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PubMed1994

Serum and Cyst Fluid Tumor Marker Levels in the Differential Diagnosis of Benign Ovarian Cysts

Serum and cystic fluid levels of CA 125, CA 19.9, carcinoembryonic antigen (CEA), and alpha-fetoprotein (AFP) were assayed in 74 consecutive women of median age 30 years (range 15 to 74 years) undergoing surgery for adnexal cysts of presumed benign nature. Median (range) serum levels of CA 125, CA 19.9, CEA and AFP were 46.5 IU/ml (4.3-406), 28.5 IU/ml (1-96.3), 1.4 ng/ml (0.5-3.5) and 2.4 ng/ml (1-9.9) in 44 endometriotic cysts; 22.5 (4.7-82), 4.9 (1-226),1.3 (0.7-4.8) and 4 (0.5-10.5) in 11 dermoid cysts, 14 (8.6-25.1), 3.2 (1-6), 1 (0.3-2.8) and 3.7 (1.9-6) in 9 mucinous cysts, and 6.9 (0.5-104), 18 (1-132), 0.8 (0.1-1.9) and 2.1(1-5.4) in 10 cases with mixed histotypes. Corresponding cystic fluid levels were 342,864 (1,418-3,404,682), 228,000 (117-2,500,000), 106 (0.5-2,908) and 1.3 (0.4-51) in endometriomas; 843,895 (10,842-1,676,948), 740,039 (77-1,280,000), 470 (61-880) and 2.5 (1-4) in dermoids; 3,485 (27.2-149,804), 9,007 (36.4-153,475), 1,631 (402-11,096) and 1 (0.5-2.5) in mucinous cysts, and 13,068 (5,300-43,767), 412 (1-142,700), 0.8 (0.4-5.3) and 2.3 (1-4) in the mixed histotype group. No significant between group differences were detected in serum marker levels. Patients in the mucinous cyst group had significantly lower CA 125 cystic fluid levels compared with women with endometriomas and dermoids (P<0.05). Fluid aspirate tumor marker measurements did not aid in the differential diagnosis of benign ovarian cysts, mainly due to the extremely wide scattering of values.

Journal Article↗

PubMed1986

[Hydatid cyst fluid (Echinococcus granulosus) biochemistry. Influence of site on cyst permeability].

Eleven metabolites were determined in 19 hydatid cyst fluids of variable size and localization, and in patients plasma before surgery. Specific indirect immunofluorescent antibody titration was carried out. Sodium (132 +/- 5.2 mmol/l), chloride (92.9 +/- 6.5 mmol/l) and bicarbonate (22.1 +/- 1.5 mmol/l) were found at the same concentration than in plasma. Potassium (5.4 +/- 0.3 mmol/l) and calcium levels (4.7 +/- 0.9 mmol/l) were higher than in plasma, and phosphate (0.1 +/- 0.03 mmol/l) decreased tenfold. Glucose (3.4 +/- 0.8 mmol/l), creatinine (39.3 +/- 7.2 mumol/l) and urea nitrogen (4.6 +/- 0.8 mmol/l) showed great variations. Cholesterol levels 0.06 +/- 0.03 mmol/l) were a hundredfold lower than in plasma. Total protein levels (0.34 +/- 0.09 g/l) were found at very low concentrations. Extra-pulmonary cysts showed significantly higher antibody titers than pulmonary cysts. No correlation was observed between the size of the cysts and the level of the immune response. Significant difference about the relative cholesterol concentration (cystic concentration/plasmatic concentration) was observed between pulmonary and extra-pulmonary cysts (respectively 0.0048 +/- 0.0032 and 0.018 +/- 0.01--p less than 0.05). No correlation was observed between the size of the cyst, or the corresponding levels of the immune response, and the cholesterol levels. The hypothesis of a greater membrane permeability in extra-pulmonary cyst is discussed.

Antibodies↗

PubMed2005

Non-ruptured hydatid cyst can lead to death by spread of cyst content into bloodstream: an autopsy case.

Hydatid disease is a parasitic infestation caused by a tapeworm of the genus Echinococcus, and it is common in Mediterranean regions. Cystic lesions cause symptoms via compressing adjacent organs or may be totally silent. Morbidity is usually secondary to free rupture of the echinococcal cyst with or without anaphylaxis, infection of the cyst or dysfunction of affected organs. The cyst of Echinococcus granulosus is commonly located in the liver and frequently causes no symptoms. Anaphylactic reactions as a result of cyst perforation generally occur during interventions such as needle aspiration or open surgery; however, the spillage of cyst fluid with intravascular spread resulting from trauma may also trigger anaphylaxis, and rare case reports of this kind are present in the literature. We report the case of a 17-year-old man who was admitted to the public hospital with a sudden onset of nausea, vomiting and fainting. After a short period of intervention in the emergency department he died. As the cause of his sudden death was unknown, a forensic autopsy was carried out by the Forensic Council of Turkey. The autopsy revealed a macroscopically non-ruptured hydatid cyst in the liver and laryngeal oedema. In histopathological examination, two scolices in the pulmonary artery and inflammatory infiltration mainly composed of mast cells in the larynx were detected. Sudden death in this case was attributed to anaphylactic shock caused by intravascular spread of the cyst contents.

Adolescent↗

PubMed1991

Detection of Giardia cysts by using the polymerase chain reaction and distinguishing live from dead cysts.

A method was developed for the detection of Giardia cysts by using the polymerase chain reaction (PCR) and the giardin gene as the target. DNA amplification by PCR, using giardin DNA as the target, resulted in detection of both live and dead cysts. When giardin mRNA was used as the target, the ability to amplify cDNA by PCR depended on the mode of killing. Cysts killed by freezing were not detected by PCR when giardin mRNA was the target. Cysts killed by heating or exposure to monochloramine, however, gave positive detection signals for both DNA and giardin mRNA targets. The amount of giardin mRNA and total RNA was significantly increased in live cysts following the induction of excystation. Cysts killed by freezing, heating, or exposure to monochloramine did not show a change in RNA content. The detection of the giardin gene by PCR permits a sensitive and specific diagnosis for Giardia spp. Discrimination between live and dead cysts can be made by measuring the amounts of RNA or PCR-amplified product from the giardin mRNA target before and after the induction of excystation.

Animals↗

PubMed1994

Effect of mebendazole on free amino acid composition of cyst wall and cyst fluid of Echinococcus granulosus harbored in mice.

Eighteen and 23 FAA components were detected in the cyst wall and cyst fluid of E granulosus, respectively, by using automatic amino acid analyzer. The concentrations of most of the determined FAA were higher in the cyst fluid than those in the cyst wall, especially the taurine was 5-fold higher. Mebendazole treatment resulted in an increase in the concentration of alanine, valine, lysine, and taurine in both cyst wall and cyst fluid, the most notable being the alanine in the cyst wall. The results are interpreted as a coupling of glycolysis and amino acid metabolism, suggesting an involvement of FAA metabolism in the mechanism of Meb action.

Alanine↗

PubMed1993

[Hydatid cyst of the liver. Treatment by resection of the cyst wall. Our experience apropos of a series of 495 cases].

From January 1976 to December 1990, 495 cases of hydatid cyst of the liver were treated by resection of the cyst wall. The mean age of the patients was 42 years with a female predominance (71% of cases). Confirmation of the diagnosis was essentially based on ultrasonography. At operation, the hydatid cysts were located in the right lobe of the liver in 83% of cases. The hepatic dome (segments VII + VIII) was involved in 52% of cases. After resection of the cyst wall, biliary tract lesions required common bile duct drainage with a Kehr drain in 50 cases, transcystic drainage in 22 cases and cysto-biliary disconnection in 22 cases. In every case, drainage of the residual cyst cavity was performed by a two-way catheter. Seven deaths were recorded in this series, including one from anaphylactic shock associated with intracystic injection of formalin, 3 from bronchopulmonary complications, 2 from subphrenic abscesses and 1 after surgical revision for evisceration on the 5th day. The postoperative morbidity and, consequently, the hospital stay depended on the condition of the pericystic tissues. The mean hospital stay was 12 days in the case of soft pericystic tissues and 32 days in the case of fibrotic and calcified pericystic tissues. Due to the benign nature of hydatid cysts of the liver, the authors emphasise the value of resection of the cyst wall which carries a lower operative risk and which can be performed by most surgeons.

Adolescent↗

PubMed1996

Papillary transitional cell carcinoma arising in a calyceal cyst and masquerading as a renal cyst.

We report the case of a 74-year-old man with a papillary transitional cell carcinoma, grade 1-2/3, growing within a bilobated calyceal cyst, measuring up to 8.5 cm in diameter, and masquerading as a simple renal cyst. The cyst was lined by atrophic simple and transitional epithelium and showed intracystic hemorrhage. Leakage of blood into the calyx was probably the cause of the hematuria for which the patient presented. However, with retrograde pyelography and careful gross examination of the excised kidney, no communication of the pyelocalyceal system with the cyst could be identified. By ultrasound examination and computerized tomographic scan the lesion showed several small renal cysts, measuring up to 1.1 cm in diameter, as well as several hepatic parenchymal cysts. To our knowledge, this is the first report of a papillary transitional cell carcinoma arising from a cyst of calyceal origin.

Aged↗

PubMed2003

Choledochal cysts and multilocular cysts of the pancreas.

Choledochal cyst is a rare congenital anomaly of the biliary system that may be associated with other abnormalities of the hepatobiliary tract. We report a case of an 11-year-old boy in whom the preoperative evaluation revealed a choledochal cyst and intraoperative cholangiopancreatography showed a cystic mass in the pancreas. Examination of the choledocho-pancreatico-duodenectomy specimen showed a multilocular cyst in the pancreas in addition to a segmental dilation of the common bile duct. The findings in our case adds pancreatic cyst to the spectrum of abnormalities associated with choledochal cyst and may also support the theory that choledochal cyst is the predominant abnormality in a widespread spectrum of the pancreatobiliary duct dysplasia.

Child↗

PubMedDate not supplied

Colloid cyst of the third ventricle: a comparative ultrastructural study of neuraxis cysts and choroid plexus epithelium.

Thirteen colloid cysts (CC), four Rathke cleft cysts (RCC), three follicular cysts of normal pituitary gland (FCP), four enterogenous cysts (EC), three normal choroid plexi (CP), three choroid plexus papillomas (CPP), and several samples of normal bronchial mucosa and ependyma were studied by electron microscopy. The ultrastructure of most of the CC was indistinguishable from that of RCC, FCP, EC, and normal bronchial mucosa in demonstrating nonciliated and ciliated epithelial cells, goblet cells, basal cells, and intermediate forms, some showing evidence of early squamous differentiation. Two CC displayed mostly squamous differentiation, and one contained basally situated cells resembling myoepithelial cells. Although the RCC and FCP displayed features similar to those of CC, they also contained cells with electron-dense granules indicating pituitary hormone production and scattered cells showing oncocytic change. EC were lined by either squamous cells or mucin-producing columnar cells. Every CC, RCC, FCP, and EC contained cells covered by glycocalyx. In contrast to aforementioned lesions, ependymal lining, CP, and CPP were composed of a single cell type, one with numerous villi, few cilia, and no signs of keratinization, mucin production, or glycocalyx coating. It is concluded that the ultrastructural properties of CC are the same as those of cysts of endodermal or ectodermal origin and of respiratory mucosa. No ultrastructural similarities were observed between CC and normal or neoplastic neuroepithelium. These ultrastructural findings support the concept of an enterogenous origin of colloid cysts and highlight their similarity to RCC.

Cerebral Ventricles↗

PubMed1992

[A case report of a paraesophageal bronchogenic cyst and an esophageal cyst].

There are relatively few paraesophageal bronchogenic and esophageal cysts in mediastinal tumors. It is often difficult to distinguish between these cysts. Case 1: 11 year old, male with no symptoms. An abnormal tumor shadow was revealed by chest roentgenogram. Before operating, CT, MRI and other laboratory tests were suggested that the tumor was neurogenic. A cyst with a pedicle connected to the esophageal muscle layer was found during the operation. Pathological examination confirmed a bronchogenic cyst lined with cartilage. Case 2: 38 year old female with epigastralgia. Upper gastrointestinal series revealed that the thoracic esophagus was smoothly compressed from the outside. CT and MRI showed a well-defined cystic mass in the posterior mediastinum. The cyst bordered the esophagus, but there was no direct communication between them. The pathological findings showed the presence of a double layer of smooth muscle without cartilage which was diagnosed as an esophageal cyst.

Adolescent↗

PubMed1997

[A variety of mediastinal bronchogenic cyst: the broncho-alveolar cyst].

Congenital bronchogenic cysts are usually located in the mediastinum or develop as intrapulmonary cysts. Gross examination of excised bronchogenic cysts shows them to be unilocular; histologically, these lesions are characterized by the presence of respiratory-type pseudostratified epithelium as well as small islands of cartilage and seromucinous glands. We report a case of a mediastinal bronchogenic cyst having pulmonary parenchyma within the cyst wall. The rarity of our case, the pathological and clinical features and the embryological development of bronchogenic cysts are briefly discussed.

Adult↗

PubMed1978

Anterior cervical arachnoid cyst simulating syringomyelia: a case with preceding posterior arachnoid cysts.

An arachnoid cyst lying anterior to the cervical cord at level C6-7 was found in a 28-year-old woman believed to have syringomyelia. This diagnosis was based both on previous findings at laminectomy and on computerized tomography. The diagnosis of arachnoid cyst was suspected because of clinical features atypical for classical syringomyelia and a history of arachnoid cysts found during childhood. Air myelography demonstrated an extramedullary intradural mass anteriorly that proved to be an arachnoid cyst. Drainage and subtotal resection resulted in marked clinical improvement. This case illustrates the need for reevaluation when a patient with "known" syringomyelia presents an atypical clinical picture. Anterior cervical arachnoid cyst, which may accompany or succeed posterior arachnoid cysts, should be considered.

Adolescent↗

PubMed2000

On the pathogenesis of brain tumour cysts: a volumetric study of tumour, oedema and cyst.

Chemical analysis of brain tumour cyst contents has invalidated the concept of cyst formation being the result of tumour necrosis, and a common mechanism of vasogenic brain oedema and cyst formation, namely blood-brain barrier (BBB) disruption, has been suggested. To analyse a possible relationship between the occurrence of vasogenic oedema and the presence of cysts, we performed a volumetric analysis on the MRI and CT studies of 60 patients with primary or metastatic brain tumours. We compared four groups of tumours: 30 gliomas, of which 15 were cystic and 15 not and 30 metastatic brain tumours of which 15 were cystic and 15 not. Although the mean volume of oedema was similar for cystic and noncystic tumours, the ratio of oedema to tumour volume was approximately four times as high in cystic supratentorial tumours. This would support the view that cyst formation may be related to relatively greater production of oedema, possibly due to fusion of microcysts containing oedema fluid. The ratio of oedema to tumour volume is not greater in cystic cerebellar and intraventricular tumours. This may be due to the different anatomical organization of the cerebellar white matter, and the fact that the intraventricular tumours are bordered by subcortical grey matter. In these cases, spread of oedema is impeded. Formation of a large amount of brain oedema is therefore not an essential prerequisite for cyst formation.

Adolescent↗

PubMed2001

Balloon catheter for cyst aspiration in a thoracoscopic resection of mediastinal cysts.

In a thoracoscopic resection of mediastinal cysts, aspiration of the cyst contents at the beginning of the procedure is often helpful because it allows the cyst to be more easily grasped and manipulated. Spillage of the cyst contents into the thoracic cavity may, however, occur during aspiration when an ordinary aspiration needle is used. If the cyst contents are infective, then a subsequent contamination of the thoracic cavity may develop. We therefore use a specially designed double-balloon catheter for aspiration to minimize spillage of the cyst contents into the thoracic cavity. We describe herein the usefulness of this aspiration technique.

Catheterization↗

PubMed1991

Calcifying odontogenic cyst. A review of ninety-two cases with reevaluation of their nature as cysts or neoplasms, the nature of ghost cells, and subclassification.

Ninety-two cases of calcifying odontogenic cyst (COC) were reviewed with special consideration of their nature as cysts or neoplasms, the nature of ghost cells, and classification on the basis of clinicopathologic features. The cases were divided into 79 (85.9%) cysts and 13 (14.1%) neoplasms. The cysts occurred as four variants: (1) nonproliferative COC (35 cases), characterized by a simple unicystic structure; (2) proliferative COC (17 cases), characterized by a cystic structure with multiple daughter cysts, extensive ghost cell formations, and marked tendency for calcification; (3) ameloblastomatous COC (11 cases), characterized by ameloblastoma-like, cyst-lining epithelium with ghost cells and calcifications; and (4) COC associated with odontoma (16 cases), which combined features of COC and odontoma. The neoplasms occurred as three variants: (1) ameloblastoma ex COC (two cases), which showed unifocal and multifocal intraluminal and intramural ameloblastoma proliferating from the COC-lining epithelium; (2) peripheral epithelial odontogenic ghost cell tumor (eight cases), which occurred in the gingiva and resembled peripheral ameloblastoma except for clustered ghost cells in the central portion of epithelial islands and the presence of juxtaepithelial dentinoid; and (3) central epithelial odontogenic ghost cell tumor (three cases). The latter showed ameloblastomatous or adenomatoid odontogenic tumor-like epithelial clusters with ghost cell formation and juxtaepithelial dentinoid. The clinical features of cystic and neoplastic variants were tabulated and described. On the basis of histopathologic features and their immunohistochemical reaction to polyclonal antikeratin antibody, it is suggested that ghost cells might be the result of coagulative necrosis.

Adolescent↗

PubMed2004

Radial tunnel syndrome caused by ganglion cyst: treatment by arthroscopic cyst decompression.

Compressive neuropathies of the radial nerve at the elbow can lead to one of 2 clinical entities. Posterior interosseous syndrome is primarily a motor deficiency of the posterior interosseous nerve, and radial tunnel syndrome presents as pain along the radial tunnel and extensor muscle mass. The radial nerve can be compressed at a number of sites around the elbow. In addition, numerous mass lesions reported in the literature can cause compressive neuropathy of the radial nerve at the elbow. Standard surgical management for persistent radial tunnel syndrome that is refractory to nonsurgical treatment is open decompression of the radial nerve. Cysts occurring in other joints are commonly treated arthroscopically. Supraglenoid cysts of the shoulder, meniscal cysts in the knee, and dorsal wrist ganglia are routinely treated with arthroscopic decompression or excision with management of the underlying etiology of the cyst. We present a case of radial tunnel syndrome caused by a ganglion cyst of the proximal radioulnar joint that was treated using arthroscopic excision of the cyst and decompression of the radial nerve.

Adult↗

PubMed1997

Complications after cyst excision with hepaticoenterostomy for choledochal cysts and their surgical management in children versus adults.

The aim of this study was to review the cases 200 children and 40 adults who had cyst excision combined with hepaticoenterostomy (CEHE) for choledochal cyst, with particular emphasis on post-CEHE complications and their surgical management. Patients who had CEHE at the age of 15 years or less were defined as children, and those aged 16 years or older were defined as adults. The mean age when patients became initially symptomatic was 3 years in children and 26 years in adults. Eleven adults became symptomatic as children (< or = 15 years of age). The mean age of CEHE in children and adults was 4.2 years and 35 years, respectively. The time interval between the onset of initial symptoms and CEHE was significantly less in children than in adults (P < .0001). Of the 200 children, 176 had primary CEHE, and 24 had secondary CEHE converted from cystoenterostomy or other biliary surgery. Seventy children had intraoperative cyst endoscopy, which enabled us to examine the proximal intrahepatic bile ducts for stenosis and debris, and to wash out debris, protein plugs, and stones from the intrapancreatic ducts. Of the 40 adults, 22 had primary CEHE, 18 had secondary CEHE. The mean follow-up period was 10.9 years in children and 10.7 years in adults. The number of patients with post-CEHE complications in children and adults was 18 (9.0%) and 17 (42.5%), respectively. The post-CEHE complication rate in children was significantly lower than in adults (P < .0001). The 18 children had 25 post-CEHE complications such as cholangitis, intrahepatic bile duct stones, pancreatitis, stone formation in the intrapancreatic terminal choledochus or pancreatic duct, and bowel obstruction. Twenty-seven post-CEHE complications developed in the 17 adults including 2 cases of cholangiocarcinoma. There were no post-CEHE complications in the 70 children who had intraoperative cyst endoscopy. No stone formation was seen in the 145 children who had CEHE at the age of 5 years or less. Eight stone formations were seen in seven (12.7%) of the remaining 55 children aged over 5 years. Stones developed in seven (17.5%) adults. The incidence of post-CEHE stone formation in children aged 5 years or less was significantly lower than in other children and adults (P < .0001). Reoperation was required in 15 children: revision of hepaticoenterostomy in 4, percutaneous transhepatic cholangioscopic lithotomy (PTCSL) in 1, excision of intrapancreatic terminal choledochus in 2, endoscopic sphincterotomy of the papilla of Vater in 1, pancreaticojejunostomy in 1, and laparotomy for bowel obstruction in 6. Ten adults required reoperations: revision of hepaticoenterostomy in 2, PTCSL in 2, left hepatic lobectomy in 1, endoscopic sphincterotomy in 2, exploratory laparotomy in 2, and adhesiolysis in 1. The authors conclude that early diagnosis followed by CEHE is the treatment of choice for choledochal cyst, and intraoperative cyst endoscopy is recommended as a valuable adjunct to CEHE.

Adolescent↗

PubMed1997

Successful management of ruptured choledochal cyst by primary cyst excision and biliary reconstruction.

One to two percent of patients who have choledochal cysts present with cyst rupture and bile peritonitis. Reported cases have been managed with external drainage of the cyst followed by a second procedure to excise the cyst and reconstruct the biliary tract. The authors report two cases of ruptured choledochal cyst treated with primary cyst excision and biliary drainage. The satisfactory outcome of these patients suggests that this is the preferred management.

Bile Duct Diseases↗