Case Report
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World J Gastroenterol. Dec 7, 2013; 19(45): 8445-8448
Published online Dec 7, 2013. doi: 10.3748/wjg.v19.i45.8445
Rare adult gastric duplication cyst mimicking a gastrointestinal stromal tumor
Morakod Deesomsak, Pitulak Aswakul, Pairoj Junyangdikul, Varayu Prachayakul
Morakod Deesomsak, Pitulak Aswakul, Liver and Digestive Institute, Samitivej Sukhumvit Hospital, Bangkok 10120, Thailand
Pairoj Junyangdikul, Department of Pathology, Samitivej Srinakarin Hospital, Bangkok 10250, Thailand
Varayu Prachayakul, Siriraj GI Endoscopy Center, Division of Gastroenterology, Department of Internal Medicine, Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok 10700, Thailand
Author contributions: Prachayakul V conceptualized the study; Aswakul P, Deesomsak M and Junyangdikul P acquired the data; Prachayakul V and Aswakul P wrote the manuscript.
Correspondence to: Varayu Prachayakul, MD, Siriraj GI Endoscopy Center, Division of Gastroenterology, Department of Internal Medicine, Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok 10700, Thailand. kaiyjr@gmail.com
Telephone: +66-2-4121088 Fax: +66-2-4196101
Received: March 28, 2013
Revised: June 6, 2013
Accepted: June 18, 2013
Published online: December 7, 2013
Processing time: 264 Days and 20.8 Hours
Abstract

Gastric duplication cyst is a very rare gastrointestinal tract malformation that accounts for 2%-4% of alimentary tract duplications. Most cases are diagnosed within the first year of life, following presentation of abdominal pain, vomiting, and weight loss and clinical discovery of an abdominal palpable mass. This case report describes a very uncommon symptomatic gastric duplication cyst diagnosed for the first time in adulthood. Only a few other case reports of similar condition exist, and all were identified by endosonography. The current case involves a 52-year-old male who presented with a one-month history of progressive iron deficiency anemia without overt gastrointestinal bleeding. The patient underwent esophagogastroduodenoscopy, which revealed a 2.0 cm pinkish subepithelial lesion, suspected to be a gastrointestinal stromal tumor (GIST) and source of gastrointestinal bleeding. The endosonography showed inhomogeneous hypoechoic lesions with focal anechoic areas arising from a second and third layer of the gastric wall. Differential diagnoses of GIST, neuroendocrine tumor, or pancreatic heterotopia were made. The lesion was removed using an endoscopic submucosal resection technique. Histopathology revealed an erosive gastric mass composed of a complex structure of dilated gastric glands surrounded by fibro-muscular tissue, fibroblasts, and smooth muscle bundles, which led to the diagnosis of gastric duplication.

Keywords: Gastric duplication cyst, Gastrointestinal bleeding, Endoscopy, Endoscopic ultrasonography, Endoscopic mucosal resection, Differential diagnosis, Adult

Core tip: Gastric duplication cyst is a very rare gastrointestinal malformation and most of the cases are diagnosed within the first year of life following clinical investigations of abdominal symptoms including pain, vomiting, and palpable mass. Gastrointestinal hemorrhage is a rare clinical manifestation. Here, we report a 52-year-old man who presented with a one-month history of progressive iron deficiency anemia without overt gastrointestinal bleeding. Esophagogastroduodenoscopy revealed general gastrointestinal bleeding and a 2.0 cm subepithelial tumor originating from the third layer of gastric wall. After complete removal by endoscopic mucosal resection, histopathological findings indicated a diagnosis of gastric duplication cyst with erosion.