January 2022 medical image of the month: bronchial obstruction due to pledget in airway following foregut cyst resection

No abstract available. Article truncated after 150 words. A 37-year-old woman complaining of chest pain and cough underwent resection of a mediastinal foregut duplication cyst complicated by a 10-day hospitalization with a prolonged air leak. Seven years later, she presented with worsening cough and shortness of breath, complaining of similar symptoms intermittently in the 7 years between her surgery and presentation. Chest CT showed a hyperattenuating lesion obstructing the medial basal segmental airways, with bronchoscopy revealing suture and a pledget obstructing the medial basal segmental right lower lobe bronchus. The pledget and suture were successfully removed. Repeat bronchoscopy several months later showed no residual airway foreign body, although medial basal subsegmental bronchial stenosis prevented advancement of the bronchoscope distally; this finding correlated with the CT impression of airway stenosis or occlusion in this region on the follow up CT. Bronchogenic cysts result from abnormal lung budding and development of the ventral foregut during the first trimester (1). Many …

Gallbladder Ciliated Foregut Cyst Suspected of Malignancy Preoperatively

Background. Gallbladder ciliated foregut cysts (CFCs) of the lower diaphragm are extremely rare. Furthermore, they are rarely suspected of malignancy preoperatively. Case Presentation. A 50-year-old woman was referred to our hospital for further examination and treatment of a gallbladder tumor that was detected using abdominal ultrasonography (US). After a close inspection, she was diagnosed with a gallbladder tumor that was possibly malignant. Accordingly, open whole layer cholecystectomy was performed because intraoperative US revealed a tumor located on the intraperitoneal side of the gallbladder, and a rapid intraoperative pathological diagnosis identified no malignancy. A postoperative pathological examination revealed a cystic lesion with thin walls covered with ciliated epithelium, which laid on a connective tissue with smooth muscle fibers. Based on the above results, the final pathological diagnosis was CFC of the gallbladder without malignancy. Conclusions. Cases of gallbladder CFC can be considered as cysts requiring treatment owing to CFCs’ potential for malignant transformation and high-frequency symptoms.

Adenocarcinoma arising from a foregut cyst of the diaphragm: importance of multimodality treatment: a case report

Background Benign foregut cysts usually develop in the thorax most of all in the mediastinum. Rare cases involving various abdominal organs, such as liver, stomach or pancreas have been previously published, mostly occurring in the retroperitoneum. Case presentation We herein present an adenocarcinoma of a foregut cyst involving the left side of the diaphragm, left lower lobe of the lung, and left lobe of the liver, successfully removed through multivisceral resection. In between drug holidays, postoperative oncological treatment has been ongoing for nearly 4 years. In terms of chemotherapy, FOLFOX 4 regime, capacitabine monotherapy and later on next generation sequencing has been attempted, although the patient refused the later treatment option. Despite multimodality (combined surgical and oncological) treatment, local- and later on loco-regional recurrence has been detected on follow-up staging, influencing further chemotherapy regime. Taking both the fairly unknown type of the tumor and uncertain response rate to oncological therapy into account, prolonged tumor pace with fairly stable general patient state was reached throughout the course of the disease. Conclusion Through surgical tumor resection, and postoperative chemotherapy the patient managed to maintain an acceptable quality of life without major symptoms during ongoing treatment. During our own case, with multiple organ involvement, multivisceral resection, with multimodality treatment had considerable effect in prolonging the lifespan of the patient.

Foregut Cyst in Heart: Case Report

A 70-year-old female presented with gradual onset of dyspnea with moderate exertion for 6 months. She had a history of stroke 1 month back which was resolved. On two-dimensional echo, she had a mass in left atrium (1.6 × 1.6 cm) with base attached to interatrial septum adjacent to anterior mitral leaflet. On coronary angiography, she had lesion in left anterior descending coronary artery (LAD) with 60 to 70% stenosis. But intraoperative transesophageal echocardiography revealed mass in left ventricle attached to posterior mitral leaflet undersurface. The operation was performed; coronary artery bypass graft surgery with left internal mammary artery to LAD grafting and transannular decompression of the left ventricular mass was performed. Surgery was done uneventfully. The cyst content consisted of necrotic sebaceous-type material with calcification. Histopathology of excised material revealed it to be a foregut cyst of myocardium. The patient had an uneventful postoperative course and was discharged in good clinical condition.