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PubMed1990

Diagnosis of luteal and follicular ovarian cysts in dairy cows by sector scan ultrasonography.

Sixty-seven ultrasonograms of ovarian cysts (cysts) from 35 cows were used to evaluate sector scan ultrasonography as a means for differentiating luteal cysts from follicular cysts. Initial diagnosis of cysts was made by ovarian palpation per rectum during weekly herd visits. The ovaries of each cow were then examined by ultrasonography. Ultrasonograms of cysts > 25 mm in diameter were diagnosed as either luteinized or follicular cysts and were recorded on video tape for evaluation by a second clinician. Serum progesterone concentrations at the time of examination were determined by radioimmunoassay and were used to classify luteal (> 0.5 ng/ml) or follicular (</= 0.5 ng/ml) cysts. Mean serum progesterone concentrations were 1.41 +/- 0.14 ng/ml for cows diagnosed as having luteal cysts (n = 49) and 0.40 +/- 0.13 ng/ml for cows with follicular cysts (n = 18). Sensitivity of ultrasonography for correct diagnosis of luteinized cysts was 91.5%, however, specificity was only 70.0%. Sensitivity (93.1 versus 88.9%) and specificity (75.0 versus 68.8%) were similar for cystic cows that received treatment (either gonadotropin-releasing hormone, GnRH, or prostaglandin F(2)alpha, PGF) 7 d prior to examination (n = 33) compared with cows that received no previous treatment (n = 34). Agreement between the two clinicians when diagnosing type of cyst was 80.6% (Kappa=0.5). Agreement between the two clinicians' diagnoses as well as with the progesterone classification was higher for luteal cysts (92.6%) than for follicular cysts (75.0%). Results of this study suggest that, based on serum progesterone, luteal and follicular cysts can be differentiated by means of sector scan ultrasonography; however, sector scan ultrasonography is more effective for diagnosing luteinized cysts.

Journal Article↗
PubMed1987

Cyst formation and growth in autosomal dominant polycystic kidney disease.

Previous morphologic studies on kidneys from adult patients with autosomal dominant polycystic kidney disease (ADPKD) indicates that the cysts developed from nephrons and collecting ducts in association with hyperplasia of epithelial cells lining the cyst walls. In the present study, we systematically evaluated by scanning electron microscopy 387 cysts in polycystic kidneys obtained from 10 adult patients. Some cysts were lined by cells typical of collecting duct (7.2%), proximal tubule (1.8%) or glomerular visceral (2.1%) epithelium. The remaining cysts were lined by a single layer of phenotypically undefined (84.0%) or markedly hyperplastic (4.9%) epithelium. The median plane surface area of individual cells within cysts was 182 X 10(-8) cm2. Among all cysts the surface area of single epithelial cells ranged between 22 and 2530 X 10(-8) cm2, but within single cysts the range of individual cell surface areas was more narrow. Mean cell surface area did not increase in direct proportion to cyst diameter; thus, epithelial hyperplasia is a central element in the progressive enlargement of cysts. In some cysts hyperplasia was accentuated by projections into cyst lumens of polyps, small adenomas and cord-like arrangements of cells. Epithelial polyps were found in the cysts of one non-azotemic patient, excluding renal failure as a cause of this accentuated type of epithelial proliferation. Morphologic evidence that cysts compressed adjacent renal parenchyma was observed in all kidneys. In 11 cysts bisected and then both halves thoroughly examined by scanning electron microscopy, one or two tubule openings were seen in one of the hemisections in three cysts (27.3%).(ABSTRACT TRUNCATED AT 250 WORDS)

Chromosome Aberrations↗
PubMed1992

In vitro formation and expansion of cysts derived from human renal cortex epithelial cells.

Acquired renal cysts derive from terminally differentiated tubular epithelium in adults as a consequence of increased epithelial cell proliferation, fluid accumulation and extracellular matrix remodelling. To understand better how human epithelial cysts may be initiated and progressively expand, cells from primary cultures of normal human adult renal cortex were dispersed in polymerized type I collagen. The transparent matrix permitted repeated observation by light microscopy of cyst formation from individual renal cells. The cyst cells reacted strongly with distal nephron histochemical markers (cytokeratin antibodies AE1/AE3, epithelial membrane antigen, and Arachis hypogaea lectin) but inconsistently or not at all to markers of proximal tubules (Tetragonolobus purpureas lectin and Phaseolus vulgaris erthroagglutinin lectin). The number of spherical, fluid-filled epithelial cysts that developed in a standardized microscope field quantified cyst initiation. Cyst progression was determined from the increase in the diameter (surface area) of cysts and represents a hyperplastic event. EGF or TGF alpha, were required in serum-free defined medium to cause cysts to develop from individual epithelial cells dispersed in the matrix; insulin was required as a co-factor. The EC50 for EGF was approximately 0.1 ng/ml, and for insulin 1 microgram/ml. Early cultures of normal cortex formed cysts more efficiently when dispersed in collagen matrix than cells passaged several times before suspension in the gel. Agonists of adenylate cyclase (PGE1, AVP, VIP, PTH, forskolin, cholera toxin), methylisobutylxanthine, and 8-Br-cAMP, though incapable of causing cyst formation alone in defined medium, enhanced cyst initiation and progression in the presence of EGF and insulin. Angiotensin II, TNF alpha, beta-estradiol, and pertussis toxin had no effect in the absence or presence of EGF and insulin. Pertussis toxin inhibited cyst initiation and expansion caused by EGF and forskolin but potentiated cyst initiation and expansion caused by EGF and PGE1. Cyst formation and expansion were inhibited by TGF beta 1 and 2-chloroadenosine. Polarized monolayers of human renal cortical cells grown on permeable membranes were used to independently quantify the effects of agonists on the net secretion of solute and water from the basolateral to the apical surface of the cells. PGE1, forskolin, and 8-Br-cAMP stimulated net fluid secretion that was sustained for several days; EGF enhanced forskolin-stimulated fluid secretion. We conclude that the formation and expansion of in vitro cysts derived from solitary human cortex cells depends on the coordinated interplay between cellular proliferation and fluid secretion.(ABSTRACT TRUNCATED AT 400 WORDS)

Body Fluids↗
PubMed1989

Metabolism of cyst(e)ine in rat enterocytes.

Cyst(e)ine was metabolized by rat enterocytes to pyruvate and inorganic sulfur but not to taurine. Cystine was the major extracellular form of cyst(e)ine present during the incubation, and addition of bathocuproine disulfonate, a copper chelator that maintained 60% of the total cyst(e)ine in the sulfhydryl form, had no effect on total sulfur release from cyst(e)ine. Oxidation of cyst(e)ine to 35SO4(2-) or 14CO2 was reduced by about 50% when unlabeled cysteinesulfinate was added to incubations of enterocytes with labeled cyst(e)ine. Thus, about one half of cyst(e)ine metabolism appeared to involve its oxidation to cysteinesulfinate and the transamination of cysteinesulfinate to the putative intermediate sulfinylpyruvate, which decomposes to yield sulfite and pyruvate. The remainder of cyst(e)ine catabolism in enterocytes appeared to involve release of sulfur from cyst(e)ine prior to its oxidation. Inhibition of gamma-cystathionase by propargylglycine, although incomplete, resulted in substantial inhibition of cyst(e)ine catabolism. The accumulation of cysteinethiosulfonate, which forms nonenzymatically upon incubation of cyst(e)ine with thiosulfate, and the inhibition of cysteinethiosulfonate formation by propargylglycine demonstrated the catabolism of cyst(e)ine by beta-cleavage catalyzed by gamma-cystathionase. Sulfide released from cyst(e)ine in this reaction appeared to be oxidized to thiosulfate before it was further oxidized to sulfite and sulfate. In addition to being oxidized to sulfate, some of the sulfite formed by enterocytes reacted with cyst(e)ine in the incubation medium to form sulfocysteine. Activities of enzymes of cyst(e)ine catabolism in rat enterocytes corresponded with the observed metabolism of cyst(e)ine by various pathways.

Alkynes↗
PubMed2004

Reduced renal function in patients with simple renal cysts.

BACKGROUND: Sporadic renal cysts not associated with genetic polycystic disorders are common and generally thought to be of no clinical significance. Since multiple cysts frequently develop in end-stage renal disease (ESRD), we tested the hypothesis that cysts that are solitary or few in number are an early manifestation of reduced renal function. METHODS: We evaluated 561 hospitalized patients who underwent contrast-enhanced, abdominal computed tomography (CT) and correlated clinical characteristics and parameters of renal function with the presence or absence of renal cysts. RESULTS: Age ranged from 16 to 100 years, mean serum creatinine concentration was 0.88 mg/dL (range 0.4 to 2.1 mg/dL), and mean estimated creatinine clearance was 94 mL/min/1.73 m(2) (range 22 to 218 mL/min/1.73 m(2)). The presence of cysts was significantly correlated with older age (P < 0.001), higher serum creatinine concentration (P < 0.002), and lower estimated creatinine clearance (P < 0.001). In a multivariate analysis, including age and gender, estimated creatinine clearance still correlated with the presence of cysts (P= 0.009). When patients were grouped by age, estimated creatinine clearance correlated with cysts in patients <40 years and 40 to 59 years, but not in patients 60 to 79 years or > or =80 years. There was no association of cysts with hypertension or proteinuria. In patients with cysts, serum creatinine increased progressively but not significantly with cyst number, and did not correlate with size or distribution of cysts. Renal parenchymal volume was slightly but not significantly reduced in patients with cysts. CONCLUSION: The presence of kidney cysts, even single cysts, is associated with reduced renal function in hospitalized patients younger than 60 years. This relationship may be obscured by the reduced renal function and the high incidence of cysts in older patients. These results suggest that acquired cystic kidney disease may begin early in the course of renal disease and that underlying renal disease should be considered in individuals with renal cysts prior to age 60 years.

Adolescent↗
PubMed1996

Clinical implications of renal cyst in primary aldosteronism.

The present study surveyed 69 patients with aldosteronoma to study the clinical implications of renal cysts demonstrated in computed tomography. Patients who had cysts (n = 16, 23.2%) were older and had a longer duration of hypertension and more severe hypokalemia than those without cysts (n = 53). Patients with cysts therefore had longer-term, more severe hypokalemia than those without cysts. Endogeneous creatinine clearance (Ccr), measured in 61 patients, was significantly lower in patients with cysts (58.4 +/- 7.1 ml/min, n = 16) than in those without cysts (77.3 +/- 7.1 ml/min, n = 45, P = 0.0039). This significant difference was observed even after adjusting for covariables (age, duration of hypertension, and serum potassium) between the two groups by analysis of covariance (ANCOVA). No significant difference was observed in gender, blood pressure, serum creatinine, plasma aldosterone, or PRA. Age, serum potassium levels, and systolic and diastolic blood pressure were the significant determinants in predicting Ccr in a backward stepwise multiple regression analysis (r = 0.505, n = 61, P = 0.0025). Cysts were graded into four classes on the basis of number and size. Cyst grading correlated negatively with Ccr at a Spearman rank correlation (rho = -0.33, n = 61, P = 0.0103). The incidence of chronic renal failure was significantly higher in patients with cysts (18.8%) than in patients without (0%) in a Fischer's exact probability test (P = 0.0107). Thus, both renal cysts and dysfunction arose and/or developed from common roots, i.e., the duration and severity of hypokalemia, in primary aldosteronism. In addition, we surveyed 27 patients with pheochromocytoma. Patients with renal cysts (n = 8) had a significantly longer duration of hypertension than those without cysts. No significant difference was observed in Ccr between patients with and those without cysts. Thus, a significant link between renal cysts and Ccr was a specific feature of primary aldosteronism, but not of pheochromocytoma. In summary, the renal cysts in primary aldosteronism should be recognized as a significant complication representing the extent of renal injury and dysfunction.

Adolescent↗
PubMed1987

Determination of Giardia muris cyst viability by differential interference contrast, phase, or brightfield microscopy.

Examination of Giardia muris cysts stained with the fluorogenic dyes, fluorescein diacetate (FDA) or propidium iodide (PI), by either Nomarski differential interference contrast (DIC), phase, or brightfield (BF) microscopy revealed a direct correlation between morphologic appearance and uptake of FDA or PI. Cysts incorporating FDA were all morphologically identical and exhibited (1) a clearly delineated cyst wall, (2) the presence of a distinct space between cyst wall and cytoplasm, and (3) flagella recognizable at one pole of the cyst. FDA-positive cysts also had a hyaline appearance of the cytoplasm (examined at multiple focal planes with DIC) that made it very difficult to detect the presence of nuclei, intracellular axonemes of flagella, or curved elements of the adhesive disc. However, PI-stained cysts possessed a distinct morphology that was clearly different from that of FDA-stained cysts. Examination of PI-stained cysts demonstrated the presence of well-defined nuclei, intracellular axonemes, and curved elements of the adhesive disc. The cytoplasm of PI-stained cysts contained a fine granular texture as opposed to the hyaline appearance of FDA-stained cysts, and no space was observed separating the cyst wall from the underlying cytoplasm in the PI cyst. This light microscopic comparison of viable FDA- and nonviable PI-stained cysts of G. muris demonstrates that 2 types of cysts can be distinguished and implies that structural differences can be used to identify these subpopulations of cysts.(ABSTRACT TRUNCATED AT 250 WORDS)

Animals↗
PubMed2001

[Juxta-facet cysts: magnetic resonance tomography diagnosis].

The term juxta-facet cyst summarizes synovial cysts, arising from degenerated facet joints and ganglion cysts, developing from mucinous degeneration of periarticular connective tissue. Most juxta-facet cysts are observed at the L4/5 level, which generally has the most motion within the lumbar spine. In this retrospective study 31 juxta-facet cysts in 28 patients were detected within 2898 lumbar MRI studies over a 2-year period (frequency 1%). 24 patients complained of back and lower extremity pain, the other 4 patients had unilateral back pain. In 7 cases radicular symptoms were observed, in 6 patients a neurogenic claudication. In 78% of the patients juxta-facet cysts were responsible for clinical symptoms. MRI is the diagnostic imaging technique of choice due to a high sensitivity. The juxta-facet cysts were located extradural, laterally to the thecal sack and adjacent to a degenerated facet joint. In all but one cases the cysts showed a signal intensity equivalent to cerebrospinal fluid. T2-weighted pulse sequences in sagittal orientation were very useful in delineating the hypointense cyst wall. In 1 patient with acute radicular pain MRI demonstrated a subacute hemorrhage within a juxta-facet cyst. Calcifications and gas-filled cysts can be missed with MRI, but will be demonstrated by computed tomography. 45% of the juxta-facet cysts showed an enhancement of the cyst wall after injection of Gd-DTPA. Spontaneous reduction or resolution of the cyst may occur during rest. Injection of corticosteroids into the corresponding facet joint may reduce the inflammatory process and resolve the symptoms in up to 70%. Surgical resection of the cyst is indicated in case of intractable pain and significant neurologic deficit and generally produces good relief from radicular symptoms.

Aged↗
PubMed2001

Preoperative assessment of unilocular adnexal cysts by transvaginal ultrasonography: a comparison between ultrasonographic morphologic imaging and histopathologic diagnosis.

OBJECTIVE: Our purpose was to evaluate the risk of malignancy in surgically removed ovarian cysts that were characterized before the operation as unilocular according to transvaginal ultrasonography. STUDY DESIGN: This prospective analysis included 927 premenopausal women and 377 postmenopausal women operated on at 2 European university hospitals between January 1992 and December 1997. On the basis of ultrasonographic findings the cysts were characterized either as echo-free, without solid parts or papillary formations (group 1), or as having echogenic cyst content, with solid parts or papillary formations (group 2). Ultrasonographic and macroscopic appearances of the cysts were compared with histopathologic diagnosis. RESULTS: In group 1, in premenopausal women 3 of 413 cysts (0.73%) proved to be borderline or malignant, and in postmenopausal women 4 of 247 cysts (1.6%) proved to be borderline or malignant. The figures for cysts in group 2 were 11 of 514 cysts (2.1%) and 13 of 130 cysts (10.0%), respectively. It was not possible to differentiate by transvaginal ultrasonography between benign, borderline, and malignant cysts when solid parts or papillary formations were visualized. CONCLUSIONS: This study confirmed that the risk of malignancy associated with unilocular echo-free cysts (group 1) was low. Serial ultrasonographic follow-up should therefore be the standard procedure with unilocular echo-free cysts <50 mm in diameter. In cysts with a mean diameter of >50 mm, papillary formations or solid parts may be missed by transvaginal ultrasonography. The risk for malignancy in cysts containing papillary formations or solid parts (group 2) was 3 to 6 times higher than that in unilocular echo-free cysts.

Adnexal Diseases↗
PubMedDate not supplied

DNA ploidy of ovarian and adnexal cyst fluid. A useful adjunct to cytology.

It is increasingly common for cytology laboratories to receive ovarian, adnexal and pelvic cyst fluids obtained via sonographically directed aspiration and laparoscopic techniques, especially from women who are desirous of preserving fertility or who are undergoing in vitro fertilization (IVF). Accurate characterization of such cysts is a worthwhile goal, given the superior prognosis for ovarian carcinomas that are diagnosed at an early stage. In an effort to improve upon the false-negative diagnosis rate associated with cytology, we evaluated DNA ploidy as a possible adjunctive criterion. We examined 55 benign, 3 borderline and 6 malignant aspirates received by our cytopathology laboratory; 35 were aspirated directly from the patient from clinically and ultrasonographically benign cysts, and 29 were aspirated from surgically removed benign (20) and malignant (9) cysts. Adjunctive DNA ploidy and cell cycle analysis was performed using the Cell Analysis Systems CAS-200 on Feulgen-stained cytologic smears of the 64 cyst fluids. Adequate material for DNA analysis was obtained from 33/35 in situ aspirated cysts and from 19/29 surgical specimen cysts. Forty-seven of 52 cytologically benign cysts were diploid. Of the 5 nondiploid benign cysts, 3 were follicle cysts (2 from hormonally stimulated IVF patients and 1 from a postpartum patient), and 1 was a benign cystic teratoma. Their nondiploid DNA pattern or tetraploidy may be due to a high proliferative index. The fifth nondiploid benign aspirate was from a resected benign epithelium-lined cyst; its DNA histogram contained a conspicuous tetraploid population. All 9 malignant cysts were cytologically malignant. Of the 3 borderline cysts, 1 was nondiploid, and 2 were diploid. All 6 fully malignant cysts were nondiploid; 2 of them were tetraploid. Based on our results, we conclude that DNA ploidy analysis of cells derived from ovarian and adnexal cyst aspirates is feasible (in 95% of cases) and relatively specific (90%) and has a relatively high negative predictive value (92%). The results are not sufficiently predictive of the histology of the lesion to warrant therapeutic intervention based on ploidy alone (sensitivity of nondiploid results, 78%; positive predictive value of nondiploid results, 58%). Nondiploidy should suggest consideration, but is not conclusive, of a malignancy diagnosis. There may even be prognostic implications to the ploidy pattern, particularly in borderline tumors, in which nondiploidy portends a poor prognosis.

Adnexal Diseases↗
PubMed1997

Biochemical composition of benign thyroid cyst fluid.

Although the availability of thyroid cyst fluid is easy by fine-needle aspiration, less is known about the biochemical composition of thyroid cyst fluid. The authors have, therefore, determined the biochemical composition of 18 benign thyroid cyst fluid specimens. They found that the activities of aspartate aminotransferase (AST), lactate dehydrogenase (LDH), and the concentrations of total protein, total bilirubin, and uric acid were highly increased in thyroid cyst fluid specimens when compared with normal human serum specimens. The concentrations of glucose, cholesterol, and triglycerides in cyst fluid were within normal serum limits. Selenium (Se) concentrations in most cyst fluids were low. Moreover, there was no correlation between Se and other biochemical parameters. Protein electrophoresis of cyst fluid specimens yielded high concentrations of alpha 1 and especially alpha 2 globulin fractions indicating an inflammation. The concentrations or activities of biochemical analytes were not significantly different in pure and mixed cysts. Those parameters were also not significantly different between cyst fluids of different colors. The gross appearance of the fluid and the presence of certain biochemical analytes were consistent with a hemorrhagic origin of most of the cyst fluid specimens. However, some biochemical markers indicate that autolysis or necrosis of thyroid tissue may also contribute the composition of thyroid cyst fluid. The reason for lower Se concentration in the thyroid cyst fluid may be the lower Se concentration in the Turkish population. These results also suggest that the fluid color or nature of cyst, e.g., pure or mixed cyst, is not a main determinant of biochemical composition of benign thyroid cyst fluid.

Alanine Transaminase↗
PubMed2001

The surgical management of congenital liver cysts.

BACKGROUND: Most series that report the results of surgical treatment for congenital liver cysts focus more on the technical aspects of the operation than on the late outcome of these patients. In this paper, we emphasize the importance of appropriate patient selection and adequate surgical technique for successful long-term outcome. METHODS: Twenty-four consecutive patients with congenital liver cysts were selected for surgical treatment. According to our own classification, 13 patients had simple liver cysts, nine had multicystic liver disease, and two had type I polycystic liver disease. All of these patients were treated by the fenestration technique. An open approach was used for five patients (group 1) treated between 1984 and 1990. In 19 patients (group 2) treated since 1991, a laparoscopic approach was used. The incidence of complicated liver cysts was 40% in group 1 and 68% in group 2. RESULTS: There were no treatment-related deaths in this series. The mean postoperative hospital stay was significantly shorter for patients who underwent successful laparoscopic fenestration (p < 0.05). In the open group (group 1), there were no postoperative complications, and all patients were alive and free of symptoms during a mean follow-up of 130 months, without any sign of cyst recurrence. In the laparoscopic group (group 2), four patients were converted to open surgery. One of these patients had an inaccessible posterior cyst; another had bile within the cystic cavity. A further two cases had complicated liver cysts with an uncertain diagnosis between congenital and neoplastic cysts. Four patients (21%) developed peri- or postoperative complications. During a mean follow-up time of 38.5 months, none of the patients with simple liver cysts incurred late symptoms or signs of cyst recurrence. In the six patients with multicystic liver disease, one developed disease-related cyst progression (17%) and required reoperation. One of the two patients with type I polycystic liver disease (50%) developed asymptomatic disease-related cyst progression. CONCLUSIONS: When patients are carefully selected and a proper surgical technique is employed, excellent long-term results with a low morbidity rate can be achieved in patients with congenital liver cysts. Patients with multicystic liver disease or type I polycystic liver disease are more prone to late cyst recurrence. A tailored approach is thus indicated for patients with congenital liver cystic disease. However, the laparoscopic approach appears to be the gold standard for the treatment of highly symptomatic or complicated simple liver cysts.

Adult↗
PubMed2004

Natural history of sonographically detected simple unilocular adnexal cysts in asymptomatic postmenopausal women.

OBJECTIVE: To determine the natural history of simple unilocular adnexal cysts in asymptomatic postmenopausal women. METHODS: Eight thousand seven hundred ninety-four asymptomatic postmenopausal women underwent transvaginal ultrasound as part of routine gynecological check-up at our institution between January 1995 and June 2002. All patients in whom a simple unilocular adnexal cyst was found out were offered surgical treatment or conservative follow-up with serial transvaginal ultrasound at 6-month intervals. In all these cases, serum CA-125 levels was determined. RESULTS: Two hundred twenty-three simple adnexal cysts in 215 women were found out (prevalence: 2.5%). Annual incidence did not change significantly. Sixty-six (30.6%) women were lost after initial diagnosis. One hundred and forty-nine patients with 153 cysts were entered ultimately in the study. Forty-five (30%) underwent surgery (34 after initial diagnosis and 11 during follow-up). A total of 49 cysts were removed. The most frequent histological diagnosis was serous cystadenoma (84%). There was a case of a stage IA ovarian carcinoma (2% of the cysts removed, 0.6% of all the cysts included in the study). One hundred and four patients with 104 cysts underwent conservative follow-up throughout the study period. Forty-six (44%) of these cysts resolved spontaneously (74% of them within 2 years). In 14 (30%) of these women, a new cyst was diagnosed when follow-up went on. In 58 patients, cysts persisted during all study period (median follow-up: 48 months, range: 6-90 months), 69.6% of them remained unchanged, 17.2% increased, and 17.2% decreased. Patients in whom cysts resolved spontaneously had a shorter menopausal time (P=0.001) and tend to be younger (P=0.06). No differences were found regarding cysts' features. CONCLUSION: The risk of malignancy of simple adnexal cysts in asymptomatic postmenopausal women is low. Almost half of them will resolve spontaneously during follow-up. Most of those that persist remain unchanged. Asymptomatic postmenopausal women having simple adnexal cysts can be managed conservatively with a very reasonable degree of reassurance.

Adnexal Diseases↗
PubMed1998

Primary cysts of the iris pigment epithelium. Clinical features and natural course in 234 patients.

OBJECTIVE: To describe the clinical characteristics, natural course, and complications of a large group of patients with primary iris pigment epithelium (IPE) cysts. DESIGN: Observational case series. PARTICIPANTS: Two hundred thirty-four patients with primary IPE cysts participated. RESULTS: Primary IPE cysts were classified as central in 6 patients (3%), midzonal in 50 patients (21%), peripheral in 170 patients (73%), and dislodged in 8 patients (3%). Central (pupillary) IPE cysts were found only in males, peripheral IPE cysts were found most often in females (69%), and no gender predilection was detected for midzonal and dislodged IPE cysts. Central and peripheral IPE cysts occurred in young patients (mean age, 20 and 33 years, respectively), whereas midzonal and dislodged IPE cysts were seen in slightly older patients (mean age, 52 and 45 years, respectively). Central IPE cysts were visible when the pupil was not dilated and appeared most often as a round or collapsed brown lesion arising from the pupillary margin, most commonly superonasally. Midzonal IPE cysts were brown and fusiform, best visualized after pupillary dilation. Peripheral IPE cysts produced a characteristic bulging in the iris stroma near the iris root, but they were directly visible in only 78% of cases. After wide dilation and patient and slit-lamp positioning, they appeared as a round clear lesion behind the iris, most often in the inferotemporal quadrant. Finally, dislodged IPE cysts appeared as a brown oval lesion, free floating in the anterior chamber (12%) or in the vitreous (12%), or fixed in the anterior chamber angle (75%). One hundred twenty-four patients (53%) were followed for a mean of 35 months (range, 3 months-19 years). In these patients, complications associated with IPE cysts included lens subluxation in one case (1%), iritis in one case (1%), focal cataract in two cases (2%), glaucoma in two cases (2%), and corneal touch in five cases (4%). CONCLUSION: Primary IPE cysts have characteristic clinical features that serve to differentiate them from intraocular malignancies. Most cysts have a benign clinical course, and treatment is rarely necessary.

Adolescent↗
PubMed1999

Differential diagnosis of anterior segment cysts by ultrasound biomicroscopy.

BACKGROUND: To describe the ultrasound biomicroscopic (UBM) features of anterior segment cysts. DESIGN: A retrospective case series. PARTICIPANTS: One hundred eighteen eyes with anterior segment cysts examined by UBM at The New York Eye and Ear Infirmary between August 1992 and November 1997 were included in this study. INTERVENTION: The authors reviewed demographic and diagnostic data from the medical record including ocular and medical history, age, race, gender, and intraocular pressure. Ultrasound data concerning the type, number, position, and acoustic characteristics of cysts were recorded. The authors then correlated the written, clinical, and UBM characteristics. RESULTS: One hundred eyes (92.6%) had neuroepithelial cysts. Ninety (83.3%) of these had primary neuroepithelial cysts, 10 (9.3%) had cysts associated with uveitis, 7 (6.5%) had implantation cysts, and 1 (0.9%) had a cavitated ciliary body tumor. Neuroepithelial cysts typically were round or ovoid, thin-walled, and echolucent. Of the 90 eyes with primary neuroepithelial cysts, 56 (62.2%) had 3 or fewer cysts; multiple cysts (>3 per eye) were found in 34 eyes (37.8%). The multiple cysts occupied more than 180 degrees in 12 patients (13.3%). Primary neuroepithelial cysts were located at the iridociliary junction (74.2%), pars plicata (14.0%), pars plana (6.8%), and iris (5.0%). Implantation cysts (seven eyes) tended to have thicker walls and two contained a copious, echogenic material. CONCLUSION: The UBM results provide important information regarding location and extent of anterior segment cystic lesions. Ultrasound characteristics may help differentiate between neuroepithelial, implantation, and neoplastic cysts.

Adolescent↗
PubMed1993

[Covered rupture of periocular dermoid cysts. Clinico-histologic study].

BACKGROUND: Dermoid cysts are common periocular tumours that occur in childhood and can, in case of rupture, result in persistent granulomatous inflammation. Histologically signs of chronical inflammation of the wall of the dermoid cyst are occasionally found in dermoid cysts that show no clinical symptoms. The aim of this study is to analyze frequency and etiology of this inflammation. PATIENTS AND METHODS: The charts of 21 patients that were operated on because of a dermoid cyst at Heidelberg University Eye Hospital between 1986 and 1993 have been examined concerning anamnesis, clinical symptoms, localisation of the cyst and incidents during operation. The dermoid cysts were assessed macroscopically, and histologically by means of serial sections (three cuts every 200 microns). RESULTS: Histologically 8 patients (38%), of which only one had clinical symptoms, showed an inflammation of the wall of the cyst. The serial histological sections revealed a hidden rupture, that is a damage of the epithelium with a remaining pseudo-capsule of connective tissue, in these 8 patients. Hidden ruptures occurred proportionately most often at the age of 20 to 40. All cysts with a volume of more than 2197 mm3 showed a hidden rupture. CONCLUSIONS: Hidden ruptures seem to be the reason for inflammations of the wall of a dermoid cyst. By way of the rupture, the content of the cyst gets into contact with the surrounding tissue, which results in a granulomatous reaction to the foreign body with remaining pseudo-capsule, to begin with. Etiologically a hidden rupture is promoted by the growth of the dermoid cyst and the pubertal enlargement of the sebaceous glands in the wall of the cyst. As a hidden rupture may result in a complete one with corresponding clinical symptoms, and as the risk to rupture a cyst during operation is higher in case of a cyst with hidden rupture, we recommend an early operative removal of dermoid cysts, if possible at the age of 3 or 4, but at least within the first 10 years.

Adolescent↗
PubMed1991

[Splenic cysts. Their morphology, diagnosis and therapy].

Over a 10-year period, nine patients (four men, five women, mean age 27 years) underwent surgery for splenic cysts (six epidermoid cysts, two mesothelial cysts and one pseudocyst). Six patients had had suggestive clinical symptoms, but, in the other three, the cysts were only discovered by chance on ultrasound scan. Three of the patients with epidermoid cysts had raised serum concentrations of the tumour markers carcinoembryonic antigen (CEA) or carbohydrate antigen (CA 19-9. All six benign epidermoid cysts contained immunohistochemically demonstrable CEA and/or CA 19-9 in the inner epithelial layer, implying a mesothelial origin for these cysts. In five cases the splenic cysts were completely extirpated (splenectomy in two, hemisplenectomy in one, enucleation in two); in four cases cyst resection was performed, leaving part of the cyst adherent to the spleen. In one of these four patients, a 4 cm cyst persisted postoperatively in the hilus of the spleen, but has remained unchanged over an 8-year period. Splenic cysts are usually benign, despite the presence of tumour markers in the cyst wall, and do not require removal. The only indications for surgical intervention are complications (e.g. rupture), symptomatic cysts or asymptomatic cysts with an increased risk of rupture (diameter greater than 5 cm). The very rare parasitic and infective forms must always be surgically sterilized.

Adolescent↗
PubMed1994

Follicle cyst formation after administration of different gonadotrophin-releasing hormone analogues for assisted reproduction.

The aim of this study was to examine the occurrence of ovarian cysts during the administration of three different gonadotrophin-releasing hormone analogues (GnRHa) in the long protocol as well as their characteristics, management and outcome compared with patients with no cyst formation. A total of 172 in-vitro fertilization (IVF) cycles in which GnRHa was administered at menstruation were analysed. Group B consisted of 72 cycles in which buserelin was used. Of these, 10 (13.9%) were with cysts (group B1) and 62 (86.1%) without cysts (group B2). Group T included 49 cycles in which triptorelin was injected. Of these, seven (14.2%) were with cysts (group T1) and 42 (85.7%) without cysts (group T2). Group L comprised 51 cycles in which leuprolide was administered. Of these, eight (15.7%) were with cysts (group L1) and 43 (84.3%) without cysts (group L2). All women with ovarian cysts had higher serum oestradiol concentrations and all except five underwent cyst aspiration with no complication. No differences were observed in the number of follicles and oocytes between groups B, T and L or between the groups with cysts and those without cysts. The pregnancy rate was similar in all groups. In conclusion, follicle cyst formation does not seem to be related to the use of a specific GnRHa, its short- or long-acting form or to the mode of administration. In addition, follicle cyst aspiration is a safe and successful solution to the problem of functionally active ovarian cysts.

Adult↗