[Considerations in the surgical treatment of enterogenic mediastinal cyst].

Introduction: Mediastinal alterations causing esophageal dysfunctions originate from malignant or inflammatory diseases and in a few cases from congenital anomalies.
Case Report: The authors report the medical history of a 27-year-old woman whose large (35-40 mm in diameter) cystic lesion was causing compression of the middle third esophagus and dysphagia. Because of subjective complaints resection was made from a right posterolateral "muscle-preserving" thoracotomy. Histological examination verified an intramural, esophageal cyst. After the 7th postoperative day the patient was discharged from the hospital, currently she is without symptoms and complaints.
Discussion: In the background of esophageal dysfunctions can be a mediastinal lesion causing external compression. This lesion, in a few cases, is a congenital anomaly, which develops during the separation of the respiratory- and the digestive apparatus. Probably the effect of increased divisional tendency can create the partial duplication of developing organs, i.e. trachea, esophagus. Later these are described as bronchogenic or enterogenic cysts. Literature mentions cases about ciliated columnal epithelium, ventricular mucosa or malignancy covering the inner surface of the cyst. Preoperative examinations are not enough to describe a mediastinal cyst. According to the surgical guidelines a case without complaints is only a relative indication to operate. If it is followed, an occasional malignant transformation will not be recognized, or will be recognized too late.
Conclusion: As we know, a mediastinal cystic lesion never regresses. Because of the tendency of malignant transformation, in the absence of operative contraindication, surgical resection is the method of choice even in symptom-free cases.