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PubMed2001

Marsupialization of the cyst as a step in laparoscopic management of ovarian cysts.

STUDY OBJECTIVE: To compare a traditional technique of ovarian cyst management with a marsupialization method (MM) developed by the authors. DESIGN: Prospective, observational study (Canadian Task Force classification II-1). SETTING: Central Asian city teaching hospital. PATIENTS: Eighty-one women with benign ovarian cysts. INTERVENTION: Traditional laparoscopic cyst management and MM. Cysts were removed through a cannula site after being placed into an endobag and marsupialization. With this technique, cysts were emptied partially or completely by aspiration and brought outside the abdominal cavity through a 1.5- to 2.5-cm cannula incision site. Some of the cyst contents may be removed during extraction. The technique allows the surgeon to interrupt cyst pedicles extracorporally or intracorporally. MEASUREMENTS AND MAIN RESULTS: With traditional methods of laparoscopic cystectomy the spillage rate was 18% (6 patients), compared with 16% (8 patients) for MM. Operating time, blood loss, and mean hospital stay were not statistically different between groups (p >00.5). CONCLUSION: With MM technique, cystectomy is simple, reliable, and cost effective.

Adolescent↗

PubMed1996

The hybrid epidermoid and apocrine cyst. A combination of apocrine hidrocystoma and epidermal inclusion cyst.

We describe four cases of unusual superficial cutaneous cysts that have a lining epithelium composed of apocrine cells immediately adjacent to keratinizing squamous epithelium with an intact granular layer. Two of the cysts were on the nipple of the breast and two of the cysts were on the face. The lumina of all four cysts contained keratin. Immunoperoxidase staining for carcinoembryonic antigen in the facial cysts showed positive staining within the apocrine cells of the lining epithelium in one case. The pathogenesis of these lesions is uncertain. We suggest that these unusual cysts be called hybrid epidermoid and apocrine cysts.

Adult↗

PubMedDate not supplied

Comparison of hepatocyte growth factor levels of epithelial ovarian cancer cyst fluids with benign ovarian cysts.

Hepatocyte growth factor (HGF) is known to take role in oncogenesis and tumoral behavior of the tumors of the organs that contain mesenchymal and epithelial cells together. This study aims to compare HGF levels in cyst fluids of epithelial ovarian cancer and benign ovarian cysts and look for the role of HGF in ovarian carcinogenesis. Twenty-four consecutive patients with ovarian cancer and 34 with benign cysts of ovary were recruited prospectively at Gynecologic Oncology Departments of SSK Ankara Maternity Hospital and Hacettepe University School of Medicine between 2001 and 2002. Cyst fluids were collected during primary staging in cancer patients and during laparatomy for benign patients. HGF levels were measured by enzyme-linked immunosorbent assay method. Median HGF levels of the benign ovarian cysts and epithelial ovarian tumoral fluids were found as 3822 pg/ml (85-15,253 pgr/ml) and 12,962 pgr/ml (4136-16,025 pgr/ml), respectively. Malign cyst fluids have higher HGF levels when compared with benign ovarian cysts (P < 0.01). This finding suggests that HGF may take a paracrine role in oncogenic differentiation and tumoral development of epithelial ovarian cancers. Mechanisms that take role in HGF secretion and the answers of the neighboring epithelial cells to HGF during tumoral development need to be investigated.

Adenocarcinoma, Clear Cell↗

PubMedDate not supplied

Comparison of HGF (hepatocyte growth factor) levels of epithelial ovarian cancer cyst fluids with benign ovarian cysts.

Hepatocyte growth factor (HGF) is known to take a role in oncogenesis and tumoral behavior of the tumors of the organs that contain both mesenchymal and epithelial cells. This study compares HGF levels in cyst fluids of epithelial ovarian cancer and benign ovarian cysts to look for the role of HGF in ovarian carcinogenesis. Twenty-four consecutive patients with ovarian cancer and 34 with benign ovarian cysts were recruited prospectively at the Gynecologic Oncology Departments of SSK Ankara Maternity Hospital and Hacettepe University School of Medicine between 2001 and 2002. Cyst fluids were collected during primary staging in cancer patients and during laparatomy for benign patients. HGF levels were measured by ELISA method. Median HGF levels of the benign ovarian cysts and epithelial ovarian tumoral fluids were found to be 3822 pg/ml (85-15253 pg/ml) and 12962 pg/ml (4136-16025 pg/ml), respectively. Malignant cyst fluids have higher HGF levels when compared with benign ovarian cysts (P < 0.01). This finding suggests that HGF may take a paracrine role in oncogenic differentiation and tumoral development of epithelial ovarian cancers. Mechanisms that take a role in HGF secretion and the responses of neighboring epithelial cells to HGF during tumoral development need to be investigated.

Adenocarcinoma, Clear Cell↗

PubMed1998

Solitary true cyst of the pancreas in two adults: analysis of cyst fluid and review of the literature.

Solitary true cyst of the pancreas in adults is extremely rare. We report two adult cases of solitary true cyst of the pancreas. In a 53-yr-old woman there was discovered, incidentally, a unilocular cyst of 7.0 x 6.5 cm in size in the tail of the pancreas that was noted on abdominal US and CT scan. A 16-yr-old boy presented with abdominal pain, and an abdominal US and CT scan revealed a 6.5 cm cystic mass located in the tail of the pancreas. Both patients underwent distal pancreatectomy. Histologically, the cyst was lined with flattened cuboidal and squamous epithelium without morphological alterations. Analysis of the cyst fluid revealed high CA 19-9 (>100,000 U/L) and Span-1 levels (>60,000 U/L) in both cases. Immunohistochemically, the lining epithelial cells of true cyst were positive for CA 19-9 staining. The clinicopathological features of solitary true cyst of the pancreas in adults are briefly reviewed.

Adolescent↗

PubMed1992

Fetal choroid plexus cysts: beware the smaller cyst.

Current literature suggests that amniocentesis be performed on fetuses with simple choroid plexus cysts only when such cysts are 1.0 cm or greater in diameter and bilateral. At retrospective analysis of 3,769 patients, choroid plexus cysts were noted in 87 (2.3%), representing a rate three times greater than that of previous reports. Eight-three patients underwent amniocentesis. Six (7.2%) had abnormal karyotypes. Four patients had the commonly associated chromosomal abnormality trisomy 18. Two had karyotypes not usually associated with this problem: mosaic Turner syndrome and trisomy 21. Of the six patients with abnormal karyotypes, one had a 4-mm-diameter unilateral choroid plexus cyst and three had bilateral cysts of 3-5 mm. Only one patient with a 16-mm cyst had any associated structural abnormality discovered at rigorous ultrasound examination. Karyotyping may be necessary in fetuses with small choroid plexus cysts. Deciding which patients should be encouraged to undergo amniocentesis is made more complex by these data.

Amniocentesis↗

PubMed1994

Hepatic peribiliary cysts: multiple tiny cysts within the larger portal tract, hepatic hilum, or both.

PURPOSE: To describe characteristic imaging features of hepatic peribiliary cysts. MATERIALS AND METHODS: Four patients with hepatic cysts in which the radiologic (n = 3) or histologic (n = 1) findings were consistent with peribiliary cysts of the liver (multiple small cysts seen exclusively in the larger portal tract, hepatic hilum, or both at gross examination and dilatations of extramural peribiliary gland at histologic examination) underwent computed tomography (CT) and ultrasound (US). In three patients, CT was performed after drip infusion of cholangiographic contrast material. RESULTS: Contrast material-enhanced CT clearly depicted many tiny cysts along the larger portal veins up to the third- or fourth-order branch (n = 3). US depicted multiple cysts in the echogenic portal tract definitely (n = 2) or equivocally (n = 2). On cholangiographic contrast-enhanced CT scans, cystic areas were located adjacent to or surrounding the bile ducts, and the possibility of biliary dilatation, communication, or both was disproved. CONCLUSION: Hepatic peribiliary cysts can be diagnosed with US and enhanced CT, especially with CT performed after administration of cholangiographic contrast material.

Aged↗

PubMed1998

Persistent milia, steatocystoma multiplex and eruptive vellus hair cysts: variable expression of multiple pilosebaceous cysts within an affected family.

BACKGROUND: Steatocystoma multiplex (SM) and eruptive vellus hair cysts (EVHC) are conditions characterized by numerous cutaneous cysts with a clinical resemblance, such as age of onset, location, appearance of the lesions and mode of inheritance, but with distinctive histologic features. Recently, some authors have proposed that the two conditions are variants of one entity originating in the pilosebaceous duct, while others suggest that SM and EVHC are two distinct entities, on the basis of the different expression of keratins. Milia are small round cysts, commonly involving the face. In 1994, Menni and Piccinno reported the first association, in a family, between persistent infantile milia in a 9-month-old girl and SM in the father. The authors hypothesized a relationship between these two conditions. OBJECTIVE: We describe a family in which the mother showed cystic lesions and milia and her 4-year-old son and her 18-month-old daughter presented persistent infantile milia. METHODS: In addition to the clinical and genetic documentation, a biopsy was performed in the son and two biopsies in the mother. RESULTS: The histologic examination of one of the son's milium-like papules showed in the superficial dermis a small cyst typical of a milium. In serial sections it was possible to see a connection with a vellus hair follicle by an epithelial pedicle. The histologic examination of one of the mother's papules on the forehead showed a large round cystic structure with histologic features of EVHC. Close to the cyst wall, serial sections showed flattened sebaceous gland lobules. The histologic findings of the second biopsy taken from the chest showed the typical features of a steatocystoma. CONCLUSIONS: The relationship between milia, SM and EVHC is discussed; the three disease should be considered as subtypes of multiple pilosebaceous cysts that may all present overlapping histologic features. The different level of the pilosebaceous duct where the cyst originates should explain the different clinical manifestations.

Child, Preschool↗

PubMed1978

Intracranial supratentorial cysts in children excluding tumor and parasitic cysts.

The intracranial, liquid-containing cysts in children (excluding tumor and parasitic cysts) are relatively frequent in neurosurgical practice. They raise several problems about their nosology, etiology, clinical and radiological diagnosis, and treatment which are analyzed in a series of 36 cases of supratentorial cysts. The most frequent clinical feature is increased head circumference (22 cases) followed by epileptic fits (18 cases), as well as mental and motor retardation (19 cases). Fundi were found abnormal in only one case out of three. Electroencephalogram was abnormal in almost every case, showing either spikes, spikes and waves or localized slow waves, or an asymmetric depression of the electrical activity. Radiological investigation is essential for diagnosis. Plain radiographs of the skull may show an asymmetry (11 cases). Carotid angiogram and pneumoencephalography give the diagnosis of the lesion without accuracy as to the histology. Computerized axial tomography shows the position of the liquid cavity within the head. The surgical approach (simple shunting [6], direct approach [19], or both [7]) should be carefully considered according to anatomical variety and age of the child. An anatomical classification is proposed, based on the radiological, surgical and pathological findings. Three types of cysts are defined: external cysts (cortical or extracortical) which may or may not be communicating with the ventrioles or the subarachnoid space; internal cysts which again may or may not be communicating; and the corticoventricular cysts. The ultrastructural study represents further progress in the attempt to define the exact anatomical type.

Brain Diseases↗

PubMedDate not supplied

Secondary excision of choledochal cysts after previous cyst-enterostomies.

BACKGROUND/AIMS: Patients with a choledochal cyst previously treated by internal drainage should undergo secondary cyst excision. The results of such secondary excisions have not yet been reported. METHODOLOGY: Over a 27-year period, 121 patients underwent excision of a choledochal cyst at our hospitals. Of these, 14 patients underwent secondary cyst excision following internal drainage. These patients were compared retrospectively with the remaining 107 patients who underwent primary cyst excision. RESULTS: Blood loss and operative time were greater, and early and late post-operative complications were significantly more frequent in the secondary excision group. Wound infection (early complication), pancreatic stones (late complication), and hepatolithiasis (late complication) were significantly more common in the secondary excision group. Histologically, inflammation and biliary glands were more frequently seen in the resected bile ducts in the secondary excision group. CONCLUSIONS: The long-term results of secondary excision of choledochal cysts are worse than after primary excision. The frequent late complications may be related to the development of biliary glands as a consequence of cyst-enterostomy.

Adolescent↗

PubMed1992

Ciliated enteric duplication cyst presenting as a pancreatic cystic neoplasm: report of a case with cyst fluid analysis.

Pancreatic cysts include inflammatory pseudocysts, cystic tumors (serous and mucinous), and various rare cystic lesions. We report a case of a ciliated enteric duplication cyst that presented on computed tomographic scan as a pancreatic cystic neoplasm. Cyst fluid analysis revealed markedly increased concentrations of carcinoembryonic antigen and CA 125 and increased fluid viscosity. These features are typical for a mucinous cystic neoplasm of the pancreas and demonstrate a potential pitfall associated with the diagnosis of pancreatic cysts by chemical analyses. Enteric duplications involving the pancreas are rare, usually of gastric origin, and usually communicate with their enteric source. Morphological and histochemical analysis suggest that this cyst was of caudal foregut origin. This is the first reported case of a ciliated foregut cyst involving the pancreas. The chemical characteristics of the cyst fluid of these lesions have not been described previously.

Aged↗

PubMed1990

[Laparoscopic surgery of ovarian cysts. Indications and limits as found in a series of 169 cysts].

The new laparoscopic surgical techniques which have been adapted for treating ovarian cysts fulfil a double purpose; to reduce the need for traditional surgical treatment while at the same time being sure to remove the whole of the cyst wall. They make it possible in this way to avoid unnecessary laparotomies for many patients. They forestall recurrences of the cyst while at the same time lessening the risk of adhesion formation. We present a series of 169 adnexal masses of which 158 were treated successfully using these techniques. This experience has made it possible for us to work out an exact operative protocol for transparietal and intra-peritoneal cystectomies and for transparietal oophorectomies. All histological kinds of ovarian cysts that are benign can be treated laparoscopically, but endometriomas and dermoid cysts made it fail in 18.1% and 5.7% of cases respectively. Only in a few cases ultrasound guided punctures of the cysts could be carried out and that only in ovarian cysts with clear fluid in women of reproductive age. Apart from this limited group, from now on laparoscopy should be the treatment for most adnexal cystic masses. Laparoscopy is the only way after looking carefully at the whole of the pelvis, to work out whether it is possible to operate on them through the laparoscope and this now allows a varied attitude to treatment to be adapted and changing according to each case.

Adolescent↗

PubMed1988

Post-inflammatory arachnoid cyst of the quadrigeminal cistern. Observation of development of the cyst.

Arachnoid cysts of the quadrigeminal cistern are rare. Patients with this lesion are usually normal at birth, and signs of increased intracranial pressure (IICP) develop at about 4 to 12 months of age. However, there has been no report about this mechanism. A case of arachnoid cyst of the quadrigeminal cistern is presented. In this case, the process of the cyst growth was observed during the course of follow-up for shunted hydrocephalus. Symptoms coincided with the growth of the cyst. Therefore, the development of the clinical symptoms was thought to be due to IICP caused by cyst expansion. Our case was complicated by inflammation, something that may offer a key to solving the mechanism of cyst fluid accumulation and the relationship between symptoms and development of the cyst.

Arachnoid↗

PubMed1993

Simple bone cyst. Treatment by trepanation and studies on bone resorptive factors in cyst fluid with a theory of its pathogenesis.

Simple bone cysts were treated by trepanation. The technique consists of drainage of cyst fluid, lavage of the cystic cavity with saline, and the making of multiple drilling holes through the cortical and the medullary bone of the cyst wall. Injection of corticosteroid was omitted. In 11 cases treated by this method, the clinical outcome was good. Biochemical analyses of the cyst fluid showed bone-resorptive factors, i.e., prostaglandins, interleukin 1, proteolytic enzymes. Electrophoretic analysis of proteolytic enzymes in polyacrylamide gel containing sodium dodecyl sulfate and polymerized gelatin showed proteins with molecular weights of about 130,000, 92,000, 72,000, and lower than 50,000. Increase in such bone-resorbing activities seems to be one of the causative factors in simple bone cysts. The technique was effective in decompressing the internal pressure of the cysts, improving the blood flow through the medullary bone of the cyst wall, stimulating the periosteum to induce bone formation, and eliminating bone destruction.

Adolescent↗

PubMed1996

[Bronchial cyst in a patient with a high serum CA19-9 concentration that fluctuated with the cyst fluid volume].

A 44-year-old woman was found to have an abnormally high concentration of CA19-9 in serum. Five years later, she underwent a right upper lobectomy for an abnormal shadow on a chest roentgenogram, because it was thought to indicate a malignant tumor. A chest CT scan revealed a cyst with fluid in the right upper lobe. During the 5 years before the lobectomy, the serum CA19-9 concentration rose when the cyst fluid volume increased, and fell when the cyst fluid volume decreased. Before the operation, the serum CA19-9 concentration was very high and the cyst was swollen. The cyst wall was found to be lined with ciliated columnar epithelial cells and to contain hyaline cartilage and smooth muscle, which led to the diagnosis of bronchial cyst. The surface epithelium and cyst fluid were positively stained by a monoclonal antibody against CA19-9. The serum CA19-9 concentration decreased and was within the normal range 3 months after the operation.

Adult↗

PubMed1995

Evaluation of cyst fluid analysis in the diagnosis of pancreatic cysts.

The pre-operative differential diagnosis of pancreatic cystic lesions is often difficult because of the lack of reliable clinical or radiological criteria. In order to improve the pre-operative recognition of these lesions, we performed cyst fluid analysis for enzymes (amylase and lipase), tumour markers (CEA, CA 19-9, CA 125, CA 72-4), and cytology in 52 pancreatic cysts. The cases included 21 pseudocysts, 12 mucinous cystic neoplasms, 7 ductal carcinomas, 7 benign lesions, and 5 rare malignancies observed from 1989 to 1994. Cyst fluid amylase, lipase, CEA, and CA 19-9 were variable and not discriminant between the groups. CA 125 fluid levels were high in 63% of malignant cysts. CA 72-4 fluid levels were significantly higher in mucinous cystic tumours than in pseudocysts (p < 0.0001), showing 95% specificity in detecting mucinous or malignant cysts. Cytology showed a sensitivity of 61% and a specificity of 100%. CA 72-4 determination raised the sensitivity of cytology to 92% in detecting mucinous or malignant cysts. This study confirms the low sensitivity of cytologic examination and low amylase specificity in distinguishing cystic neoplasms from pseudocysts. Cyst tumour markers assay is useful to improve the sensitivity of cytology, and CA 72-4 shows the best specificity in detecting (pre)malignant neoplasms.

Adenocarcinoma, Mucinous↗

PubMed1998

[Lateral meniscal cyst. Retrospective study of 105 cysts treated with arthroscopy with 5 year follow-up].

UNLABELLED: A retrospective study was performed on 122 patients with 124 lateral meniscal cysts, selected from a series of 8100 knee arthroscopies (1.5 per cent). Eight of the patients were lost for follow up, 11 patients had chronic anterior cruciate ligament deficiency or previous medial meniscectomy. Therefore 105 of 124 patients were included in this study. Average follow-up was 5 years (range of 1 to 12.5 years). MATERIAL AND METHODS: Mean age was 33 years (range of 12 to 69 years). All patients had pain over the joint line with a palpable mass. All were noted to have a meniscal tear at the time of surgery and 60 (57 per cent) had a horizontal cleavage component. They were all arthroscopically treated. RESULTS: Meniscal tears were treated by arthroscopic partial meniscectomy in 104 cases and meniscal repair in one case. Cysts were treated by intra-articular debridement in 91 cases and open cystremoval in 14 cases. Eleven cysts recurred and a second arthroscopy was required. The clinical results, including cysts recurrence, were excellent or good in 87 per cent of cases. Osteoarthritis following treatment of these meniscal cysts occurred in 9 per cent of cases. CONCLUSION: When there is a cyst and no other intra-articular damage, the prognosis was excellent at 5 year follow-up. For lateral meniscal cysts; arthroscopic partial meniscectomy with intra-articular debridement yields predictable results.

Adolescent↗

PubMed1988

Apocrine cells in breast cyst fluid and their relationship to cyst type: a morphometric study.

The morphology of apocrine cells exfoliated in breast cyst fluid (BCF) was studied in 78 BCF samples obtained from 39 premenopausal patients with gross cystic disease who were bearing two simultaneously aspirated cysts. 57/78 samples showed cell clusters suitable for computer-assisted cytometry. This was performed on 5820 cells using a Leitz Texture Analysis System (TAS). We measured the surface areas of cytoplasm, nucleus and nucleolus; we also calculated the nuclear/cytoplasmic (N/C), nuclear/nucleolar (N/n) ratios and the nuclear roundness factor (RF). Cysts were divided according to the cationic pattern of BCF: Type I, K+/Na+ greater than 1.5; Type II, K+/Na+ less than 0.66. The cytometric analysis was made on 47 samples of Type I and 10 samples of Type II. At the light microscope, no difference was apparent between the apocrine cells coming from Type I or Type II cysts. Cytometric measurements showed significant differences for the apocrine cells aspirated from Type I vs. Type II cysts for the mean cytoplasmic area (97.13 +/- 24.28 S.D. mu2 vs. 59.66 +/- 14.90 S.D. mu2, respectively) and the mean nucleolar area (4.35 +/- 0.99 S.D. mu2 vs. 2.75 +/- 0.71 S.D. mu2, respectively). Our data do not allow the inference of apocrine changes in the epithelium lining the cysts simply from the cationic pattern of BCF. The significantly wider cytoplasm and nucleoli of the apocrine cells aspirated from Type I cysts could reflect different functional stages of these particular cells.

Adult↗