Gastric duplication cyst in the adult. A case report.

Gastric duplication cyst is a very rare congenital anomaly accounting up to 4-9% of all gastrointestinal tract duplications. It is a quite rare anomaly in adults, the majority of cases are diagnosed in the neonatal period. Gastric duplication cysts are usually asymptomatic in the adult. They are usually discovered incidentally in TAC or RMN, although the best specificity diagnostic test is the echoendoscopy. The best election treatment is the surgical complete extirpation. We describe a case of an adult patient who is diagnosed of the incidentally gastric cyst duplication.

El quiste de duplicación gástrico es una anomalía congénita muy rara que representa entre 4 y 9% de todas las duplicaciones del aparato digestivo. Es una alteración bastante rara en el adulto y la mayoría de los casos se diagnostica en el periodo neonatal. En el adulto suele cursar de forma asintomática y la TC o RMN la descubren de forma incidental, aunque la prueba que la diagnóstica con mayor eficacia es la ecoendoscopia. La extirpación quirúrgica completa de la lesión se considera el tratamiento de elección. Se presenta el caso clínico de una paciente con un quiste de duplicación gástrico diagnosticado de forma incidental.

Actitud ante los quistes tiroideos recidivantes con citología benigna / Approach cytologically-benign recurrent thyroid cysts

Introducción. El objetivo de este estudio ha sido determinar la incidencia de carcinoma en los quistes recidivantes citológicamente benignos y evaluar la indicación quirúrgica en estos pacientes. Pacientes y método. Revisión de todos los pacientes intervenidos por recidiva tras la aspiración de un nódulo tiroideo quístico, solitario o dominante en un bocio multinodular (BMN), con estudio citológico preoperatorio benigno, desde enero de 1992 hasta diciembre 2002. Se han excluido los nódulos mixtos. Resultados. Se ha intervenido a 34 pacientes con una edad media de 43 años (rango, 18-76; 5 varones y 29 mujeres). En el 75% de los casos se trataba de nódulos únicos y en el 25% eran nódulos dominantes en el seno de un bocio multinodular. El número medio de citologías con drenaje completo fue de 2,3 (rango, 23) por paciente, y se observó contenido hemorrágico en el 35% de los casos. Se realizó tiroidectomía total en los casos de BMN y lobectomía con itsmectomía en los nódulos solitarios. La biopsia extemporánea fue benigna en el 91% de los casos y no concluyente en el resto; no se identificó en ningún caso la presencia de carcinoma. En el estudio anatomopatológico definitivo se evidenció un carcinoma papilar en 3 pacientes (8,8%) y un carcinoma papilar oculto separado del quiste en 4 (11,8%). En todos estos casos, la biopsia peroperatoria fue benigna. En los quistes mayores de 3 cm, el riesgo de malignidad ha sido más elevado (el 23 frente al 0%; p < 0,05). Conclusiones. Dada la incidencia de carcinomas, se debe considerar la realización de una tiroidectomía en los quistes tiroideos recidivantes, especialmente en los mayores de 3 cm, con independencia del resultado del estudio citológico (AU)

Introduction. The aim of this study was to determine the incidence of carcinoma in cytologically-benign recurrent thyroid cysts and to evaluate the surgical indications in these patients. Patients and method. We reviewed all patients undergoing thyroid surgery between January 1992 and December 2002 for cytologically-benign solitary or dominant cystic nodules in multinodular goiter that recurred after aspiration. Mixed nodules were excluded. Results. Thirty-four patients (29 women and five men) with a mean age of 43 years (18-76) underwent surgery. Seventy-five percent were solitary nodules and 25% were dominant nodules within a multinodular goiter. The mean number of fine needle aspirations with complete drainage was 2.3 (2-3) per patient with hemorrhagic aspirate in 35%. Total thyroidectomy was performed in multinodular goiters and lobectomy with isthmectomy in solitary nodules. Intraoperative biopsy revealed benign lesions in 91% and was inconclusive in the remainder; no cases of carcinoma were identified. Definitive pathologic findings revealed the nodule to be a papillary carcinoma in 3 patients (8.8%) and occult papillary carcinoma separate from the cyst in 4 patients (11.8%). In all these patients intraoperative biopsy showed benign disease. The risk of malignancy was higher in cysts larger than 3 cm (23% vs 0%; p < 0.05). Conclusions. Given the incidence of carcinoma, surgical resection should be considered in recurrent cystic thyroid nodules, especially in those larger than 3 cm, regardless cytological study (AU)

[Approach to cytologically-benign recurrent thyroid cysts]. / Actitud ante los quistes tiroideos recidivantes con citología benigna.

INTRODUCTION: The aim of this study was to determine the incidence of carcinoma in cytologically-benign recurrent thyroid cysts and to evaluate the surgical indications in these patients. PATIENTS AND METHOD: We reviewed all patients undergoing thyroid surgery between January 1992 and December 2002 for cytologically-benign solitary or dominant cystic nodules in multinodular goiter that recurred after aspiration. Mixed nodules were excluded. RESULTS: Thirty-four patients (29 women and five men) with a mean age of 43 years (18-76) underwent surgery. Seventy-five percent were solitary nodules and 25% were dominant nodules within a multinodular goiter. The mean number of fine needle aspirations with complete drainage was 2.3 (2-3) per patient with hemorrhagic aspirate in 35%. Total thyroidectomy was performed in multinodular goiters and lobectomy with isthmectomy in solitary nodules. Intraoperative biopsy revealed benign lesions in 91% and was inconclusive in the remainder; no cases of carcinoma were identified. Definitive pathologic findings revealed the nodule to be a papillary carcinoma in 3 patients (8.8%) and occult papillary carcinoma separate from the cyst in 4 patients (11.8%). In all these patients intraoperative biopsy showed benign disease. The risk of malignancy was higher in cysts larger than 3 cm (23% vs 0%; p<0.05). CONCLUSIONS: Given the incidence of carcinoma, surgical resection should be considered in recurrent cystic thyroid nodules, especially in those larger than 3 cm, regardless cytological study.