A Retroperitoneal Bronchogenic Cyst Mimicking a Pancreatic or Adrenal Mass
A 42-year-old woman was admitted to the hospital with sharp continuous epigastric pain of 2 months duration with postprandial augmentation. She denied any other gastrointestinal symptoms or weight loss. Her medical and surgical history was insignificant beside psoriasis and smoking. She had neither a history of previous pancreatitis nor hypertension or clinical signs for hypercortisolism, but irregular vaginal bleedings. Physical examination was normal, with a BMI of 25.6 kg/m2. Serum laboratory tests showed signs of inflammation and a CT scan of the abdomen (fig. ) showed a cystic mass of 5 × 3.6 × 4 cm located adjacent to the pancreatic tail and left adrenal gland. She was treated with antibiotics. Endoscopic ultrasonography with fine needle aspiration was performed and showed a polycystic structure with anechoic and hyperechoic portions. Microbiological analysis and analysis for lipase were negative. There were no malignant cells, but carcinoembryonic antigen (CEA) was elevated with 3,777 µg/l (normal <5) in the cyst, but normal in the serum with 4.3 µg/l. Because of the association to the adrenal gland and the history of vaginal bleeding, endocrine evaluation for adrenal hypersecretion was performed. All tests were normal, including renin and aldosterone, plasma and urine catecholamines, metanephrines, estradiol, luteinizing hormone, follicle-stimulating hormone and cortisol.\nWe suspected a cystic adrenal tumor, therefore we performed a diagnostic laparoscopy. The cystic and encapsulated lesion with smooth and clear boundaries was not discriminable from the left adrenal gland. The pancreas, stomach, diaphragm and aorta were adjacent to the cyst, but not involved. The mass was resected laparoscopically with the left adrenal gland. Postoperative recovery was uneventful.\nIn the pathological workup the cyst had a smooth inner lining and contained a grey viscous mass. Microscopically, it consisted of ciliated, respiratory epithelium, seromucous glands and fully developed cartilage, without any malignant or dysplastic cells (fig. ). The adrenal gland was histologically inconspicuous and had no direct contact or connection to the cyst.