Journal List > J Korean Med Sci > v.19(5) > 1019847

Song and Suh: The First Case of Intraperitoneal Bronchogenic Cyst in Korea: Letter To Editor
To the editor:
We read with interest the article by Kim et al., "The first case of intraperitoneal bronchogenic cyst in Korea mimicking a gallbladder tumor" on the June 2004 issue of J Korean Med Sci (1). In their report, they emphasized the case was the first case of intraperitoneal bronchogenic cyst in Korea. However, we found two other previously reported cases of intraperitoneal bronchogenic or foregut cyst through search of the Korean literature (2, 3) and a case of subphrenic bronchogenic cyst near the liver through a search of the English literature (4). Thus, it seems to be controversial whether the case of Kim et al. should be the first example of intraperitoneal bronchogenic cyst in Korea. Furthermore, they described, "Among the cysts of foregut origin, those containing cartilage or seromucinous respiratory glands are designated as bronchogenic cysts; those containing two well-developed layers of smooth muscle without cartilage are designated as esophageal cysts; and those with none of these distinguishing features are classified as foregut cysts (5)" in their discussion. However, there was no mention whether their case contained cartilage or seromucinous respiratory glands. They only described "Microscopically, the cyst is lined by a layer of pseudostratified ciliated columnar epithelial cells occasionally interspersed with goblet cells. Thus, the cyst was histologically diagnosed as a bronchogenic cyst". Considering these two sentences, the more appropriate diagnosis would have been a foregut cyst. Indeed, clear diagnostic criteria are required especially for the diagnosis of bronchogenic cysts in unusual locations (6), and the most reliable criterion is the presence of cartilage in the wall (7). Practically, however, it is often difficult to find. Therefore, the criteria referenced by Kim et al. (5) seem to be rational. Although Park et al. reported their case as a bronchogenic cyst, they also suggested that the diagnosis of their case was controversial because there was no cartilage or seromucinous glands (2). The case of Kim et al. (4) contained identifiable hyaline cartilage and therefore is supposed to be the subdiaphragmatic bronchogenic cyst according to well established histologic criteria.

References

1. Kim KH, Kim JI, Ahn CH, Kim JS, Ku YM, Shin OR, Lee EJ, Lim KW. The first case of intraperitoneal bronchogenic cyst in Korea mimicking a gallbladder tumor. J Korean Med Sci. 2004. 19:470–473.
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2. Park JS, Lee DH, Lim JW, Ko YT, Lee SM, Yang MH. Intramuscular bronchogenic cyst of gastric body: a case report. J Korean Radiol Soc. 2001. 44:707–710.
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3. Heo PS, Kim YB, Song HS, Kim JS, Lee JH, Kim HY, Yoo JY. A case of foregut cyst of gallbladder. Korean J Gastroenterol. 2000. 36:272–275.
4. Kim YC, Goo JM, Han JK, Lee KH, Lee HS, Im JG. Subphrenic bronchogenic cyst mimicking a juxtahepatic solid lesion. Abdom Imaging. 2003. 28:354–356.
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5. Harvell JD, Macho JR, Klein HZ. Isolated intra-abdominal esophageal cyst. Case report and review of the iterature. Am J Surg Pathol. 1996. 20:476–479.
6. Gould SJ, Hasleton PS. Hasleton PS, editor. Congenital abnormalities. Spencer's pathology of the lung. 1996. 5th ed. New York: McGraw-Hill;70–71.
7. Salyer DC, Salyer WR, Eggleston JC. Benign developmental cysts of the mediastinum. Arch Pathol Lab Med. 1977. 101:136–139.
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