Duplicación quística del esófago / Cystic duplication of the esophagus

RESUMO

Duplication is defined as the presence of a complete or partial double structure, with a variable length. In esophagus, duplications, diverticuli and cysts might be manifestations of the same embriologic defect. The most common is the Cystic Duplication of the esophagus (CDE), which represents the esophageal duplication, either spherical or tubular, with squamous or columnar epithelium, and a double muscular layer. Clinical Case: male, 38 years old with no previous relevant data, and sudden, complete and persistent post ingestion aphagia, intense presternal pain, and a 12 Kg. weight loss in 15 days. Endoscopy showed unsurpassable stenosis of the lower third of the esophagus, with normal mucosa. Total esophagectomy and replacement with a gastric tube, was performed. He had a good postoperative course. PATHOLOGY: A total esophagectomy open specimen showing a cystic structure at the posterior wall was submitted, which showed a thick, muscular-like wall and hemorrhagic internal surface. Microscopically it had a pseudostratified columnar, ciliated epithelium, alternating with sloughed hemorrhagic areas, fibrosis and stromal siderophagi Leiomuscular double-layered wall. CDE is very infrequent, and is the second most frequent after leiomiomas as a benign esophageal mass. From 10 to 15 percent of all digestive duplications take place at the esophagus. There are different theories to explain its origin. Differential diagnosis must be made mainly with brochogenic cyst, generally anterior and with cartilage. Treatment is surgical.