The patient is a globe tattler and has traveled extensive places in East Asia.  She is unmarried.

Based on the radiological findings, differential diagnosis of diaphragmatic cyst / bronchogenic cyst may be proposed. The multiplicity of the lesions, suggests, need to consider the possibility of Hydatid cyst- a possibility also supported by a history of frequent travels and visit the East Asian countries.  The Adrenal /pancreatic/splenetic origin can be ruled out. The origin from diaphragmatic crus/ stomach wall or retroperitoneal tissue is a reasonable consideration. Possibility of cystadenoma was considered prior to surgery, but multiplicity and lack of wall irregularity or solid component argued against this possibility.

A preoperative endoscopy failed to reveal any communication with the stomach lumen. The endoscopy revealed smooth indentation over the mucosa.

The patient underwent surgery which revealed origin from the stomach wall, thus rendering the diagnosis of multiple gastric duplication cysts.

HPE report: The section showed cyst wall composed of mucosa, submucosa and muscularis mucosa.  The mucosa was predominantly of gastric body type in the main cyst. Mild chronic inflammation was seen in the lamina propria. The other cyst was lined by columnar cells with areas of mucin secreting epithelium.  Thus the diagnosis of (multiple) gastric duplication cysts was rendered.

Credits: Dr. Niti Singhal, Bright Point Hospital, Abu Dhabi Email: [email protected]