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Primary intracranial arachnoid cysts are not too infrequent, but cases involving a familial occurrence of arachnoid cysts or bilateral symmetrical cysts in one patient have rarely been reported. We report bilateral arachnoid cysts of the middle cranial fossa in siblings.
A 54-year-old woman was admitted to the hospital for evaluation of meningitis. Tuberculous meningitis was suspected initially because of general findings and a high adenosine deaminase activity (ADA) value in the cerebrospinal fluid. Administration of antituberculous drugs was not effective. Computed tomography scanning revealed progression of ventricular enlargement. A ventriculo-peritoneal shunt was placed upon diagnosis of hydrocephalus due to meningitis. The presence of a large abdominal cyst formation was demonstrated. Cryptococcus was detected in the cyst fluid, leading to a diagnosis of cryptococcal meningitis. Intravenous administration of fluconazole (400 mg/day) was begun. Excision of the cyst was performed when Cryptococcus was no longer detected in the cyst fluid. The patient recovered uneventfully.
The paraurethral cyst or Skene's duct cyst is a rare congenital anomaly in the female newborn. It appears like a round, yellow or orange-colored cystic mass on either side of the urethral meatus. The reported incidence is 1 in 2.000 to 7.000 female births. The low frequency of the Skene's duct cyst and the little awareness of it and its benignity may lead to wrong diagnosis that underestimates its incidence. There are authors that agree with surgical treatment of paraurethral cyst to obtain an early resolution, even though a majority agrees to manage conservatively.
An unusual case of aneurysmal bone cyst recurring after operation as a simple bone cyst is reported. Different theories on etiology and pathogenesis of aneurysmal bone cyst, simple bone cyst, and central giant cell granuloma of the jaws are resumed and similarities demonstrated. It is suggested that these three lesions have a common dysvascular etiology and that local environmental factors within the bone may differentiate the pathogenesis.
Slit ventricle syndrome, known to occur from malfunction of the shunt procedure for hydrocephalus, is reported after cyst-peritoneal shunt for temporal arachnoid cyst. Two children aged 12 and 10 years, who underwent cyst-peritoneal shunting for a large temporal arachnoid cyst at the age of 10 and 5 years, respectively, recently experienced several episodes of severe headache. Prior to admission, repeated CT scans did not reveal any morphological change in either of these two patients. Evidence of high intracranial pressure by lumbar tap revealed shunt malfunction. Both patients became free of neurological complaints and deficits after shunt revision. Despite elevated intracranial pressure due to shunt malfunction, neuroimaging studies showed no morphological changes in slit ventricle syndrome. Delay in both the diagnosis and prompt treatment may result in complete loss of visual acuity and even death. It is important to suspect this complication in patients with persistent elevated intracranial pressure symptoms and signs after any shunting procedure, regardless of unchanged neuroimaging studies. Once this is suspected, lumbar tap may be necessary and the choice of treatment is shunt revision.
We present the case of a woman who suffered from an acutely infected diffuse mass in the right neck. This mass had grown rapidly after difficult extraction of a tooth. Histologic analysis of the excised material revealed a lateral neck cyst with a lymph node that showed signs of an acute inflammation near the cyst. These findings support the theory that a preexisting lateral neck cyst may be "activated" by an intraoral inflammation. The different theories of the origin of lateral neck cysts are presented and discussed in the context of the case description.
Two patients are presented where lesions adjacent to the joint line of the knee were diagnosed clinically and on magnetic resonance imaging (MRI) as meniscal cysts. No concomitant meniscal tears were seen, and the MRI signal was not completely homogenous. The diagnostic imaging influenced the surgical management in a manner inappropriate for the definitive diagnoses of fibromyxoid sarcoma and monophasic synovial sarcoma. Not all cysts produce a purely homogenous signal on MRI due to haemorrhage or high protein content fluid, and not all meniscal cysts are associated with a meniscal tear. In the absence of a meniscal tear and with mixed signal on MRI we advise caution in the diagnosis of a meniscal cyst and advocate shared management with either orthopaedic or radiological colleagues with a special interest in oncology to obtain a tissue diagnosis before definitive treatment.
We report a case of a neonatal male with a prenatal diagnosis of umbilical cord cyst that was finally diagnosed as an ileal duplication cyst after post-natal surgical exploration of the umbilical mass. To our knowledge, a similar case has never been reported previously. Although this form of presentation of enteric duplication cyst is exceptional, it should be taken into consideration when evaluating suspected umbilical cord cysts.
AIMS: To investigate whether epidermoid cysts, branchial cysts, craniopharyngiomas and cholesteatomas express S100 proteins differentially by immunohistochemical assaying the presence of S100A1, S100A2, S100A3, S100A4, S100A5, S100A6 and S100B. METHODS AND RESULTS: Immunopositivity/negativity was recorded for each S100 protein in a series of 52 cases consisting of 12 epidermoid cysts, 12 branchial cysts, 15 adamantinomatous craniopharyngiomas and 13 acquired cholesteatomas. Except in the case of the craniopharyngiomas, immunoreactivity was assessed independently in the basal membrane and the basal, the internal and the keratin layers. Our data show that in contrast to S100B, which was rarely expressed, S100A1, S100A2, S100A4 and S100A5 were often present in these four types of epithelial lesions. S100A3 and S100A6 and, to a lesser extent, S100A5 were the most differentially expressed proteins across the different histopathological groups analysed. These three proteins are expressed more often in craniopharyngiomas and cholesteatomas, the two more aggressive types of lesions. CONCLUSIONS: This is the first study to report data on the expression of seven S100 proteins in different histopathological groups of epithelial head and neck lesions, whose precise embryological origins are still a matter of debate. S100 proteins could possibly be used as markers to target this embryonic origin, since our results show that S100A3 and S100A6 (and, to a lesser extent, S100A5) are expressed differentially across these different groups of epithelial lesions.
The histologic characteristics of a case of epidermoid cyst formation with an epithelioid cell granuloma that developed in intrapancreatic accessory spleen were investigated, with the aim of clarifying its origin as well as etiologic factors. The patient, a 48-year-old male, was found to have a cystic lesion in the tail of the pancreas and renal cell carcinoma (clear cell carcinoma) during a medical check up. The pancreatic mass appeared to be a so-called "mucinous tumor" on imaging, and combined resection of the body and tail of the pancreas and the spleen was performed together with a left nephrectomy. The lesion in the tail of the pancreas was then demonstrated to have accessory splenic tissue with cyst formation in its central region. The cystic wall was covered with stratified squamous epithelium and ductal epithelium with squamous metaplasia, and pancreatic islet cells were evident at various sites within the accessory spleen. Formation of epithelioid cell granuloma tissue was observed around the cysts. The epithelium of the cyst was positive for CA19-9 and negative for antibodies against mesothelial cells, whereas the pancreatic island cells were positive for insulin. These results suggested that cystic epithelium in the accessory spleen could be derived from pancreatic duct epithelium. Frequent recurrence of chronic inflammation and epitheloid cell granuloma formation may have resulted from an aberration of the ectopic remaining pancreatic tissue in the spleen.
Changes of diagnosing foetal malformations via sonography are greatest with regard to the skull. Anencephalus or hydrocephalus are most frequent, whereas cysts are comparatively rare. In the case under report a large intracranial cyst was diagnosed during the 33rd week of pregnancy. After moderate size increase spontaneous birth of a normal boy occurred during the 38th week. Prenatal findings were confirmed post partum via diaphanoscopy, sonography, ventriculography and computed tomography. The definite diagnosis of the suspected arachnoidal cyst, however, could be established only at the age of 8 months on the occasion of craniotomy with fenestration of the cyst. The problems connected with prepartal and postpartal diagnosis of foetal intracranial cystic space-occupying growths and their management are shown on the basis of the case report and the references. Prenatally it is recommended to proceed along conservative and cautious lines. A warning is issued against exaggerated enthusiasm in trying to manage foetal malformations by means of interventions monitored by ultrasound.
We report a case of follicular hybrid cyst arising in a nevus sebaceus. Histopathologic findings showed one part with the features of a trichilemmal cyst and the other part with those of a pilomatricoma. To our knowledge, this is the first case of follicular hybrid cyst associated with nevus sebaceus. We consider that the cyst in our case is derived from the hair matrix and from the follicular isthmus.
The epidermoid cyst with a seborrheic verruca-like cyst wall is a newly described variant of the epidermoid cyst. The cyst wall of this variant shows changes simulating seborrheic keratosis and verruca. Our case of a subcutaneous mass was shown histopathologically to have this variant.
A case report of a female neonate referred with antenatally diagnosed cystic lesions within the right hemithorax and under the left hemidiaphragm is presented to highlight the ease with which these lesions can be resected in an asymptomatic post-natal infant with minimally invasive surgery. The diagnostic and cosmetic benefits of minimally invasive surgery are also demonstrated. While excising the documented thoracic cyst, another small cyst was identified adherent to the right main bronchus. An elective laparoscopic excision of the abdominal cyst was also successful. A brief review of the complications and treatment of foregut duplication cysts is detailed.
A mass of 8 cm in diameter was revealed in the right upper lung field of a 46-year-old female patient. The chest X-ray film taken one year previously revealed only a linear shadow in the same position, which was thought to be a vacant cyst. The levels of carbohydrate antigen (CA) 19-9 in cyst fluid and serum were elevated, at 410,000 and 130 U/ml, respectively. After surgical resection, serum CA19-9 returned to normal. Pathologically, the cyst wall was lined with bronchial epithelium with no evidence of malignancy. Immunohistochemical study revealed CA19-9 positivity in the bronchial epithelium of the cyst wall.
We report on a 31-year-old Japanese female with an epidermoid cyst developed in the right inguinal region. The lesion was excised and drained by a surgeon. Since there was a local recurrence of the lesion within 2 months, the patient visited us, and the lesion was completely excised. Only the cells in the lowermost layer of the cyst wall showed dysplasia, which was characterized by irregular, and hyperchromatic nuclei with coarsely clumped nuclear chromatin pattern. However, solar elastosis was not observed, and spongiosis surrounding the atypical cells was present. In addition, melanophages were seen in the upper dermis. In conclusion, atypical keratinocytes in the lowermost portion of the cyst wall were deemed to be secondary to inflammation due to treatment by a surgeon rather than to development of both in situ and invasive squamous cell carcinomas in an epidermoid cyst.
An asymptomatic neuroepithelial cyst (colloid cyst) located in the leptomeninges between the inferior colliculus and the paravermal region of the superior cerebellum was an incidental postmortem finding. The cyst was lined by ciliated pseudostratified columnar epithelium of the respiratory tract type as lell as cuboidal epithelium of the ependymal type. Its developmental relationship to previously described colloid and paraphyseal cysts in the third ventricle is discussed.
The results of surgical treatment of 29 children with cysts, and 10--with cyst-like formations of the abdominal cavity and retroperitoneal space are described. In majority of the patients, a cyst at the terminal stage was revealed. In presence of complications, they were operated on with tentative diagnosis of acute appendicitis, or ileus. The operation consisted of cyst enucleation, its elimination with resection, or removal of the organ, creation of cystodigestive anastomosis. Postoperative lethality was 12.8%.