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Symptomatic sacral extradural arachnoid cyst associated with lumbar intradural arachnoid cyst.

A case of sacral extradural arachnoid cyst associated with lumbar intradural arachnoid cyst in a 35-year-old male is reported. The patient presented with a history of severe sacrococcygeal pain, constipation, and dysuria for several months. Computed tomographic (CT) myelograms and magnetic resonance imaging (MRI) scans showed a huge sacral cyst without neural components. A favorable outcome could be achieved by decompression of the cyst, obliteration of the fistulous channel between the cyst and the thecal sac, and fenestration of the arachnoid cyst into the subarachnoid space. The relevant literatures are also reviewed.

Adult↗

Ganglion cyst and synovial cyst of the temporomandibular joint. Two case reports.

Ganglion cysts and synovial cysts are lesions rarely associated with the temporomandibular joint. Ganglion cysts arise from myxoid degeneration of the connective tissue of the joint capsule, are filled with viscoid fluid or gelatinous material, and have a fibrous lining. Synovial cysts also contain gelatinous fluid and are lined with cuboidal to somewhat flattened cells consistent with a synovial origin. One case of a ganglion cyst and one case of a synovial cyst of the temporomandibular joint are presented, and their differential diagnosis and management are discussed.

Adult↗

Endoscopic and endoscope-assisted neurosurgical treatment of suprasellar arachnoidal cysts (Mickey Mouse cysts).

Suprasellar arachnoid cysts represent less than 10% of all intracranial arachnoid cysts. Some of them may be quiescent throughout life, some may become symptomatic as they become enlarged and some disappear spontaneously. In this study we discuss the surgical strategies for endoscopic and endoscope-assisted treatment of suprasellar (Mickey Mouse) cysts and analyze the clinical results and experience collected over some years in our department upon doing these operations routinely. Between December 1996 and December 2003, 13 patients (7 female and 6 male patients), mean age 29 years, underwent endoscopic or endoscope-assisted procedures for suprasellar cysts at our department. The indication for surgical treatment was based on the neurological and radiological examination. The goal of surgical treatment was to normalize the cerebrospinal fluid flow and to establish a communication, permanently, between the cyst cavity and the intraventricular or/and subarachnoid space. Intraoperatively we observed in all patients no complications. Seven of 13 patients, who had received shunt systems in other hospitals before admission in our clinic, remained shunt-free postoperatively. Overall clinical improvement was achieved for a long period of between 6 and 74 months in 11 patients, one developed a psychomotor disturbance and another one, who had epilepsy before treatment, was unchanged postoperatively. Our data suggest that suprasellar cysts are well treated by endoscopic or endoscope-assisted procedures with good clinical outcome and low surgical morbidity.

Adolescent↗

Follicular cyst in a patient with myotonic dystrophy: a case of cyst with differentiation toward follicular infundibulum, isthmus, inner root sheath, and hair.

We report a case of follicular cyst, which developed in a patient with myotonic dystrophy (MyD). Histopathologically, the cyst showed infundibular and trichilemmal keratinization, inner root sheath differentiation, aggregation of basaloid cells, and pilomatricoma-like changes in the pericystic connective tissue. These findings have been reported in follicular cysts with Gardner's syndrome (GS). Interestingly, pilomatricoma is known as one of the skin diseases associated with MyD, though there have been no reported cases of cyst formation with differentiation toward portions of hair follicle in a MyD patient. In our case, we hypothesized that the cyst might be derived from embryonic follicular germinative cells or follicular stem cells under the genetic influence of the MyD gene, as observed in follicular cysts in patients with GS.

Adult↗

Infected hepatic cyst in a patient with multiple hepatic cysts: report of a case diagnosed by change of ultrasonographic findings.

Liver cysts are commonly observed, but infection of a liver cyst is a rare complication. Although patients have clinical symptoms, such as a high-grade fever and abdominal pain, diagnosing an infected cyst by abdominal ultrasonography, computed tomography (CT) with contrast medium and magnetic resonance imagings (MRI) is not always easy. We experienced an unusual case who had only clinical symptoms, such as high-grade fever and a right quadrant abdominal pain, but no imaging findings when admitted. Careful observation using ultrasonography once a week revealed signs of an infected cyst containing echogenic fluid 32 days after admission. We performed percutaneous transhepatic cystic drainage. When a patient has liver cysts and complains of high-grade fever and abdominal pain, liver cysts should be considered as a focus of sepsis, and we recommend repeat use of ultrasonography or CT, even if no typical findings occur the first time.

Aged↗

Ciliated hepatic cyst without smooth muscle layer: a variant of ciliated hepatic foregut cyst?

The ciliated hepatic foregut cyst (CHFC) is a rare lesion that may arise from remnants of the embryonic foregut. Its wall is lined by pseudostratified ciliated columnar epithelium, and is characterized by the presence of bundles of smooth muscle. Herein is presented two cases of ciliated hepatic cyst without smooth muscle layer. One case was an incidental autopsy finding, and the other was a surgically resected cystic lesion of the liver. Both cysts were <2.0 cm in diameter, and were located subcapusularly in the medial segment (S4) of the liver. The histological appearance of the two cases was identical. They had an epithelial lining of ciliated pseudostratified cells with occasional goblet cells, and lacked a smooth muscle layer, as shown by the actin immunostaining. The lining epithelium contained cells positive for immunohistochemical staining of surfactant apoprotein A, suggesting the embryonic foregut origin of the cysts and differentiation toward bronchiolar structures, rather than ciliated metaplasia of the epithelium of the simple (cholangiogenic) cyst. It is considered that ciliated hepatic cysts of the present case are a rare histological variant of CHFC where the smooth muscle layer is inconspicuous or absent.

Aged↗

Is it possible to differentiate between choledochal cyst and congenital biliary atresia (type I cyst) by antenatal ultrasonography?

Both choledochal cyst and congenital biliary atresia (type I cyst) may share the same ultrasonographic pattern. We report 2 cases which were shown to have cystic structures on the upper abdomen by antenatal ultrasonography. The size of the choledochal cyst found at 24 weeks' gestation increased steadily as gestational age advanced. But the size of the cyst in congenital biliary atresia found at 29 weeks' gestation remained unchanged throughout the remaining pregnancy. Cyst enlargement, therefore, may suggest the possibility of a choledochal cyst.

Adult↗

Cystplastic cyst-subarachnoid shunt procedure for arachnoid cyst of the middle cranial fossa--technical note.

A cystplastic cyst-subarachnoid shunt procedure using a ventricular catheter of Denver type shunt system was performed in seven patients with non-communicating middle cranial fossa arachnoid cyst. The operation technique consists of: linear incision of the outer membrane of arachnoid cyst and intrusion into the cyst; followed by a 5 mm incision of both the inner membrane of the arachnoid cyst and the arachnoid membrane; insertion of a 2-3 cm length of the ventricular catheter, cut as required with silk thread bound around the midpoint of the tube, into the subarachnoid space; fixation of the tube to the arachnoid membrane by a silk thread with Weck clips; and finally suturing of the outer membrane of arachnoid cyst by a nylon thread. During the follow-up period of 3 months to 3 years after the operation, the symptoms were relieved in all patients, and no recurrence or complication was observed.

Adolescent↗

Symptomatic perirenal serous cysts of müllerian origin mimicking renal cysts on CT.

OBJECTIVE: Our aim was to describe the clinical presentation, CT appearance, and management of a series of symptomatic perirenal serous cysts of müllerian origin, confirmed by laparoscopic resection. CONCLUSION: Perirenal serous cysts of müllerian origin are uncommon lesions that may present as large symptomatic perirenal cystic masses mimicking exophytic renal cysts on CT. Serous cyst of müllerian origin should be considered in the differential diagnosis when CT reveals a large solitary perirenal cyst in a woman with flank or abdominal pain or both. Laparoscopic resection may be an effective treatment of such cysts.

Adult↗

Meningiomas associated with large cysts with neoplastic cells in the cysts walls. Report of two cases.

Two adults presented with frontal lobe masses. As visualized by computerized tomography, both lesions were large cysts with contrast-enhancing mural nodules and enhancing circumferential rims. En bloc resections of the mural nodules and cyst walls were performed. Pathological evaluation of each nodule disclosed a meningioma, and neoplastic cells were found in the distant cyst walls. Although the walls of large cysts associated with some meningiomas have been composed of reactive glia or collagen, the neoplastic character of the cysts in the present cases underscores the need for resection and careful pathological evaluation of the large cysts associated with meningiomas.

Aged↗

[A case of asymptomatic urachal cyst in autopsy--histopathological study of urachal cyst and review of the literature of 99 cases during a 10 year period in Japan].

Disorders of urachal remnants are common. While urachal cysts are usually asymptomatic, infection may mimic a variety of acute abdomen. Here we report a very rare case of urachal cyst that protruded in the urinary bladder cavity and among 99 accumulated cases, only 4 cases have been reported similar to this case characterized by intravesical development from 1990 to 1999. An uninfected urachal cyst was found in a 79-year-old male who had died of bile duct carcinoma. The cyst showed ovoid protrusion into urinary bladder cavity from the dome (3.5 x 2.0 x 2.0 cm in size). Histopathologically, the cyst wall was thin and consisted of fibrous connective tissue with muscular tissue and peripheral nerve, and lined by cuboidal epithelium but no inflammatory cells could be seen. Urachal cysts occur in both sexes are affected with equal frequency, and frequently occur in a younger population. In clinical symptoms the umbilical manifestations are predominant in patients younger than 30 years old, while the bladder manifestations are predominant in those older than 30.

Aged↗

Neuroepithelial cysts in a patient with Joubert syndrome plus renal cysts.

Joubert syndrome is a rare genetic neurologic disorder associated with hypoplasia or absence of the cerebellar vermis. The classic form is characterized by ataxia, hypotonia, eye movement abnormalities, developmental delay, and abnormal breathing patterns. In contrast, other patients have the additional feature of kidney cysts. This population could represent a distinct form of Joubert syndrome. One case of Joubert syndrome with subcortical neuroepithelial cysts was recently described. We report a new case of Joubert syndrome with overlapping features, including diffuse progressive central nervous system neuroepithelial cysts and kidney cysts. Our data suggest that neuroepithelial cysts occur in conjunction with Joubert syndrome associated with kidney cysts.

Brain Diseases↗

Nucleolar organizer regions (NORs) in simple and proliferating trichilemmal cysts (pilar cysts and pilar tumors).

Simple trichilemmal cysts or pilar cysts and pilar tumors are relatively rare entities often under-reported by pathologists. The pilar cysts are thought to proliferate and progress to pilar tumors. These pilar tumors can further undergo malignant change. We analyzed 25 pilar cysts and eight pilar tumors, including three with atypia and one malignant pilar tumor, with a view to study the above progression and assess the degree of cell proliferation using the Nucleolar Organizer Regions (AgNORs). There was a progressive increase in the AgNOR count from one dot per nucleus in pilar cysts to 1.5-2 in benign pilar tumors. AgNORs in pilar tumors with atypia (2.8) was more than the benign pilar tumors but were definitely less than the malignant pilar tumors (3.5). The malignant pilar tumor showed bizarre AgNORs and cells with as many as eight to nine AgNORs. Thus AgNOR counts suggested that there is a progressive increase in the degree of cell proliferation and thereby the AgNOR staining from pilar cysts to pilar tumors. This AgNOR staining could also be used to assess the cell proliferation in case of pilar tumors with atypia where it is difficult to rule out malignancy.

Cell Proliferation↗

Multiple pigmented follicular cysts: a subtype of multiple pilosebaceous cysts.

Pigmented follicular cyst is a rare disorder which typically presents as a pigmented papule on the head or neck and which, histologically, exhibits terminally differentiated, pigmented hair shafts in an epidermoid cyst. We report a 22-year-old man with the multiple variant of this disorder. Clinically he had numerous brown-blue to flesh-coloured, domed-shaped papules, on the anterior chest and abdomen, of 10 years duration. Histologically, hybrid cysts exhibiting trichilemmal and epidermoid keratinization were seen. The cysts contained numerous pigmented, terminally differentiated hair shafts and, embedded in the wall of one cyst, was a sebaceous gland. The condition of multiple pigmented follicular cysts, is thought to represent a distinct subtype within the spectrum of multiple pilosebaceous cystic disorders.

Adult↗

Breast cyst type does not predict the natural history of cyst disease or breast cancer risk.

The sodium (Na) and potassium (K) concentrations were measured in the fluid of 169 breast cysts aspirated from 101 consecutive patients presenting to a single clinic. The Na/K ratio was used to define cysts as either apocrine (Na/K less than 3) or flattened (Na/K less than 3) in type. There was no consistency in the type of cyst for individual patients. Cyst type was not predictive of further cyst development, neither was a particular cyst type associated with the development of, or a history of, breast cancer.

Age Factors↗

Differentiation of hydatid cyst from cysticercus cyst by proton MR spectroscopy.

The metabolite patterns obtained by ex vivo proton MR spectroscopy of fluid from different locations of hydatid cysts of sheep and humans (n = 16) and cysticercus cysts of swine and humans (n = 25) were compared with an objective of differentiating the two parasites on the basis of their metabolite pattern. The spectra from hydatid fluid differed from cysticercus cyst by the absence of creatine in the former. When the hydatid cyst was fertile, malate and/or fumarate was also observed, which was absent in cysticercus cyst. The most likely explanation for the presence of creatine only in the cysticercus fluid is its active diffusion from the surrounding host tissue along with a contribution from the musculature present in the bladder wall of the cyst.

Animals↗