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Gastric duplication cyst: a challenging EUS differential diagnosis between subepithelial gastric lesion and exophytic pancreatic cystic neoplasm—a case report and a literature review

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Abstract

Gastric duplication cysts are rare congenital malformation with a potential neoplastic progression and they may represent a challenge in differential diagnosis with exophytic pancreatic cyst neoplasm. We describe a case of a 38-year old man, complaining of recurrent epigastric pain due to a large abdominal mass, referred to our Hospital for EUS evaluation. Differential diagnosis was between gastric duplication cyst and exophytic pancreatic cyst because of FNA pointed out amylase 1280 UI/L and CEA 593.33 ng/mL. Despite antibiotic prophylaxis, an overinfection of the lesion occurred after the FNA, likely due to the technical failure to drain the cyst completely. Afterwards, the patient was referred to surgery and the pathologist confirmed the diagnosis of gastric duplication cyst. In this setting, EUS procedure has gained a leading play, complementary to traditional imaging tests, although its role has been not yet standardized in the reported literature. Here, we describe and discuss our demanding case, and we propose an algorithm to simplify and standardize the diagnostic workup.

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Abbreviations

GDC:

Gastric duplication cyst

DC:

Duplication cyst

EUS:

Endoscopic ultrasound

FNA:

Fine-needle aspiration

FNB:

Fine-needle biopsy

CEA:

Carcino-embryonic antigen

PCCE:

Pseudostratified columnar ciliated epithelium

CH-EUS:

Contrast-enhanced harmonic endoscopic ultrasound

PMN:

Papillary mucinous neoplasm

CT:

Computed tomography

GIST:

Gastrointestinal stromal tumors

SA:

Splenic artery

SV:

Splenic vein

END RES:

Endoscopic resection

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Funding

The authors received no financial support for the research, authorship, and/or publication of this article.

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Authors and Affiliations

  1. Gastroenterology and Endoscopy Unit, Mater Olbia Hospital, SS 125 Orientale Sarda, 07026, Olbia, Italy

    Marco Massidda, Chiara Rocchi, Salvatore Francesco Vadalà di Prampero & Milutin Bulajic

  2. Clinica Medica, Dipartimento di Scienze Mediche, Chirurgiche e Sperimentali, University of Sassari, Viale San Pietro 43, 07100, Sassari, Italy

    Giulia Tomassini

  3. Department of Diagnostic Services, Pathology Unit, ASL Gallura, Via Bazzoni Sircana, 07026, Olbia, Italy

    Paolo Cossu Rocca

  4. General Surgery Unit, Mater Olbia Hospital, SS 125 Orientale Sarda, 07026, Olbia, Italy

    Vincenzo Tondolo

  5. Radiology Unit, Mater Olbia Hospital, SS 125 Orientale Sarda, 07026, Olbia, Italy

    Gabriella Manzoni

Authors
  1. Marco Massidda
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  2. Chiara Rocchi
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  3. Giulia Tomassini
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  8. Milutin Bulajic
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Contributions

MM: conceptualization, investigation, project administration, and writing—original draft; RC: supervision, visualization, and writing—original draft. TG: software, visualization, and writing—review and editing. VPSF: supervision and visualization. CRP: investigation. TV: investigation. MG: investigation. BM: investigation, validation, visualization, and supervision. All the authors read and approved the final manuscript.

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Correspondence to Marco Massidda.

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Massidda, M., Rocchi, C., Tomassini, G. et al. Gastric duplication cyst: a challenging EUS differential diagnosis between subepithelial gastric lesion and exophytic pancreatic cystic neoplasm—a case report and a literature review. Clin J Gastroenterol 15, 560–567 (2022). https://doi.org/10.1007/s12328-022-01619-3

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  • DOI: https://doi.org/10.1007/s12328-022-01619-3

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