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PubMed1977

Fluid turnover in renal cysts.

Cystic puncture was performed percutaneously in 18 patients with solitary renal cysts and in 22 with multiple, congenital renal cysts. With the aid of tritiated water it was possible to estimate the fluid turnover in the cysts and compare it with their volume, pressure and potassium and creatinine levels. Fluid turnover was rapid in all the renal cysts. Two to five hours after i.v. injection of tritium, the tritium concentration in cystic fluid averaged 88% of the concentration in plasma fluid in patients with polycystic kidneys and 73 percent in patients with solitary cysts. Fluid turnover was more rapid in small than in large cysts, but there was no such difference between cysts with high and low pressure. It is possible that the fluid turnover was slightly faster in cysts with high potassium and creatinine levels than in those with low levels. The results show that the fluid turnover in a renal cyst of 10 ml is considerable--probably more than 100 ml/24 hours. This indicates that fluid inflow to the cyst comes mainly from cells in the cyst wall and not from a single glomerule. Fluid probably leaves the cyst actively via cells in the cyst wall, since the fluid turnover does not increase with high cyst pressure. The fluid turnover is probably secondary to the active solute transportation, which is performed by the cyst cells. This means that these cells have a tubular cell-like function and should respond to pharmacotherapy.

Adult↗
PubMedDate not supplied

Formation of the Giardia cyst wall: studies on extracellular assembly using immunogold labeling and high resolution field emission SEM.

Encystment of the intestinal protozoan, Giardia, is a key step in the life cycle that enables this parasite to be transmitted from host to host via either fecal oral, waterborne, or foodborne transmission. The process of encystment was studied by localizing cyst wall specific antigens with immunofluorescence for light microscopy and immunogold staining for field emission scanning electron microscopy. Chronological sampling of Giardia cultures stimulated with endogenous bile permitted identification of an intracellular and extracellular phase in cyst wall formation, a process which required a total of 14-16 h. The intracellular phase lasted for 8-10 h, while the extracellular phase, involved the appearance of cyst wall antigen on the trophozoite membrane, and the assembly of the filamentous layer, a process requiring an additional 4-6 h for completion of mature cysts. The extracellular phase was initiated with the appearance of cyst wall antigen on small protrusions of the trophozoite membrane (approximately 15 nm), which became enlarged with time to caplike structures ranging up to 100 nm in diameter. Caplike structures involved with filament growth were detected over the entire surface of the trophozoite including the adhesive disc and flagella. Encysting cells rounded up, lost attachment to the substratum, and became enclosed in a layer of filaments. Late stages in encystment included a "tailed" cyst in which flagella were not fully retracted into the cyst. Clusters of cysts were seen in which filaments at the surface of one cyst were connected with the surface of adjacent cysts or the "tailed" processes of adjacent cysts, suggesting that the growth of cyst wall filaments may be at the terminal end. In conclusion, the process of encystment has been shown to consist of two morphologically different stages (intracellular and extracellular) which requires 16 h for completion. Further investigation of the extracellular stage with regard to assembly of the filamentous layer of the cyst wall may lead to innovative methods for interfering with production of an intact functional cyst wall, and thereby, regulation of viable Giardia cyst release from the host.

Animals↗
PubMed1987

A new method to determine Giardia cyst viability: correlation of fluorescein diacetate and propidium iodide staining with animal infectivity.

The viability of Giardia muris cysts was studied with the fluorogenic dyes fluorescein diacetate (FDA) and propidium iodide (PI). G. muris cysts were seen to fluoresce intensely green with FDA at an excitation wavelength of 450 to 490 nm. Cysts stained with PI fluoresced bright orange at an excitation wavelength of 450 to 490 nm and bright red at 545 to 546 nm. Examination of isolated G. muris cyst preparations stained with FDA-PI revealed that greater than 85% of the cysts stained green with FDA and less than 15% stained orange-red with PI. Using the mouse model for giardiasis, we inoculated FDA- or PI-stained cysts into neonatal mice. Feces were examined at days 3, 5, 8, and 11 postinoculation for the presence of cysts. Using 1,000 FDA-stained cysts as the inoculum, we detected cysts at days 5, 8, and 11 postinoculation in 19 of 19 mice, whereas a 50-fold greater dose of cysts produced infection in 27 of 27 mice at day 3 as well as at days 5, 8, and 11 postinoculation. Inoculation of mice with either 5,000 or 50,000 PI-stained G. muris cysts did not produce infection in any of the animals. Necropsy of mice infected with FDA-stained cysts showed trophozoites within the intestines. No trophozoites were detected within animals inoculated with PI-stained cysts. These results demonstrate that FDA-positive cysts are viable, as determined by infectivity, while PI-positive cysts are nonviable and incapable of producing G. muris infections in vivo.(ABSTRACT TRUNCATED AT 250 WORDS)

Animals↗
PubMed1992

The role of fine-needle aspiration and pneumocystography in the treatment of impalpable breast cysts.

Prior studies have suggested that the recurrence rate is lower in breast cysts treated by pneumocystography (injection of air into cyst cavities after cyst aspiration) than in cysts treated by fine-needle aspiration alone. To determine if this is the case for impalpable breast cysts, we reviewed the hospital records and mammograms of 38 women with 41 impalpable cysts. Mammograms obtained immediately after aspiration show that pneumocystography was successful in 18 and unsuccessful in 20 of the 41 cysts. Four cysts were excluded from the study: one cyst that recurred after aspiration and was sampled by biopsy and three cysts for which immediate post-aspiration mammograms were unavailable but which had recurred or persisted 3 years after aspiration. Review of follow-up mammograms made 4 months to 3 years after the aspiration showed that three (17%) of 18 cysts in the group with successful pneumocystography recurred and 11 (58%) of 19 cysts in the unsuccessful group recurred (p = .02). No difference was found in the number of recurrent cysts in relation to estrogen therapy or menopausal status. Our results indicate that impalpable breast cysts treated by pneumocystography are less likely to recur than are cysts treated by aspiration alone.

Adult↗
PubMed2002

The natural history of simple renal cysts.

PURPOSE: Although simple renal cysts are common in older patients, little is known concerning their natural history. We examined the natural history of renal cysts by investigating the prevalence and sequential changes in their size and number in individuals. MATERIALS AND METHODS: We collected data on 14,314 individuals who participated in a multiphasic health screening program at our institute in 1999. An ultrasound renal cyst prevalence survey was performed. As a longitudinal study, 45 patients with renal cysts were followed a mean of 6 years from January 1993 to December 1999. RESULTS: In the prevalence survey 1,700 individuals (11.9%) had at least 1 renal cyst on ultrasound. The ratio of men-to-women with cysts was 2:1. The prevalence of renal cysts increased more than 7-fold with age from 5.1% in the fourth to 36.1% in the eighth decade of life. Our longitudinal study revealed that the majority of cysts increased in size and number. The average increase in size and the rate of enlargement were 2.82 mm. and 6.3% yearly, respectively. Cysts in patients younger than 50 years grew more rapidly than those in patients 50 years old and older, at a rate of 3.94 and 1.84 mm. yearly, respectively (p = 0.010). Multiloculated cysts progressed more rapidly than simple cysts (6.93 versus 2.18 mm. yearly, p <0.0001). CONCLUSIONS: The prevalence of renal cysts increases with age and shows a remarkable difference in incidence by sex. Renal cysts progress in size and number, and appear to grow more rapidly in younger patients. The natural history of multiloculated cysts may be distinct from that of simple cysts and warrants further investigation.

Adolescent↗
PubMed1990

[Clinicopathologic assessment of esophageal cysts--a report of 8 cases].

We experienced 8 cases of esophageal cysts on between January, 1965 and March, 1989. During the same period, 320 cases of mediastinal tumors were operated in our department, and esophageal cysts were 2.5% of these cases. They were 7 males and 1 female, and ranged in age from 5 to 51 (mean 29.9) years. The cysts were located in the right in 6 and in the left in 2, and in the upper third of the esophagus in 1, middle third in 3 and lower third in 2 cases. A correct preoperative diagnosis was made in only 1 case. The definite diagnoses were not obtained from thoracic CT scans and esophagography. We tried transesophageal ultrasonic endoscopy in the recent 2 cases, and could diagnosed in 1 case as a cyst in the esophageal wall. The another case, we could not diagnose, was a cyst attached to the esophageal wall by a muscular stalk. We experienced 2 cases of post operative bleedings, so we must be careful of hemostasis of the muscular layers after enucleation of the cysts. Histological examinations of the cysts showed ciliated columnar epithelium in all cases. Cartilage were observed (bronchogenic cysts) in 4 patients (50%) and two muscle layers were observed (duplication cysts) in 4 other patients (50%). But 2 cases of bronchogenic cysts had two muscular layers, 1 case of them was well-defined. And 1 case of duplication cyst had poor two muscular layers. We cannot divide clearly the esophageal cysts into bronchogenic cyst or duplication cyst, in the point of having cartilage and double muscle layers.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed2006

Oral contraceptives for functional ovarian cysts.

BACKGROUND: Functional ovarian cysts are a common gynecological problem among women of reproductive age worldwide. When large, persistent, or painful, these cysts may require operations, sometimes resulting in removal of the ovary. Since early oral contraceptives were associated with a reduced incidence of functional ovarian cysts, many clinicians inferred that birth control pills could be used to treat cysts as well. This became a common clinical practice in the early 1970s. OBJECTIVES: This review examined all randomized controlled trials that studied oral contraceptives as therapy for functional ovarian cysts. SEARCH STRATEGY: We searched the computer databases of CENTRAL, PubMed, POPLINE, and EMBASE for randomized controlled trials. We also examined the reference lists of articles and wrote to authors of all studies identified to seek articles we had missed. SELECTION CRITERIA: We included randomized controlled trials in any language that included oral contraceptives used for treatment and not prevention of functional ovarian cysts. Criteria for diagnosis of cysts were those used by authors of studies. DATA COLLECTION AND ANALYSIS: Two authors independently abstracted data from the articles and entered them into RevMan 4.2. We used Peto odds ratios with 95% confidence intervals for dichotomous outcomes. MAIN RESULTS: We identified four randomized controlled trials from three countries; the studies included a total of 227 women. Treatment with combined oral contraceptives did not hasten resolution of functional ovarian cysts in any trial. This held true for cysts that occurred spontaneously as well as those that developed after ovulation induction. Most cysts resolved without treatment within a few cycles; persistent cysts tended to be pathological (e.g., endometrioma or para-ovarian cyst) and not physiological. AUTHORS' CONCLUSIONS: Although widely used for treating functional ovarian cysts, combined oral contraceptives appear to be of no benefit. Watchful waiting over several cycles is appropriate. Should cysts persist, surgical management is often indicated.

Contraceptives, Oral, Combined↗
PubMed1986

Clinical and radiographic features of simple and hydatid cysts of the liver.

The advances of hydatid chemotherapy and the non-operative management of simple (epithelial) hepatic cysts make a correct diagnosis of increasing importance. Twenty-six patients with hepatic hydatid cysts and eleven with simple cysts were reviewed. In both groups clinical presentation was most frequently due to pain. Sex, age and size of the cysts were similar. Hydatid serology was negative in six of the hydatid patients (23 per cent). None of the simple cyst patients had positive serology but one had a borderline titre. Ultrasound and computerized tomography identified daughter cysts within the main cyst in only 17 hydatid cysts (65 per cent) and considerable intra-cyst debris was also present in five of the simple cysts. Seven of the simple cysts were deroofed surgically and the remainder underwent percutaneous aspiration. Sixteen of the hydatid cysts were found to have a biliary communication whereas this was not found with any simple cyst. The difficulties in making a precise diagnosis in some patients with a liver cyst should deter the interventional radiologist and restrain the hydatid chemotherapist.

Adult↗
PubMed2006

Coexisting secondary intraneural and vascular adventitial ganglion cysts of joint origin: a causal rather than a coincidental relationship supporting an articular theory.

OBJECTIVE: To introduce the clinical entity of an intraneural ganglion cyst coexisting with a vascular adventitial cyst arising from the same joint. DESIGN: Retrospective review. PATIENTS: Two patients presented with predominantly deep peroneal neuropathy due to complex superior tibiofibular joint-related cysts. In addition to having peroneal intraneural ganglion cysts, these patients had vascular adventitial cysts: one involving a capsular arterial branch, the other a capsular vein [as well as a large, recurrent, intramuscular (extraneural) ganglion]. We then reviewed MRIs of 12 other consecutive cases of intraneural ganglia (10 peroneal and 2 tibial) arising from the superior tibiofibular joint that we treated, as well as other reported cases in the literature to determine if there were other (unrecognized) examples supporting the combination of clinical findings and radiographic patterns. RESULTS: Retrospective analysis of MRIs in the two surgically proven cases of peroneal intraneural ganglia with vascular adventitial cyst extension showed a common imaging pattern that we have termed "the wishbone sign," consisting of the connection of the ascending limb of the peroneal intraneural ganglion and the longitudinal limb of the vascular adventitial cyst in the axial plane. Our review suggests that vascular adventitial cyst extension occurs in a large proportion of cases of peroneal intraneural ganglia. A similar growth pattern was noted in a case of a tibial intraneural ganglion. CONCLUSIONS: The combination of intraneural and vascular adventitial cysts is understandable given our knowledge of normal and pathologic anatomy of para-articular cysts. The combination of intraneural ganglia and vascular adventitial cysts broadens the spectrum of clinical presentations of these cysts and suggests that cysts and their content can dissect from a joint along neurovascular bundles. These cases provide important evidence to support the articular theory for the pathogenesis of not only neural but vascular adventitial cysts as well.

Diagnosis, Differential↗
PubMed2000

Shunt-independent surgical treatment of middle cranial fossa arachnoid cysts in children.

The best operative intervention for children with arachnoid cysts remains the subject of controversy. Recent reports stress that craniotomy for cyst fenestration is associated with a low incidence of morbidity and mortality and may leave the child shunt-independent. Among a total of 66 intracranial arachnoid cysts operated on in the authors' department from 1985 to 1997, 44 cases (67%) were located in the middle cranial fossa. A higher incidence in the first decade of life (53 cases) and a marked male predominance (45 cases) were recognized. Headache, cranial deformities, symptoms of raised intracranial pressure, and seizures constituted the most frequent features of the clinical presentation. To determine which treatment provides the greatest benefit with the lowest incidence of complications, the records of the 44 patients with arachnoid cysts in the middle cranial fossa were reviewed. The mean age of these patients was 4.6 years (range 0-16 years). Different types of initial surgical procedures were performed. In 33 patients with middle cranial fossa arachnoid cysts (MCFAC) the initial surgery took the form of craniotomy with excision of the cyst walls and fenestration into the basal cisterns. Shunting procedures were performed in 9 patients: cysto-peritoneal shunts (CPS) were placed in 4 patients and ventriculo-peritoneal shunts (VPS), in 3 patients, and cyst excision was performed in addition to CPS in 2 patients. Excision of the cyst membrane alone without fenestration was performed in 2 patients. The initial treatment was successful in terms of reduced symptoms and decreased cyst size, with no additional treatment needed for the cyst, in 79% (26/33) of patients who had undergone excision of the cyst walls and fenestration into the basal cisterns, compared with 66% (6/9) of patients who had undergone shunting procedures. Cyst membrane excision was not successful in any of the patients who underwent this procedure alone. No significant difference in morbidity was noted between these different treatment options. On follow-up CT scan and MRI, cysts of types I and II (Galassi classification) exhibited a steady tendency to reduction or obliteration. These results confirm that radical excision of the outer and inner membranes of the cyst wall with fenestration into the basal cistern is a safe and effective shunt-independent procedure for MCFAC, especially for those of types I and II.

Adolescent↗
PubMed1995

Isolated fetal choroid plexus cysts and trisomy 18: a review and meta-analysis.

OBJECTIVE: Risk of trisomy 18 in a fetus with ultrasonographic diagnosis of choroid plexus cysts and no other anomalies is controversial. Using our data and current literature, we performed a meta-analysis and estimated the positive predictive value of isolated choroid plexus cysts for trisomy 18. STUDY DESIGN: Between Jan. 1, 1989, and Dec. 31, 1992, all women undergoing ultrasonographic examination at our institution were prospectively evaluated for fetal choroid plexus cysts and cytogenetic outcome. In addition, all reports dealing with fetal choroid plexus cysts obtained from MEDLINE (1983 through 1992) were assessed. Only prospective studies with > 10 cases of choroid plexus cysts were further evaluated to determine the total number of fetuses with choroid plexus cysts and otherwise normal sonograms. Frequency of aneuploidy was determined by analysis of our data and the included studies. To estimate the positive predictive value of choroid plexus cysts from trisomy 18, a theoretic 2 x 2 table was constructed with values available from the literature. RESULTS: Eighty fetuses with choroid plexus cysts were identified in our unit. Of 74 fetuses with isolated choroid plexus cysts, there were no cases of trisomy 18. Meta-analysis identified 2 cases of trisomy 18 among 748 fetuses with isolated cysts (1/374). To derive a positive predictive value of isolated choroid plexus cysts for trisomy 18, we reviewed the literature and found a total of 50 fetuses with trisomy 18 who underwent ultrasonographic examination in the midtrimester. There were 3 cases of isolated choroid plexus cysts, and 12 of 50 (24%) had otherwise normal ultrasonographic results. Using a midtrimester incidence of 1 in 2461 for trisomy 18 (Hsu LYF. In: Milunsky A, ed. Genetic disorders of the fetus. 3rd ed. Baltimore: Johns Hopkins University Press, 1992: 155-210; Hook et al. Am J Hum Genet 1989; 45:855-61) and a prenatal prevalence of 0.95% for choroid plexus cysts (based on a review of the literature), we obtained a positive predictive value of 1 in 390. CONCLUSION: On the basis of the risk for trisomy 18 obtained from our meta-analysis (1/374) and its close approximation to the estimated positive predictive value (1/390), our data do not support the routine offering of invasive prenatal cytogenetic testing in cases of isolated choroid plexus cysts.

Brain Diseases↗
PubMed1994

Surgical management of choledochal cysts.

Choledochal cysts are an unusual cause of biliary obstruction with up to 85% of reported cases being of the type I variety, that is, fusiform dilations of the common bile duct. Recommended management of this type I cyst is complete surgical excision; however, difficulties arise in type IVa cysts when the cystic dilation extends up into the intrahepatic biliary tree. The purpose of this study is to review the management of choledochal cysts with particular reference to the type IVa variety. Statistical analysis of outcome differences was undertaken using Fisher's exact test. A total of 23 consecutive patients with choledochal cysts seen at our institution in a 5-year period were reviewed: 8 patients had type I cysts, 1 patient had a type III cyst, and 14 patients had type IVa cysts. All type I cysts underwent complete cyst excision with hepaticojejunostomy and modified Houston loop formation. Of 14 patients with type IVa cysts, 13 underwent complete excision of the extrahepatic portion of the cyst with hepatico- and cystojejunostomy and modified Hutson loop formation. One patient required hepatic lobectomy. With a mean follow-up of 33 months, 4 patients with type IVa choledochal cyst have had episodes of recurrent cholangitis, with access to the library tree being achieved via the Hutson loop in 3 of the 4 patients. Three of these cases represented anastomotic strictures that were treated nonoperatively. We concluded that recurrent cholangitis and anastomotic stricture after resection of type IVa choledochal cysts is frequent and recommend Hutson loop formation at the time of primary resection.

Adolescent↗
PubMed1999

Incidence of intrahepatic biliary cysts in biliary atresia after hepatic portoenterostomy and associated histopathologic findings in the liver and porta hepatis at diagnosis.

BACKGROUND/PURPOSE: The association of intrahepatic biliary cysts in biliary atresia (BA) after hepatic portoenterostomy has drawn the attention of many pediatric surgeons and has become an important subject in clinical management, but the incidence and causes of this association are not well known. METHODS: During the last 14 years, we operated on 33 BA patients by hepatic portoenterostomy. Five patients could not be followed up over a 1-year period, so the remaining 28 patients had their intrahepatic structure investigated by periodic magnetic resonance imaging (MRI), and were confirmed at autopsy. The authors also reviewed the preoperative conditions of these patients and the histopathologic changes in the liver biopsy and the porta hepatis specimens taken at portoenterostomy. RESULTS: (1) Intrahepatic biliary cysts were found in 6 of the 28 patients studied (21%). Of 16 patients who were operated on after 1989 and are undergoing follow-up by MRI, 4 (25%) had cysts. (2) Five of the 6 patients with cysts had episodes of cholangitis before or at the time of discovery of the cysts, and 4 of them have had their jaundice reappear since the discovery of the cysts. (3) The intralobular spaces (ILS) with fibrosis and the number of bile ducts had increased in the group with cysts compared with those in the group without cysts. (4) The bile duct maximum size in the porta hepatis (PH) was similar in the groups with and without cysts, but a denudation of the mucosal lining cells in the duct, and a fibrosis and inflammation around the duct had increased in the group with cysts compared with those in the group without cysts. (5) Statistically, the fibrosis found in the ILS and the inflammation around the bile duct found in the PH were induced as a correlative factor affecting cyst formation. CONCLUSIONS: The association of intrahepatic biliary cysts in BA after portoenterostomy is frequent. The fibrous change in the ILS and the inflammatory process around the bile ducts might be potential causes of cyst formation.

Bile Ducts↗
PubMed2003

Subglottic cysts: the Great Ormond Street experience.

OBJECTIVE: Subglottic cysts are a relatively rare, non-malignant cause of airway obstruction. In this study we reviewed the details of the patients who were treated for subglottic cysts in our department in order to evaluate the presentation and treatment of patients with this condition. METHODS: We performed a retrospective case note analysis of 55 patients with subglottic cysts. Case notes were examined to determine the following details for each patient: date of birth, gestational age at birth, history and length of intubation, age at presentation, presenting symptoms, findings on endoscopy, treatment given for subglottic cysts, recurrence(s) of cysts after initial treatment, and follow up for a minimum of 6 months post diagnosis. RESULTS: Fifty five patients were identified, 35 male, 20 female. Ninety four percent were born prematurely at 24-31 weeks gestation. All patients were intubated in the neonatal period. The median duration of intubation for all patients was 10 days (range 1-126). Fifty one patients underwent intervention for their subglottic cysts at their initial, diagnostic microlaryngoscopy and bronchoscopy (MLB), and recurrent cysts occurred in 22 cases. A total of 82 procedures for cyst removal were performed, using either the carbon dioxide laser or microinstruments. Subglottic stenosis was a commonly associated feature in our series of patients, being present in 38 patients. Eleven of the 14 patients who presented to our department with tracheostomies in situ were decannulated after removal of their subglottic cysts. CONCLUSIONS: This review of the largest series of patients with subglottic cysts reported to date, reinforces our view that such cysts are rare but potentially reversible causes of upper airway obstruction, and that they result from injury to the larynx as a result of endotracheal intubation. Treatment of the cysts will often be sufficient to correct the obstructed airway allowing successful extubation or decannulation of a tracheostomy. Patients who have had subglottic cysts treated should have access to long-term follow up as there is a tendency for these cysts to recur.

Bronchoscopy↗
PubMed1998

Ovarian cysts in children and adolescents: their occurrence, behavior, and management.

STUDY OBJECTIVE: To evaluate the characteristics and symptoms of ovarian cysts, their connection with the methods of treatment, and the effectiveness of the therapy. METHODS: A retrospective analysis of data on girls with ovarian cysts was performed at a university clinic. Participants included 119 girls in whom 144 ovarian cysts were found by ultrasound examination performed either routinely or for a specific purpose. One group of patients received gestogen to facilitate resolution of the cyst and as treatment of menstrual disorder. Others received clomiphene citrate exclusively as therapy for menstrual irregularity. Aside from this, patients were treated by surgical intervention, or only follow-up sonography was performed. The site, number, size, and type of the cysts were examined. The indications for ultrasonography and the effectiveness of the treatment were analyzed. RESULTS: The ovarian cysts were mostly unilateral, unilocular, and simple, with the size varying between 3 cm and 5 cm in diameter in 90 cases, more than 5 cm in 41 cases, and less than 3 cm in 13 cases. A number of cysts were found incidentally on ultrasound. Girls were scanned most often because of irregular bleeding (80 cases). Hormonal treatment was given in 105 cases, whereas in 35 cases only follow-up sonography was performed. Cysts resolved spontaneously in 4.5 weeks on average, or in 3 weeks after hormonal treatment. Surgical therapy was necessary for nine patients. The indication for surgery was the detection of complex cysts indicative of dermoid type, size of the cysts, severe pelvic pain, or failure of the cyst to resolve or decrease in size spontaneously or in response to treatment as determined by follow-up sonography. All of the cysts were benign on pathological evaluation. CONCLUSION: Most ovarian cysts in girls could be managed conservatively, even the larger ones greater than 5 cm in diameter. Only exceptional cases required surgical therapy. Hormonal treatment shortened the duration of the cysts somewhat, but not significantly, and thus was useful mainly in the treatment of concomitant menstrual disorders.

Adolescent↗
PubMedDate not supplied

Lumbar intervertebral disc cyst as a cause of radiculopathy.

BACKGROUND CONTEXT: Lumbar radiculopathy is commonly caused by degenerative conditions such as a herniated disc or lumbar spinal stenosis. Less common etiologies include intraspinal extradural masses such as synovial cysts and gas-containing ganglion cysts. Intraspinal extradural cysts that communicate with the intervertebral disc are a rare entity and thus, an uncommon cause of lumbar radiculopathy. There are only ten cases of an intervertebral disc cyst reported in the literature. PURPOSE: To document the first reported case of an intervertebral disc cyst in North America. Two series of Japanese patients with intervertebral disc cyst confirmed radiographically and intraoperatively have recently been reported. STUDY DESIGN: A case report of an intervertebral disc cyst at L4-5 causing an L5 radiculopathy. OUTCOME MEASURES: Japanese Orthopaedic Association score for low back pain. METHODS: The patient and the authors involved in the patient's management were interviewed. All medical records, radiographic imaging studies, intraoperative findings, and pertinent literature were also reviewed. RESULTS: Preoperative magnetic resonance imaging (MRI) scan demonstrated a well-localized cyst compressing the ventral aspect of the thecal sac at L4-L5. Discography and subsequent computed tomographic (CT) scanning demonstrated the cyst communicating with an intervertebral disc herniation via an annular rupture. Decompressive discectomy and surgical excision of the disc cyst from the spinal canal resulted in complete recovery and resolution of the preoperative radiculopathy. Clinical improvement was documented using the JOA scoring system. Patient's preoperative score was 4/15, and postoperative score was 15/15. CONCLUSION: Although exceedingly rare, an intervertebral disc cyst should remain in the differential diagnosis of any extradural intraspinal mass ventral to the thecal sac. Diagnosis of an intervertebral disc cyst requires recognition of this uncommon entity and a high index of suspicion. Discography and post-discography computerized tomography (CT) scan confirm the diagnosis. Operative treatment includes decompression, and excision of the cyst and is reserved only for cases in which the cyst results in clinical symptoms unresponsive to nonoperative management.

Adult↗
PubMed2003

Immunohistochemical and genetic analysis of mandibular cysts in heterozygous ptc knockout mice.

BACKGROUND: Alterations of human patched (ptc) homolog have been proven to be responsible for basal cell nevus syndrome (BCNS). Mandibular cysts in heterozygous ptc knockout mouse (ptc+/- mouse) were microradiologically, histologically, immunohistochemically, and genetically examined to investigate the possible role of the ptc gene and its associates in the jaw cysts. METHODS: The mandibular bones were prepared from 63 ptc+/- mice and 6 ptc+/+ mice. Soft X-ray radiographs and histological sections were examined for detection of the presence of mandibular cysts. The mandibular cysts were immunohistochemically investigated using anti-ptc, shh, and smo antibodies. PCR analysis of loss of heterozygosity (LOH) of ptc was performed in genomic DNA from the mandibular cysts. RESULTS: Six ptc+/+ mice showed no pathologic change in any examinations. Microradiologically, ptc+/- mice did not show any apparent lesion. Mandibular cysts were often multiple, and were histologically detected in the alveolar bones or periodontal ligaments of the molars in 16 (25.4%) ptc+/- mice. The mandibular cysts were lined by thin parakeratotic stratified squamous epithelium and contained keratinized materials. Immunohistochemical examination showed sonic hedgehog (shh) protein mainly in cyst lining epithelium, and ptc and smoothened (smo) proteins in cyst lining epithelium, and surrounding fibrous connective tissue. Expression of ptc protein in the cyst lining epithelium tended to be weak as compared with incisor enamel organs and gingival stratified squamous epithelium. LOH of the ptc gene couldn't be found in lining epithelium of mandibular cysts in any ptc+/- mice. CONCLUSIONS: Ptc+/- mouse is a useful model of BCNS from the standpoint of occurrence of jaw cysts, and downregulation of ptc protein in cyst lining epithelium caused by gene targeting would be associated with formation of jaw cysts in ptc+/- mice.

Animals↗
PubMed2002

The natural history of adnexal cysts incidentally detected at transvaginal ultrasound examination in postmenopausal women.

OBJECTIVE: To determine the natural history of adnexal cysts incidentally detected at transvaginal ultrasound examination and judged to be benign in postmenopausal women. METHODS: One hundred and thirty-four postmenopausal women referred for ultrasound examination and found to have an adnexal cyst judged to be benign and not causing any symptoms were followed with transvaginal ultrasound at 3, 6 and 12 months, and then every 12 months. The referring physician treated the patient at his/her own discretion. RESULTS: One hundred and sixty cysts were found, 121 (76%) being unilocular and 39 more complicated. Seventy-two cysts (45%) had a largest diameter of 3-19 mm and 88 (55%) had a largest diameter of 20-80 mm. Median follow-up time was 3 (range, 0.3-8) years. In twelve women (9%) the cysts were removed during follow-up, all their cysts (n = 14) being benign. The indication to operate was a change in cyst morphology or increased cyst size in five (4%) women. In 39 (29%) women, the cysts disappeared; in 18 (13%), new cysts developed; and, in 65 (49%), the number of cysts and their location remained unchanged. Regression of cysts was observed in 54% (33/61) of women < 60 years vs. in 8% (6/73) of those > or = 60 years (P = 0.0001). Ultrasound findings remained unchanged in 34% (21/61) of women < 60 years vs. in 77% (56/73) of those > or = 60 years (P = 0.0001). CONCLUSIONS: The results support conservative management of adnexal cysts incidentally detected at transvaginal ultrasound examination and judged to be benign in postmenopausal women. Whether such cysts need to be followed-up at all and, if they do, how often and for how long, remains an open question.

Adnexal Diseases↗