laparoscopic	Terasaka T	[44]
China	2015	8	M	L adrenal gland	4	Asymptomatic	Laparoscopic	Zhang D	[45]
India	2015	34	F	R hypochondrium	10 × 6	R flank heavy	Laparoscopic	Trehan M	[46]
China	2015	52	M	L crus of the diaphragm	2.5 × 2.5 × 0.5	Asymptomatic	Laparoscopic	Jiang X	[47]
Türkiye	2015	25	F	L adrenal gland	4	L flank pain	Laparoscopic	Bulut G	[48]
Korea	2015	57	M	L adrenal gland	4.8 × 2.5	Asymptomatic	Laparoscopic	Yoon YR	[49]
China	2017	48	F	L adrenal gland	8 × 6 × 5.5	Epigastric pain	Laparoscopic	Wang M	[17]
China	2018	78	M	Inferior of the L renal vein, L side of IVC	7	Asymptomatic	Robotic	Liu Q	[50]
China	2018	33	M	L hepatic hilum	4.5	Asymptomatic	Robotic	Liu Q	[50]
Türkiye	2018	38	F	L adrenal gland	NA	L upper abdominal pain	Laparoscopic	Bolton JW	[51]
India	2020	30	M	L adrenal gland	7 × 5	Upper abdominal pain	Laparoscopic	Sinha V	[52]
China	2020	33	M	R adrenal gland	3.1 × 5.9	Asymptomatic	Laparoscopic	Wen Y	[53]
China	2020	27	M	L adrenal gland	2.1 × 4.1	Asymptomatic	Laparoscopic	Wen Y	[53]
China	2021	41	F	L adrenal gland	3.5 × 3	Lumbar back discomfort	Laparoscopic	Qingyu J	[54]
China	2021	17	F	L adrenal gland	2.9 × 1.7 × 2.8	Epigastric pain	Laparoscopic	Wu LD	[55]
China	2021	53	F	L adrenal gland	3.3 × 2.7 × 3.5	Back pain	Laparoscopic	Yuan K	[22]
New Zealand	2021	39	M	L adrenal gland	3	L flank pain	Laparoscopic	Cowan S	[56]
Japan	2022	16	F	Under the L diaphragm	3.8	Upper abdominal pain	Laparoscopic	Tadokoro T	[57]
China	2022	27	M	R adrenal gland	3.6 × 3.5 × 3.4	Asymptomatic	Laparoscopic	Hu BY	[58]
China	2022	18	M	L adrenal gland	7.1 × 3.6 × 7	Asymptomatic	Laparoscopic	Hu BY	[58]
China	2022	6	M	L adrenal gland	4.5 × 2.8 × 8	Abdominal pain	Laparoscopic	Hu BY	[58]

Tokuda et al[19] reported the first laparoscopic resection of such cysts in 1997, with a focus on cysts up to 3 cm in size. It is worth noting that this particular surgical treatment has been predominantly documented in China, with 17 cases (37.8%). Subsequently, 8 cases were recorded in Japan (17.8%), while 6 cases were reported in the United States (13.3%). The observation of differences based on regional and racial factors is consistent with the findings reported by Liang et al[20]. Comprehensive literature reviews were sequentially conducted by Cetinkurşun et al[21], Liang et al[20], Govaerts et al[6], and Yuan et al[22] in the years 1997, 2005, 2012, and 2021, respectively. It is noteworthy to emphasize that the aforementioned research included a significant cohort of patients who underwent surgical procedures utilizing the open technique. After successful surgical resection and pathological confirmation of the bronchogenic cyst, comprehensive preoperative assessment, which plays a crucial role in guiding the surgical approach. Table 1 presents the results of a series of presurgery laboratory tests conducted on the patient, providing a detailed account of the patient's clinical status prior to the operation. This includes the actual values of various measured parameters, their corresponding normal reference values, and the units of measurement. Specifically, the leukocyte or WBC count, which measures the total WBCs in the bloodstream, was determined to be within the typical reference range, indicating no infection or inflammation. Additionally, the table reports the values of four tumor markers: CA19-9, CEA, AFP, and CA125, all of which are within their normal reference ranges, indication the absence of evidence for cancer. This comprehensive laboratory analysis, alongside a thorough physical examination, underscored the absence of contraindications for surgical extraction of the tumor, facilitating a well-informed decision to proceed with laparoscopic resection. Furthermore, our study was extended to incorporate the latest findings from the preceding 2 years and address any deficiencies that were not covered in previous enquiries. These collaborative endeavors resulted in consistent discoveries concerning the clinical attributes of the illness, including elements such as the age of the patients, initial symptoms, and prevalent anatomical sites of the cysts.

CONCLUSION

In summary, retroperitoneal bronchogenic cysts, while rare and often asymptomatic, are typically identified incidentally and best managed through surgical removal, with laparoscopic excision being the preferred method. The case discussed illustrates the successful laparoscopic resection of such a cyst, emphasizing the importance of a multidisciplinary approach for optimal diagnosis and management. The challenges in preoperative diagnosis due to the deep anatomical locations of cyst highlight the need for prompt intervention to prevent complications. The current literature supports the effectiveness of laparoscopic surgery, noting a favorable long-term prognosis without recurrence. Future research should focus on enhancing diagnostic techniques and exploring less invasive treatment options, underscoring the necessity of further studies to improve patient care for this condition.

ACKNOWLEDGEMENTS

We would like to express our gratitude to our patient and their family for allowing us to publish this case report.