PMC5939876_01
Preoperative imaging diagnoses. (A) Chest CT scan at the day before admission shows a smooth cystic tumor measuring 67 x 51 x 60 mm (white arrow). CT value was 28 HU. The esophagus was compressed by the cystic tumor. (B) An abdominal CT at the day before admission revealed a normal shape of the stomach (white arrow). (C) Transverse contrast-enhanced chest CT at 5 days after admission showed the sharply defined mass measuring 47 x 70 x 85 mm (white arrow). CT value was 31 HU. (D) Transverse contrast-enhanced abdominal CT at 5 days after admission showed a huge contusion of the stomach wall (black arrow).
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An abdominal CT revealed a normal shape of the stomach (Figure 1A and B). Transverse contrast-enhanced abdominal CT showed a huge lump in the stomach wall (Figure 1C and D).
Gastroscopy images. (A, B) After admission, gastroscopy showed a mass with a smooth surface causing a partial obstruction of the lower esophagus and stomach fundus. (C, D) The day before admission, gastroscopy showed a mass with a smooth surface causing partial obstruction of the lower esophagus and a normal stomach fundus.. Abbreviations: E, esophagus; G, gastro.
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After admission, a mass with a smooth surface causing partial obstruction of the lower esophagus (labelled E on Figure 2) and stomach fundus (labelled G on Figure 2) was observed by gastroscopy (Figure 2A-D).
Intraoperative images. (A) Brown fluid was observed in the bronchogenic cyst after dissection of the cystic wall. (B) The nutrient artery (arrow) supplying the cyst was revealed distinctly. (C) The shape of the bronchogenic cyst was revealed. (D) Because of the gastric hematoma, a violet surface (arrow) was observed after incision of the diaphragm.
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The cyst showed an exophytic swelling appearance and dense adhesions were observed between the cystic wall and the esophageal mucosa (Figure 3A-D).
Immunohistochemical and histopathological examination of the cyst sections. (A) Positive expression of CA199, original magnification x200. (B) Positive expression of CA125, original magnification x200. (C, D) The cystic wall was lined with ciliated columnar epithelium. The wall also contained cartilage and bronchogenic glands (H&E stained, original magnification x40).. Abbreviation: CA, carbohydrate antigen.
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We also detected positive expression of CA199 and CA125 in cyst sections by immunohistochemical staining (Figure 4A and B). A bronchial cyst of the esophagus was finally confirmed based on these findings (Figure 4C and D).
(A) A control esophagogram showed that the esophagus (black arrow) had neither stenosis nor leakage. (B) The shape and function of the stomach (white arrow) were normal.
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A control esophagogram (barium meal) performed on postoperative day 30 showed neither stenosis nor leakage (Figure 5A-D), and oral fluid intake was resumed.