Esophageal cyst
Introduction
Introduction to esophageal cyst Esophageal cysts are less common benign esophageal masses and are residual tissues of the embryonic stage. Because its morphology is similar to benign tumors, it is generally included in benign esophageal tumors, and its incidence is second only to esophageal leiomyoma, and most of them are located in the esophageal wall. It can produce the corresponding symptoms by compressing the surrounding organs, and early detection of early surgery is the only way to treat. basic knowledge Sickness ratio: 0.1% Susceptible people: no special people Mode of infection: non-infectious Complications: hemivertex malformation Esophageal duplication
Cause
Causes of esophageal cyst
(1) Causes of the disease
The cause of esophageal cysts remains unclear. There are a variety of hypotheses. Most believe that esophageal cysts may originate from ectopic cells in the human embryonic foregut and are considered to be a variant of the mediastinal intestinal cyst.
(two) pathogenesis
Esophageal cyst is a benign tumor-like lesion of the esophagus after leiomyomas and esophageal polyps. Smith performed excellent embryological research on its occurrence. It is more logical to compare some other theories. Some cells from the tracheal or esophageal embryo base The detachment shifts to the mesoderm tissue that will develop into the muscular layer. The degree of separation from the embryonic base determines the location of the lesion. The shape of the displaced epithelium determines the shape of the lesion, and the location of the hair growth and the degree of differentiation determine the lining of the lesion. During the esophageal development process, it is covered by pseudo-stratified columnar epithelium many times, once with cilia, and later turned into squamous epithelium. The cardia-like gland is from pseudo-stratified columnar epithelium, and there may be acid-secreting cells, so the lining of the cyst May be scaly, pseudo-stratified column (with or without cilia), or gastric mucosa.
The cysts commonly seen in adults are elliptical and contain mucus or brown serous fluid. The cysts located in the esophageal wall are covered by expanded muscle fibers and are not closely connected to the muscular layer or mucosa. The cysts are generally 5 to 10 cm, but In the infant, a large cyst can be seen. The most common sacral columnar epithelium is the pseudo-stratified columnar epithelium, the gastric mucosa epithelium is the second, the squamous epithelium is the least, and the cartilage is found in the wall.
Prevention
Esophageal cyst prevention
There is no effective preventive measure for this disease. Early detection and early diagnosis are the key to the prevention and treatment of this disease.
Complication
Esophageal cyst complications Complications, vertebral deformity, esophageal duplication
Patients with esophageal cysts may have congenital malformations of the cervical or thoracic vertebrae, with vertebral deformities being the most common. According to Pokorny and Goldstein (1984), some esophageal duplications can be communicated or connected through the diaphragm and jejunum repeat deformities, occasionally. The esophageal cyst or repeat deformity can be attached to or in communication with the adjacent spinal canal, known as neuronteiic entero cysts.
Symptom
Symptoms of esophageal cysts Common symptoms Dysphagia, wheezing, weight loss, tracheal space, masses, esophageal malignant lesions, cysts, nausea, dyspnea, chest pain, cough
The clinical symptoms of esophageal cysts depend mainly on the location, size, structure, extent of the lesion and the type of epithelial cells on the inner wall of the cyst.
Symptom
(1) Children's esophageal cysts: The main clinical symptoms are respiratory symptoms with different degrees. The giant esophageal cyst can occupy most of the chest cavity and press the lungs, and the mediastinum can be displaced to the healthy thoracic cavity. The sick children can have severe respiratory distress. Sometimes, small esophageal cysts can also cause more serious airway obstruction, especially esophageal cysts located at the entrance to the thoracic cavity and tracheal carina. This case requires urgent treatment, such as improper treatment or improper treatment. The child soon died of respiratory distress.
In infants with esophageal cysts causing partial esophageal obstruction, the clinical symptoms often manifest as esophageal reflux.
(2) Adult esophageal cyst: often asymptomatic. If the cyst gradually enlarges and compresses the trachea or bronchus, the patient may have manifestations of tracheal obstruction. Some patients also have esophageal obstruction symptoms. The symptoms of airway obstruction mainly include cough and difficulty breathing. And wheezing, some patients with paroxysmal asphyxia and repeated respiratory infections, esophageal obstruction manifested as dysphagia, reflux, nausea, vomiting, weight loss and chest pain, severe chest pain more than bleeding in the cyst, once the infection occurs inside the cyst The above symptoms may be aggravated or their properties changed. In 1978, Gatzinsky et al reported a case of intramural esophageal cyst complicated with massive hemorrhage in the mediastinum. In 1983, Poston and Rahamim reported that one case of endoluminal esophageal cyst was infected with cystic fluid. Completely pus.
2. Physical examination
When a large esophageal cyst compresses the lungs, trachea or bronchus, the examination may reveal indirect signs or direct signs. If the esophageal cyst protrudes into the neck, the palpation of the neck may touch the cystic mass, but pay attention to the cause. Neck masses caused by other causes and strict differential diagnosis.
Examine
Examination of esophageal cyst
X-ray inspection
In many cases, the diagnosis of esophageal cysts is very difficult, and even if a variety of imaging examinations are performed for patients, it is still impossible to confirm the diagnosis.
(1) X-ray chest X-ray: In the chest X-ray of infants and children, the esophageal cyst is mainly characterized by X-ray signs of mediastinal (posterior mediastinum) with block shadow or mediastinal tumor. If the sick child has clinical manifestations of esophageal cyst, Sometimes the diagnosis is easier, but because these lesions tend to be close to the spine, posterior mediastinal neurogenic tumors (sphingomoma, neuroblastoma, and neurofibroma) should be considered.
(2) esophageal X-ray barium meal examination: small-volume intramural esophageal cysts in the esophageal X-ray barium meal examination, often have a typical X-ray signs: cystic anterior wall cyst image shows local esophageal wall There are round or oval filling defects, smooth edges, the upper and lower edges are often gentle slopes rather than sharp angles, which can be used for differential diagnosis of esophageal leiomyomas; orthotopic esophageal barium meal, esophageal cysts The edge of the shadow is sharper, and the surface is covered with a normal mucosal phase or the mucosa disappears; sometimes, the sputum has a shunt sign when passing through the lesion, which is also one of the basis for the diagnosis of esophageal cyst. The patient observes the angiography of the esophagus after fluoroscopy. If the lesion shows activity with swallowing action, it indicates that the lesion is closely related to the esophagus. Large esophageal cyst can cause the expectorant to stay or obstruct in the esophageal lumen. Adult esophageal cyst is half of the common lesion shadow in esophageal barium meal examination. In the lumen; some larger esophageal cysts have a diverticulum-like change or a double esophageal image.
(3) esophageal CT examination: According to reports in the literature, esophageal CT scan may further provide information on the cystic nature of esophageal cysts, which has reference significance for its diagnosis.
(4) MRI examination: There are few reports on the diagnosis of esophageal cysts by MRI. Rafal and Markisz (1991) believe that with the accumulation of clinical experience, MRI is expected to be one of the alternative methods for the diagnosis of esophageal cysts.
2. Endoscopy
The most important manifestation of endoscopic examination of esophageal cysts is that the esophageal mucosa of the lesion surface of the esophageal cavity is intact and the color is normal. At the same time, endoscopic examination can confirm whether the esophageal mucosa on the surface of the lesion is ulcerated or not. Malignant lesions, Bhutani and other authors reported in 1996 that esophageal endoscopic ultrasonography is useful for the diagnosis of esophageal cysts, which can show the size of the cyst and its tissue level, and can accurately indicate the etiology of esophageal submucosal tumors based on its ultrasound structure.
Diagnosis
Diagnosis and differentiation of esophageal cyst
Diagnosis relies on X-ray barium meal and esophagoscopy.
The disease must be differentiated from esophageal smooth muscle, lipoma, fibromyxoma, neurofibromatosis, hemangioma and esophageal abscess, cancer liquefaction and meningocele.
