A six-year old being evaluated for mild abdominal pain and left upper quadrant tenderness receives an abdominal ultrasound demonstrating a cystic mass intrinsic to the wall of the stomach. A magnetic resonance image is obtained.

 

 

 

[size=20px]The most likely diagnosis of this gastric mass is

 

A pancreatic pseudocyst

 

B splenic pseudocyst

 

C ganglioneuroma

 

D peliosis

 

E enteric duplication cyst[/size]

E

E

correct

 

This child has an enteric foregut duplication cyst. The origin of these dissociated foregut malformations is unclear; hypotheses include that they arise from pinching off the embryonic ventral foregut forming budding remnants, migration of an aberrant rest, supernumerary lung buds and incomplete involution of the connecting stalk or fistula that connects with the respiratory or digestive tract. There is an association with esophageal atresia and tracheoesophageal fistula. Gastric foregut duplication cysts have a lining of pseudostratified ciliated columnar epithelium distinguishing them from simple gastric duplications.

 

Many affected children are asymptomatic. Respiratory symptoms (for lesions in the chest) and pain are the most common symptoms. Computerized tomography is the diagnostic study of choice. Most do not have a communication with the gastrointestinal tract but usually share a muscular wall. Thoracoabdominal cysts may be large and can connect to stomach or small intestine. The treatment of choice for foregut duplication cysts is complete excision. There is a ten percent incidence of a second enteric duplication.

 

This patient’s history is not consistent with the development of a posttraumatic pseudocyst of the pancreas or spleen. The location and appearance of the lesion is not that of a ganglioneuroma or neoplastic process. Peliosis is a rare liver abnormality with multiple blood filled cavities (http://www.radrounds.com/photo/peliosis-hepatis); most cases of peliosis are asymptomatic and do not require treatment.