Clin Endosc.  2021 Sep;54(5):767-770. 10.5946/ce.2020.195.

Endoscopic Ultrasound Through-the-Needle Biopsy for the Diagnosis of an Abdominal Bronchogenic Cyst

• Cassiani J
• Crinò SF
• Manfrin E
• Rivelli M
• Gabbrielli A
• Guglielmi A
• Pedrazzani C

• KMID: 2520563
• DOI: http://doi.org/10.5946/ce.2020.195

Abstract

A 57-year-old woman with epigastric pain was diagnosed with a 6-cm abdominal cystic lesion of unclear origin on cross-sectional imaging. Endoscopic ultrasound (EUS) demonstrated a unilocular cyst located between the pancreas, gastric wall, and left adrenal gland, with a regular wall filled with dense fluid with multiple hyperechoic floating spots. A 19-G needle was used to puncture the cyst, but no fluid could be aspirated. Therefore, EUS-guided through-the-needle biopsy (EUS-TTNB) was performed. Histological analysis of the retrieved fragments revealed a fibrous wall lined by “respiratory-type” epithelium with ciliated columnar cells, consistent with the diagnosis of a bronchogenic cyst. Laparoscopic excision was performed, and the diagnosis was confirmed based on the findings of the surgical specimen. Abdominal bronchogenic cysts are extremely uncommon, and a definitive diagnosis is commonly obtained after the examination of surgical specimens due to the lack of pathognomonic findings on cross-sectional imaging and poor cellularity on EUS-guided fine-needle aspiration cytology. EUS-TTNB is useful for establishing a preoperative histological diagnosis, thus supporting the decision-making process.

Keyword

Bronchogenic cyst; Endoscopic ultrasound-guided fine needle aspiration; Endoscopic ultrasound-guided through-the-needle biopsy; Laparoscopy; Pancreatic cyst

Figure

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  Fig. 1. (A) Computed tomography revealing a well-defined, non-infiltrative lesion of uncertain origin with suspected contact with the diaphragmatic crus (white arrow). (B) Endoscopic ultrasound revealing cystic content with a pseudo solid aspect, with a hypoechoic internal echo pattern with multiple hyperechoic spots and comettail artifacts. (C) Ultrasound view of the MorayTM (US Endoscopy, Mentor, OH, USA) microforceps during sampling of the cystic wall. (D) A through-the-needle biopsy specimen of the cystic wall composed of cellular stroma supporting a monolayer of the covering epithelium (hematoxilin and eosin [H&E], ×4). (E) The epithelium is composed of cylindrical, ciliated cells (black arrows) and interspersed mucinous cells. Elastic fibers beneath the epithelium and fusiform mesenchymal cells compose the stroma wall (H&E, ×40). (F) Immunohistochemical positivity for desmin in leiomuscular cells in the wall (desmin, ×40). (G) Macroscopic examination of the specimen showing a multilocular cystic lesion filled with a dense mucoid fluid. (H) Histological examination showing a cyst wall of the bronchogenic type, with “respiratory-type” epithelium overlying a muscularis propria layer with accessory mucinous glands (H&E, ×4).

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