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[Light and electron microscope studies on cysts of Sarcocystis fusiformis in the muscles of calves infected experimentally with oocysts and sporocysts of the large form of Isospora bigemina from dogs. 1. The development of cysts and "cyst wall" (author's transl)].

In several experiments young calves were infected with Isospora bigemina (large form) sporocysts excreted by dogs which had been fed with raw beef containing Sarcocystis fusiformis cysts. On the 27th, 34th, 62nd, 76th and 150th day p.i. the calves were killed and the development of S. fusiformis cysts in muscles cells was studied by light and electron microscopy. On the 27th day p.i. in light microscope preparations numerous schizonts, merozoites and endodyogeny-stages were seen in various organs, such as the liver, lung, kidney, heart, small intestine, esophagus, skeletal muscles, diaphragm, cerebrum, and cerebellum. The merozoites measured 7-8 mug by 2-3 mum. Beginning with the 34th day p.i. numerous cysts containing small numbers of metrocytes only were observed in electron microscopy, too. The cysts developed from a parasitophorous vacuole within the host cells. At first this vacuole was limited by a single unit membrane, which soon became thickened byosmiophilic material at numerous places inside of the vacuole. This complex, called primary wall (= Primärhülle), reached a thickness of up to 200-250 A in all cysts. During growth of the cyst this primary wall became regularly folded forming alternating long and short club-shaped protrusions. The longer protrusions were about 0.6 mum long and 0.2-0.3 mum in diameter, whereas the short protrusions were of about 0.13 mum in length. In light microscopy the combined protrusions had the appearance of a very thin cyst wall because of their small size and their close proximity to each other. Later, all protrusions became longer with a maximum of about 3 mum in length without any change in the diameter. Yet, from the 76th day p.i. these protrusions appeared no longer straight, but they became folded over, following a course along the surface of the cyst. Evidently the protrusions did not increase in number after their initial formation, for the distance between them became greater in older cysts. No fibrillar elements were seen within these protrusions which probably accounts for the folding over. The zone of the superficial folded protrusions was not thicker than 1 mum so that in light microscope even the old cysts appeared as relatively thin walled. The interior of the original electron-pale parasitophorous vacuole bacame progressively condensed during the growth of the cyst. There was development of an amorphous ground substance, containing fine fibrils and granules. The ground substance became divided into thin speta (not visible with the light microscope) forming numerous changer-like hollows. The parasites were very closely packed within these hollows. At the beginning of the cyst formation only metrocytes were found within the young cysts, whereas on the 76th day p.i. and later only the infectious merozoites were present. It is therefore concluded that about 3 months after inoculation of calves with sporocysts of the large form I. bigemina from dogs the cysts are fully differentiated, thus being ready for a new transmission...

Animals

[Light and electron microscope studies on cysts of sarcocystis fusiformis in the muscles of calves infected experimentally with oocysts and sporocysts of isospora hominis Railliet et Lucet, 1891. 1. The development of cyst and cyst wall (author's transl)].

In several experiments young calves were infected with isospora hominis sporocysts excreted by human males who had ingested raw beef containing Sarcocystis fusiformis cysts. On the 29th, 48th, 62nd and 98 day p.i. the calves were killed and the development of S. fusiformis cysts in muscle cells was studied by light and electron microscopy. Beginning with the 48th day p.i. numerous cysts containing small numbers of metrocytes only were observed. The cysts developed from a parasitophorous vacuole within the host cells. At first this parasitophorous vacuole was limited by a single unit membrane, which soon became thickened at numberous places inside of the vacuole by osmiophilic material. This complex is called primary wall (equal to Primärhülle), reaching a thickness of up to 32 nm in old cysts. This primary wall became regularly folded. forming palisade-like protrusions. On the 62nd day after inoculation these protrusions measured about 2-3 mum in length and 0.5-0.7 mum in diameter. In light microscopy the combined protrusions had the appearance of a radially striated "thick wall", because of their close proximity to each other.

Animals

[Pigmented cysts. Pigmented epidermal cysts and pigmented trichilemmal cyst].

The clinical and histopathological picture of the pigmented epidermal cyst and the pigmented trichilemmcyst is illustrated by three case-reports. The pigment is melanin, which is located in the epithelium of the cyst-wall, the corneocytes of the lumen and in macrophages in the dermis. The clinical appearance of melanin pigmented cysts is blue due to the Tyndall-phenomenon.

Adult

Cyst fluid from human autosomal dominant polycystic kidneys promotes cyst formation and expansion by renal epithelial cells in vitro.

Autosomal dominant polycystic kidney disease (ADPKD) is characterized by progressive renal enlargement, culminating in renal insufficiency in over one half of affected individuals. The highly variable onset and clinical course of ADPKD may be due to factors extrinsic to the genetically defined renal cysts. In this study, cyst fluid samples from 12 nonazotemic and 18 azotemic ADPKD subjects were examined for in vitro biologic activity that promotes cellular proliferation and the secretion of fluid by renal epithelial monolayers, two pathogenetic mechanisms that have critical roles in the formation and the rate of expansion of renal cysts. Cyst fluid added to culture medium (final concentrations, 1 to 20%) caused Madin-Darby canine kidney cells and human kidney cortex (HKC) cells derived from primary cultures to form cysts in Type I collagen matrix. Cyst fluid stimulated the net transepithelial secretion of fluid by polarized monolayers composed of these same cells. Absolute levels of fluid secretory activity determined by MDCK bioassay were correlated directly with the rate of fluid secretion by HKC cell monolayers and with the extent of cyst formation by MDCK and HKC cells embedded in collagen matrix. The secretory activity of urine was negligible; secretory activity was detectable in the serum of normal and ADPKD subjects, but the levels were much lower than in cyst fluid. cAMP agonists prostaglandins E1 and E2, arginine vasopressin, and 8-Br-cAMP stimulated fluid secretion by MDCK and HKC monolayers, but these substances did not cause HKC cells to form cysts in collagen matrix, whereas cyst fluid did. Among other naturally occurring growth factors and autacoids, only epidermal growth factor and transforming growth factor alpha stimulated cyst formation by HKC cells; however, the capacity of cyst fluid to stimulate fluid secretion was not affected by treatment with antiserum to epidermal growth factor. It was concluded that potent, and possibly unique, substances in the cyst fluids of individuals with ADPKD support and augment biologic processes in renal epithelial cells that may be important in the promotion of progressive cyst expansion.

8-Bromo Cyclic Adenosine Monophosphate

Interrelationships between water and cellular metabolism in Artemia cysts. IV. Adenosine 5'-triphosphate and cyst hydration.

The concentration of ATP in cysts of the brine shrimp, Artemia salina, has been studied as a function of cyst hydration. Cysts dried over CaSO4 contain 0.02 gH2O/g cysts and 0.54 +/- 0.05 (S.D.) mumoles of ATP/g dried cysts. Addition of water up to 0.05 g/g cysts produced no net change in the level of ATP during incubation. Hydration levels between 0.05 and 0.62 g/g cysts resulted in a net loss of ATP, whereas above 0.65 g/g cysts a net increase was observed with incubation time. No net change in the amount of ATP, compared with dried cysts, was detected between the latter two hydrations. These results, when integrated with those from previous work, indicate that conventional aerobic energy metabolism does not begin until cyst hydrations of about 0.65 g/g are achieved. The fate of ATP in cysts hydrated to levels lower than 0.65 g/g was discussed.

Adenosine Triphosphate

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

[Light and electron microscopic studies on cysts of Sarcocystis fusiformis in the muscles of calves infected experimentally with oocytes and sporocysts of the large form of Isospora bigemina from dogs. 2. The fine structure of cyst stages].

In several experiments calves were infected with sporocytes of the large form of Isospora bigemina from dogs thus producing "thin-walled" cysts of Sarcocystis fusiformis in muscles. Following the growth of the cyst the development of the cyst stages (metrocytes, merozoites) was studied by electron microscopy. Cyst formation began about 34 days p.i. from a parasitophorus vacuole containing exclusively ovoid metrocytes. One the 62nd day p.i. mainly metrocytes and a few banana-shaped stages were present in the cysts. These banana-shaped stages were called merozoites, because we consider the process of cyst formation as an extraintestinal schizogony. From the 76th day p.i. mainly merozoites, i.e. infectious stages, were observed. The metrocytes were surrounded directly by the amorphous ground substance of the cyst's interior, whereas the merozoites were closely packed within chamber-like hollows of the ground substance. The metrocytes are globular cells, about 7 X 5 mum. These cells possess as the metrocytes of other species a typical three-layered pellicle with deep micropores, a conoid, polar ring with 22 anchored subpellicular microtubules, very few rhoptries and micronemes, a golgi complex anterior to the large nucleus. The nucleus has a spherical nucleolus consisting of granular and fibrillar zones. Chromosomal structures were seen in two different stages: large dense plaques (condensed stage), and as small dense granules of 300-400 A diameter, arranged spherically within the karyoplasm (extended stage). There is no significant difference in fine structure between the metrocytes of I. hominis-induced cysts and those from cysts after infections with the large form of I. bigemina from dog.

Animals

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

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

CT of the renal cyst: is cyst aspiration necessary?

Fifty patients with a total of 56 renal masses discovered on routine excretory urography or abdominal plain films and with ultrasonographic diagnoses of definite or probable benign cysts underwent computed tomography (CT) prior to cyst aspiration with cytologic study. All lesions met strict criteria for the CT diagnosis of benign cyst and subsequently proved to be benign cysts. In addition, CT scanning detected 11 other renal masses, only one of which could be retrospectively diagnosed on the original urogram. It is suggested that renal cyst aspiration need not be performed when lesions meet all CT criteria for a benign cyst.

Aged

CT scan and gas encephalography in diagnosis of arachnoid cyst and epidermoid cyst of Galen's cistern.

The CAT scan is insufficient to make the differential diagnosis between an arachnoid cyst and an epidermoid cyst in the cistern of Galen. Gas encephalography is necessary. This procedure reveals arachnoid cysts of the commmunicating type, but is insufficient in distinguishing between an epidermoid cyst and a non-communicating arachnoid cyst. In this situation, histograms of the absorption values in each section of the lesion may be helpful for the diagnosis.

Arachnoid

A study of biological chemistry on the nature of jaw cysts. On the maintainance of homoeostasis in jaw cyst fluid.

Jaw cyst lining cells have an active transporting mechanism for Na+ ion and K+ion, a secreting mechanism and a selecting mechanism, and they allow permeation of electrolytes, lipids and protein into cysts. The components within the cysts have a controlling metabolism, and keep the system stable. Tumour wall cells of cystic ameloblastoma have only a passive transporting mechanism for various substances. Their nature differs from that of jaw cyst lining cells.

Ameloblastoma

Congenital bile duct cysts: Classification, operative procedures, and review of thirty-seven cases including cancer arising from choledochal cyst.

Congenital bile duct cysts are observed in any part of the bile duct from the liver to the duodenum. Reports of cases of cancer arising from it are increasing. Excision of the choledochal cyst seems to be the treatment of choice and partial resection of the intrahepatic cyst followed by intrahepatic cystoenterostomy at the porta hepatis is necessary for type IV-A cysts.

Adolescent

Aneurysmal bone cyst--simple bone cyst, two aspects of the same pathologic entity?

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.

Bone Cysts

Infratentorial neuroepithelial cyst (colloid cyst). Case report.

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.

Adolescent

Squamous cell carcinoma originating in an hepatic cyst. Case report with a review of the hepatic cyst-carcinoma association.

A case of squamous cell carcinoma originating in an hepatic cyst is presented. A review of the literature reveals five other cases of carcinoma arising within congenital intrahepatic cysts; three adenocarcinomas and two squamous cell carcinomas. Neoplastic transformation may also be seen in association with Meyenburg complexes, considered by some to be the structures from which congenital cysts arise.

Adult

Intraspinal juxta-facet cysts: a case of bilateral ganglion cysts.

Juxta-facet cysts are relatively uncommon intraspinal lesions, causing radiculopathy, neurogenic claudication or myelopathy. To the best of our knowledge, only 4 cases of bilateral synovial or ganglioncysts were described. We report the 5th case of bilateral ganglioncysts of the lumbar spine. Generally, juxta-facet cysts should be differentiated from other intraspinal lesions, such as herniated discs, meningiomas and neurinomas. Correct preoperative diagnosis is necessary for adequate treatment, namely the (microscopic) resection of the cyst. After adequate treatment, complete recovery may be expected.

Aged

Prostatic utricle cysts (müllerian duct cysts).

A series of 88 male patients with prostatic utricle cysts (müllerian duct) has been compiled by adding our 3 patients to 85 cases reported. Irritative lower urinary tract symptoms were the most common presenting complaint (42 per cent), while lower obstructive symptoms were noted in 29 per cent. Of the 20 clinical case reports in boys 25 per cent presented with epididymitis often in an undescended gonad. A cystic rectal mass found in half of the patients represents the most common presenting sign, while hypospadias occurred in a fourth. Unilateral renal dysgenesis or agenesis was associated in 10 per cent of the reports. While the suprapubic surgical approach to excision has been used most commonly it has proved unsatisfactory in two-thirds of the cases. The posterior approach was used successfully in 2 boys with preservation of erectile potency in both. The wide spectrum of histopathology of these cysts prevents clear characterization. A 3% incidence of malignancy in prostatic utricle cysts is noted.

Adolescent