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PubMed2005

The role of pancreatic cyst fluid molecular analysis in predicting cyst pathology.

BACKGROUND & AIMS: Current methods to detect malignancy in mucinous cystic neoplasms of the pancreas remain inadequate. The role of detailed molecular analysis in this context was investigated. METHODS: Endoscopic ultrasound-guided pancreatic cyst aspirates were prospectively collected during a period of 19 months and studied for cytology, carcinoembryonic antigen level, and molecular analysis. Molecular evaluation incorporated DNA quantification (amount and quality), k-ras point mutation, and broad panel tumor suppressor linked microsatellite marker allelic loss analysis by using fluorescent capillary electrophoresis. The sequence of mutation acquisition was also calculated on the basis of a clonal expansion model, and comparison was made to the final pathology. RESULTS: Thirty-six cysts with confirmed histology were analyzed. There were 11 malignant, 15 premalignant, and 10 benign cysts. Malignant cysts could be differentiated from premalignant cysts on the basis of fluid carcinoembryonic antigen level (P=.034), DNA quality (P=.009), number of mutations (P=.002), and on the sequence of mutations acquired (P<.001). Early k-ras mutation followed by allelic loss was the most predictive of a malignant cyst (sensitivity, 91%; specificity, 93%). CONCLUSIONS: Malignant cyst fluid contains adequate DNA to allow mutational analysis. A first hit k-ras mutation followed by allelic loss is most predictive of the presence of malignancy in a pancreatic cyst. This approach should serve as an ancillary tool to the conventional work-up of pancreatic cysts. Cumulative amount and timing of detectable mutational damage can assist in diagnosis and clinical management.

Carcinoembryonic Antigen↗

PubMed1993

Cyst fluid analysis in the differential diagnosis of pancreatic cysts. A comparison of pseudocysts, serous cystadenomas, mucinous cystic neoplasms, and mucinous cystadenocarcinoma.

Pancreatic cystic lesions include inflammatory pseudocysts, benign serous tumors, and mucinous neoplasms, some of which are malignant. Clinical and radiologic indices are often inadequate to discriminate reliably among these possibilities. In an attempt to develop new preoperative diagnostic criteria to assist in decisions regarding therapy, the authors have performed cyst fluid analysis for tumor markers (carcinoembryonic antigen: CEA, CA 125, and CA 19.9), amylase content, amylase isoenzymes, relative viscosity, and cytology on 26 pancreatic cysts. The cases included nine pseudocysts, five serous cystadenomas, 4 mucinous cystic neoplasms, 7 mucinous cystadenocarcinomas, and one mucinous ductal adenocarcinoma with cystic degeneration. Carcinoembryonic antigen levels were high (> 367) in all benign and malignant mucinous cysts, but were low (< 23) in the pseudocysts and benign serous cystadenomas, an indication that CEA discriminates between mucinous and nonmucinous cysts (p < 0.0001). Values for CA 125 were high in all malignant cysts, low in pseudocysts, and variable in mucinous cystic neoplasms and serous cystadenomas. Levels of Ca 19.9 were nondiscriminatory. Cyst fluid amylase and lipase content were variable but were generally high in pseudocysts and low in cystic tumors. Amylase isoenzyme analysis was useful to differentiate pseudocysts from cystic tumors. Measurement of the relative viscosity in cyst fluid showed high (> serum viscosity) values in 89% of mucinous tumors and low values (< serum) in all pseudocysts and serous cystadenomas (p < 0.01). Cytologic analysis of cyst fluids was of limited value in differentiating pseudocysts from serous cystadenoma, but in seven of eight mucinous tumors provided useful diagnostic information and correctly classified three of five malignant tumors. The authors conclude that cyst fluid analysis can provide a preoperative classification of these diagnostically difficult lesions. The combination of viscosity, CEA, CA 125, and cytology can reliably distinguish malignant cystic tumors and potentially premalignant mucinous cystic neoplasms from pseudocysts and serous cystadenomas. Amylase content with isoenzyme analysis is useful to identify pseudocysts.

Antigens, Tumor-Associated, Carbohydrate↗

PubMed1987

Relation of ovarian dermoid cysts and immature teratomas: an analysis of 350 cases of immature teratoma and 10 cases of dermoid cyst with microscopic foci of immature tissue.

Three hundred fifty cases of immature teratoma of the ovary and 10 cases of ovarian dermoid cyst containing microscopic foci of immature tissue were analyzed to evaluate the relation between the two tumors. Twenty-six percent of the immature teratomas contained grossly visible dermoid cysts, 10% of them were associated with a dermoid cyst in the contralateral ovary, and 9 (2.6%) were preceded by resection of a dermoid cyst from the same ovary. Microscopic foci of slightly or moderately immature tissue were found in the walls of two of the previously excised cysts. Follow-up information available in nine of the 10 cases of dermoid cyst containing microscopic foci of immature tissue revealed no evidence of recurrence 11 months to 7 years postoperatively. Dermoid cysts that were followed by immature teratomas were characterized by high frequencies of multiplicity and rupture of the cysts. The findings suggest a relation between dermoid cysts and immature teratomas that warrants further investigation.

Adolescent↗

PubMed2004

Clinical relevance of calcaneal bone cysts: a study of 50 cysts in 47 patients.

The clinical relevance and nature of calcaneal cysts is controversial. The risk of pathologic fracture is undefined and diagnostic criteria to differentiate between cysts in patients who can be treated nonoperatively and patients who require surgical intervention are not available. To address these questions, 50 calcaneal bone cysts in 47 patients were evaluated. The majority of cysts (40 of 50) were asymptomatic and were treated nonoperatively. Cysts reaching a critical size, defined as 100% intracalcaneal cross section in the coronary plane and at least 30% in the sagittal plane, are at risk for becoming symptomatic and at risk for fracture. Fracture is a significant complication and occurred in four of 47 patients, three of whom were treated by open reduction internal fixation and bone grafting. In addition, six patients with symptomatic critical size cysts without apparent fracture were treated by curettage and subsequent autogenous bone grafting or calcium-phosphate cement filling, and there were no recurrences. We report one of the largest series of cysts in the calcaneus. The results suggest that calcaneal cysts are clinically relevant because of the potential risk of fracture and that size is a significant factor in terms of the treatment of the cyst.

Adolescent↗

PubMed2006

Management of intracorneal epithelial cysts with ethanol irrigation and cyst wall excision: A clinicopathologic report.

PURPOSE: The clinical and pathologic characteristics and the surgical treatment of 2 patients with intrastromal corneal epithelial cysts are described. METHODS: This interventional case report presents 2 young patients with decreased vision and cosmetic impairment caused by intracorneal epithelial cysts. The first patient had history of strabismus surgery, and the second patient had undergone corneal laceration repair. The cysts had enlarged gradually and dissected into the cornea, threatening the visual axis. Both patients were treated with drainage of cyst contents, chemical cytodestruction with 96% ethanol for 1 minute in a closed system, followed by cyst wall excision. RESULTS: Corneal clarity and appearance improved significantly after surgery. In the first patient, best-corrected visual acuity was 20/20 before the operation and remained stable. In the second patient, best-corrected visual acuity improved from 20/400 to 20/60 after the procedure. Histopathologic findings revealed that the cyst walls were composed of nonkeratinized stratified squamous epithelium. No recurrence was noted up to 8 and 3 months in the first and second patients, respectively. No complication occurred during the follow-up period. CONCLUSION: Intracorneal epithelial cysts may be treated safely and effectively with a combination of drainage of cyst contents, irrigation with 96% ethanol, and cyst wall excision with good visual and cosmetic results.

Adolescent↗

PubMed1999

Pericruciate meniscal cysts arising from tears of the posterior horn of the medial meniscus: MR imaging features that simulate posterior cruciate ganglion cysts.

OBJECTIVE: The purpose of this study is to describe MR imaging features of an unusual type of meniscal cyst arising from tears of the posterior horn of the medial meniscus in 10 patients. MATERIALS AND METHODS: Retrospective review of MR examinations of the knee was performed of 10 patients (nine men, one woman; mean age, 39 years) in whom evidence of a meniscal tear and a cyst-like structure around the posterior cruciate ligament (PCL) was seen. RESULTS: An oval mass with low signal intensity on T1-weighted MR images and increased signal intensity on T2-weighted MR images posterior to the PCL, simulating a PCL ganglion cyst, was seen in all 10 patients. A tear of the posterior horn of the medial meniscus was also seen in all patients. The sites of communication between the cyst and meniscal tear were observed in sagittal MR images in eight patients. Septation within the cyst and associated joint effusion were seen in eight and four patients, respectively. Arthroscopy in eight patients and transmeniscal needle drainage in the other two patients confirmed both the meniscal tear and the pericruciate meniscal cyst. CONCLUSION: Pericruciate meniscal cysts cause fluid collections posterior to the PCL, simulating a PCL ganglion cyst. Careful analysis of the posterior horn of the medial meniscus should be performed when a cyst-like structure is seen adjacent to the PCL.

Adolescent↗

PubMed1979

Popliteal cysts (Baker's cysts) in adults. I. Clinical and roentgenological results of operative excision.

Forty patients were re-examined between 6 months and 15 years (mean 4 years) after excision of a popliteal cyst. Forty-six operations had been performed, including one bilateral cyst and five recurrent cysts. The history was reviewed with respect to the preoperative symptoms, clinical and roentgenological signs, the operative and histopathological findings and the postoperative course. Fifteen operations were followed by wound healing complications or tense swelling of the calf simulating deep venous thrombosis. At clinical follow-up a reccurent cyst was found in 63 per cent of the knees. A simplified follow-up arthrography was performed in all knees, and revealed a cyst-like cavity in all but one knee. The majority of the recurrent cysts displayed irregularities of the wall that had not been seen in the preoperative arthrograms. Despite this high rate of recurrence most of the patients had fewer symptoms from the popliteal space at the time of follow-up than before the operation. as associated knee disorders were present in the majority of patients, popliteal cysts (Baker's cysts) should be regarded and, if possible, treated as secondary to the basic pathological condition of the joint. Only if the knee disorder is not curable and if the symptoms from the popliteal region are troublesome should excision of the cyst and tight closure of the communication with the joint be considered.

Adolescent↗

PubMed1988

Intradural arachnoid cysts of the spinal canal associated with intramedullary cysts.

Five patients had intradural arachnoid cysts of the thoracic spinal canal associated with syringomyelia or posttraumatic intramedullary spinal cord cysts. Three cases were diagnosed 6 to 18 years after spinal surgery and two 14 to 17 years after spinal cord trauma. In each case, delayed progression of symptoms led to the identification of the lesions. The diagnosis was assisted by the use of myelography and delayed computerized tomography scanning in two cases and by magnetic resonance imaging in all five. In each case, the arachnoid cyst appeared to compress the spinal cord or nerve roots; in three cases, the syrinx cavities appeared to exert a significant mass effect. In the two trauma-related cases, the intramedullary cysts were small and may have represented areas of cystic myelomalacia. In four cases, intraoperative real-time ultrasonography helped to localize the arachnoid and intramedullary cavities. All five patients were treated by fenestration of the arachnoid cyst; additional peritoneal shunting of the cyst was performed in one case and of the intramedullary cavity in three. In one patient, the two lesions appeared to have a balancing effect; after drainage of the arachnoid cyst, the syrinx cavity expanded and had to be treated separately. The neurological deficits were reduced in four patients and stabilized in one. Intradural arachnoid cysts and intramedullary cysts may occur together as a late complication of spinal surgery or spinal cord trauma, and either or both lesions may cause delayed neurological deterioration.

Adult↗

PubMed1991

Simple renal cysts, atypical renal cysts, and renal cell carcinoma in von Hippel-Lindau disease: a lectin and immunohistochemical study in six patients.

We compare the expression of four markers of renal tubular differentiation in six renal cell carcinomas, five atypical renal cysts, and five simple renal cysts from six patients with von Hippel-Lindau disease. Proximal tubular markers were expressed by five of six renal cell carcinomas, three of five atypical renal cysts, and zero of five simple renal cysts. Distal tubular markers were expressed by one of six renal cell carcinomas, five of five atypical renal cysts, and four of five simple renal cysts. One of the three atypical cysts which expressed distal tubular markers was associated with a renal cell carcinoma which also expressed distal tubular markers. Our findings suggest that simple renal cysts in von Hippel-Lindau disease arise more commonly from distal rather than proximal tubules, while atypical renal cysts show tubular origin similar to renal cell carcinomas.

Biomarkers, Tumor↗

PubMed1995

[Arachnoid cyst with hematoma in the cyst wall].

It is well known that arachnoid cysts can be associated with chronic subdural hematoma. We report a case of an arachnoid cyst in which the hematoma was located in the cyst wall. A 23-year-old male was found by chance to have an arachnoid cyst in the left middle fossa. We followed him up, because he had no symptoms. Two years after the initial examination, he began to complain of severe headache. MR image showed a hematoma located in the anterolateral space of the cyst. On operation, we found that arachnoid membranes had covered the hematoma. We removed the hematoma and tore the inner wall of the cyst so that cerebrospinal fluid in the cyst could flow easily into the basal cistern. Pathological examination revealed arachnoid-like tissues outside the hematoma capsules. Since the hematoma was wrapped all over by arachnoid tissues, it was considered that the hematoma was located in the outer wall of the cyst. About the mechanism of hematoma formation in this case, we suppose that some force could have split the outer wall of the cyst, and bloody fluid seeping through the wall membranes may have collected in the wall itself.

Adult↗

PubMed1994

Epidermoid cyst (cholesteatoma) and cholesterol granuloma of the temporal bone and epidermoid cysts affecting the brain.

Five cases of petrous apex epidermoid cysts, six cases of petrous apex cholesterol granuloma cysts, and seven cases of intradural cerebellopontine angle (CPA) or intracranial epidermoid cysts are reviewed. Petrous epidermoid cysts (cholesteatomas) and cholesterol granuloma cysts cannot be differentiated definitely from each other on CT scans. On MR imaging, epidermoid cysts exhibit long T1 and long T2 characteristics and can be differentiated from cholesterol granuloma cysts, which exhibit short T1 and long T2 characteristics. Intradural epidermoid cysts involving the CPA or other portions of the brain, also demonstrate long T1 and long T2 characteristics on MR scans. Intradural epidermoid cysts exhibit curvilinear areas of higher intensity on T1-weighted images, which were best evaluated on T1-weighted MR images obtained with more averages (6 to 8).

Adolescent↗

PubMed1994

Prevalence and percutaneous drainage of cysts of the sacral nerve root sheath (Tarlov cysts).

PURPOSE: To describe a percutaneous CT-guided method for drainage of perineurial (Tarlov) cysts, which are a cause of sciatica and low back pain, and to report the prevalence of these cysts within the population as detected by MR. METHODS: Five hundred sequential lumbosacral spine MRs were evaluated for the presence of a perineurial cyst. Using CT-guided percutaneous drainage techniques, seven cysts were drained in five symptomatic patients. RESULTS: Of the 500 sequential lumbosacral spine MRs, examinations from 23 patients showed perineurial cysts, a prevalence of 4.6%. Five patients (1%) were symptomatic from the cysts. After CT-guided percutaneous drainage, instant pain relief lasted from 3 weeks to 6 months without the risk or cost of spine surgery. CONCLUSIONS: Lumbosacral perineurial cysts are common lesions that are usually asymptomatic but may cause pressure symptoms. Cyst puncture can alleviate the pain. Although the cysts repressurized and the patients' symptoms returned in most cases, this technique seems to be a quick and simple way of at least attaining a pain-free interval and possibly a complete cure as occurred in one patient in this study.

Adolescent↗

PubMed2006