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Ectopic bronchogenic cyst of gallbladder: an unusual anatomical position

Published:September 11, 2022DOI:https://doi.org/10.1016/j.amjms.2022.09.001
      A 42-years-old woman presented with right upper abdominal pain for one week. She denied any previous hypertension, diabetes, hepatitis and history of surgery. On clinical examination, there was only pressure pain in the right upper abdomen. The laboratory tests, such as routine blood, liver function and electrolytes, were all within normal reference ranges. A computed tomography (CT) scan showed a cystic occupying lesion over the gallbladder measuring approximately 3.1 cm x 2.7 cm, considering a gallbladder diverticulum. A magnetic resonance imaging (MRI) suggested a restricted fluid signal in the gallbladder fossa, measuring approximately 2.9 cm x 2.7 cm (Fig. 1A-C, arrowhead). A magnetic resonance cholangiopancreatography (MRCP) suggested this cystic mass was connected to the cystic duct (Fig. 1D, arrowhead). The patient was scheduled for laparoscopic exploration. During the operation, a cystic mass about 3.0 cm × 2.5 cm near gallbladder fossa was observed. There was no connection between the cyst and the gallbladder. The gallbladder and the entire cyst were removed from the gallbladder bed successively. We opened the wall of the cyst and could see the clear yellowish-brown fluid, different from ordinary bile, gushing out. Histologically, the cyst wall was covered with Postoperative pathological sections showed that the cyst wall was covered with pseudostratified ciliated columnar epithelium (Fig. 1E and F, arrowhead), with mucous glands under the epithelium (Fig. 1E, circle), and the cyst wall contained smooth muscle (Fig. 1E, pentagram), leading to the diagnosis of bronchogenic cyst. No recurrence of the cyst was seen in this patient during the 6 months of follow-up.
      Bronchogenic cyst (BC) is a disease caused by abnormal development of the foregut embryo. The majority of BCs are reported in the world literature to be located within the mediastinum, while subdiaphragmatic BCs, especially intraperitoneal BCs, are extremely rare. Only one case of BC near the gallbladder has been reported in the world.
      • Kim KH
      • Kim JI
      • Ahn CH
      • et al.
      The first case of intraperitoneal bronchogenic cyst in Korea mimicking a gallbladder tumor.
      Due to lack of common symptoms and specific laboratory parameters, accurate preoperative diagnosis of BCs remains a challenge. The CT generally demonstrates a well-defined lesion, with water-density content, without enhancement. They may be hyperdense, due to filled with protein-rich fluid, thick mucinous or hemorrhagic content. Most of the cysts are isointense or hyperintense on T1-weighted images and high signal on T2-weighted images.
      • McAdams HP
      • Kirejczyk WM
      • Rosado-de-Christenson ML
      • Matsumoto S.
      Bronchogenic cyst: imaging features with clinical and histopathologic correlation.
      Despite these radiologic diagnostic features, the intraperitoneal BC is frequently confused with other types of masses such as lymphangioma, hematoma, abscess, and gallbladder diverticulum. The diagnostic gold standard still has to rely on histopathological microscopy.
      The treatment of BCs is surgical and the prognosis is excellent, but it must be complete and there may be a risk of recurrence if the resection is incomplete.
      • Gharagozloo F
      • Dausmann MJ
      • McReynolds SD
      • Sanderson DR
      • Helmers RA.
      Recurrent bronchogenic pseudocyst 24 years after incomplete excision. Report of a case.
      We are sharing the case here with the aim of reminding surgeons that should be aware of the potential for the ectopic bronchial cyst of gallbladder and always keep in mind when they perform a cholecystectomy, either laparoscopically or open, must be complete and there may be a risk of recurrence if the resection is incomplete.

      Funding statement

      This study was supported by the Jilin Province Department of Science and Technology, Grant/Award Number: 20200603001SF.

      Declaration of Competing Interest

      All authors have no conflicts of interest or grants to declare.

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