Mediastinal enteric cyst: An unusual cause of neonatal respiratory distress

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Mediastinal Enteric Cyst: An Unusual Cause

of Neonatal Respiratory Distress

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male baby born to a 31-year-old mother (gravida 2, para 2) by cesarean section at 38 weeks was referred to us for respiratory distress. His height, weight, and head circumference measurements were all within nor-mal limits. Routine antenatal ultrasound examination during the last trimester revealed a cystic mass in the mediastinum. The birth history was unremarkable. The parents are not rel-atives. Nasal continuous airway pressure ventilation was given for respiratory distress. Chest radiography showed a cir-cular opacity in the right middle-superior lobes and a nearly complete opacity in the left hemithorax (Figure, A). Chest tomography revealed a giant cystic lesion in the left hemithorax (Figure, B). The cystic lesion was surgically excised (Figure, C). The histopathologic findings were consistent with enteric cyst (Figure, D).

Foregut duplication cysts are rare congenital anomalies of enteric origin; they constitute 10% to 18% of all mediastinal lesions. They are further subdivided into bronchogenic, esophageal, gastric, enteric, and pancreatic cysts.1 Enteric cysts are very rare congenital anomalies among foregut

du-plication cysts and usually present with respiratory symp-toms in the neonatal period. They may be in contact with the esophagus, but they do not originate from the esopha-geal lumen, or they can have no contact with any anatomic structure of the mediastinum. The main histologic charac-teristic of the cyst is the presence of a double-layered smooth muscle wall and lining by intestinal-type epithelium.2When enteric cysts are associated with vertebral malformations, they are called neuroenteric cysts. Intrathoracic duplications can present with a wide spectrum of symptoms and can be life-threatening. Respiratory distress occurs most commonly in small infants because of pressure on bronchi or lung.3 Prompt excision is the treatment of choice because of airway obstruction. n Bahri Ermis, MD Mustafa Yildirim, MD Division of Neonatology Department of Pediatrics Varim Numanoglu, MD Ebubekir Er, MD

Department of Pediatric Surgery

Sibel Bektas, MD Department of Pathology School of Medicine Karaelmas University Zonguldak, Turkey

References

1. Azzie G, Beasly S. Diagnosis and treatment of foregut duplications. Semin Pediatr Surg 2003;12:46-54.

2. Murakami S, Isozaki H, Shou T, Sakai K, Toyota H. Foregut duplication cyst of the stomach with pseudostratified columnar ciliated epithelium. Pathol Int 2008;58:187-90.

3. Anagnostou E, Soubasi V, Agakidou E, Papakonstantinou C, Antonitsis N, Leontsini M. Mediastinal gastroenteric cyst in a neonate containing respiratory-type epithelium and pancreatic tissue. Pediatr Pulmonol 2009;44:1240-3.

Figure. A, Chest radiograph shows a circular opacity in the right middle-superior lobes and nearly complete opacity in the left hemithorax. B, Chest computed tomography scan shows a giant cystic lesion in the left hemithorax. C, The chest ra-diograph of the patient after surgery. D, Under the columnar surface epithelium, the appearance of cystic structure with a longitudinal muscular layer inside and a circular muscular outside. (Hematoxylin-eosin staining; original magnification 100.)

J Pediatr 2010;157:692.