Oesophageal duplication cysts are rare congenital oesophageal anomalies in adults and are mostly asymptomatic. Diagnosis of an oesophageal duplication cyst is usually made in infancy and childhood while investigating for respiratory distress or feeding

1
Oesophageal Duplication Cyst Masquerading as a
Gastrointestinal Stromal Tumour
Tarek I. El-Houssari, Amir Kambal, Haythem Ali,
Ashraf Rasheed
Gwent Institute for Minimal Access Surgery

• Oesophageal duplication cysts are rare entities
  that are usually found incidentally during the
  early years while investigating for respiratory
  or poor feeding complaints. Surgical excision of
  these cysts is the mainstay treatment modality
  for these cysts for fear of complications. These
  complications range from aspiration, infection,
  and bleeding to perforation.
•  
• In our case, a 39 years old gentleman presented
  with cough, progressive dysphagia, retro-sternal
  pain and nocturnal heartburn. He proceeded to
  have an upper endoscopy and a CT of the chest
  revealing an opacity at the origin of the left
  upper lobe of the lung and 5.7 x 3.9 cm oval soft
  tissue mass on the right side of the lower
  oesophagus just above the gastro-oesophageal
  junction.
• Bronchoscopy was performed and was normal and a
  diagnosis of either leiomyoma or an oesophageal
  GIST was entertained based on the endoscopy and
  the imaging.
•   
• The patient was referred then to us when we
  organised an endoscopic ultrasound revealing a
  4.5 cm sub-mucosal lesion at the level of the
  left atrium. This hypo-echoic lesion had a well
  defined capsule and was described to be
  non-cystic. No fine needle aspiration (FNA) was
  attempted in fear of the risk of dissemination of
  this presumed oesophageal GIST (Gastrointestinal
  Stromal Tumour) and we proceeded to minimal
  access resection of the lesion (Laparoscopic
  Gastro-oesophagectomy).

Introduction Oesophageal duplication cysts are
rare congenital oesophageal anomalies in adults
and are mostly asymptomatic. Diagnosis of an
oesophageal duplication cyst is usually made in
infancy and childhood while investigating for
respiratory distress or feeding difficulty.
Complications are known to occur during the
natural course of the disease due to bleeding,
infection and mass effect. We describe the
diagnostic pitfalls and management of a case of
oesophageal duplication cyst simulating
oesophageal GIST, causing retro-sternal pain,
gastro oesophageal reflux and intermittent
dysphagia.
Case Report A 40-year-old man, previously
asymptomatic, presented with nocturnal heartburn,
progressive dysphagia and retro-sternal pain. His
past history was un-remarkable. The upper
endoscopy revealed a distal sub-mucosal
oesophageal lesion and the barium swallow
confirmed the large extrinsic impression along
the right side of the distal oesophagus. Contrast
enhanced computed tomography (CT) showed a
well-circumscribed pre-vertebral thin-wall mass
measuring 50 mm in diameter. Endoscopic
ultrasonography (EUS) concurred with CT findings
and suggested it to be GIST in nature. A
laparoscopic distal oesophagectomy and proximal
gastrectomy was carried out for the presumed
symptomatic oesophageal GIST to an excellent
effect. The histology confirmed it to be a
duplication cyst. Discussion The case
demonstrates the clinical and the radiological
features of oesophageal duplication cyst and
highlights the need for a strong index of
suspicion if one has to diagnose oesophageal
duplication cyst preoperatively.
Figure 3. EUS showing the submucosal lesion 
Figure 2. Endoscopic view of the submucosal
oesophageal mass

Figure 4. Gastro-Oesophagectomy Specimen
Figure 5. Incision of the lesion confirmed it to
be cystic in nature
Figure 1. CT Images of the Oesophageal
Duplication Cyst