Intratesticular epithelial cyst in an infant

We report on a 7-month-old boy with a simple cyst of the testis who was treated with excision and testicular preservation. Benign testicular tumors are more common in children than in adults (30%). Ultrasound may permit identification of benign testicular lesions. As simple cysts are isolated benign entities they may be treated by testisparing surgery.     

Unintended pregnancy. Consequences and solutions for a worldwide problem

Malignant bone tumors require the same careful staging as, for example, lung cancer. However, well-established staging systems for non-osseous tumors are not suitable for bone tumors. Therefore we present Enneking's staging system for malign bone tumors here, which is better adapted to the special problems of these entities because it integrates clinical, radiological and histological findings. The weak points of Enneking's staging system (e.g. inflexibility, changes in radiological modalities in the past 20 years) are discussed.     

Detection of viral genome in non-neural tissues of cattle experimentally infected with bovine herpesvirus 1

Various bone disorders become manifest as cystic lesions. The differential diagnosis must include benign and malignant tumors and also non-tumorous lesions, such as osteomyelitis. The most important and most frequent types of genuine bone cyst are juvenile bone cyst and aneurysmal bone cyst. When juvenile bone cysts occur in adults they are called solitary bone cysts. Despite intensive research the pathogenesis of bone cysts is still unknown to this day, so that successful causal therapy is impossible. The main problem in the treatment of bone cysts is their high rate of recurrence, rates ranging between 20% and 50% having been cited in the international literature. A critical review of the literature reveals few publications with helpful follow-up results. Most of the publications are case reports, and they frequently merely describe various forms of treatment. More recent reports are mainly concerned with such methods as curettage, steroid injections, and continuous decompression with perforated screws. Until the early 1980s, segmental bone resection was the treatment of choice. Because of its high complication rate it has since been abandoned. In the last analysis, the only well-established method for which long-term results obtained in studies of any size have been published, is curettage of the cyst and grafting with cancellous bone from the iliac crest. In our series, 41 patients were treated with this method, and we recorded a recurrence rate of 17.1%. Complications were rare. The risk of recurrence depended on the age of the patient. A higher recurrence rate must be expected in children under the age of 10 years. For this reason, operative treatment should not be performed until after that age if possible. Newer methods, such as steorid injections and continuous decompression by means of perforated screws, had better results in some studies, but only according to a few authors. Further research is needed to show whether our method will yield good results in the long term when applied in larger patient collectives.     

Staphylococcal enterotoxin-A directly stimulates signal transduction and interferon-gamma production in psoriatic T-cell lines

MRI has gained an undisputed place in the evaluation of malignant bone tumors, not only for verifying results of conventional radiographs and clarifying differential diagnoses; it has also become increasingly important for the assessment of the malignant/benign nature of the tumor, its growth rate, definition of adequate sites for biopsy, local preoperative staging, and evaluation of the response to chemotherapy. However, several pitfalls have to be observed regarding choice of technical parameters (coils, sequences, imaging planes), tissue differentiation, and tumor staging. When staging malignant tumors, critical aspects which have to be observed are tumor extension, integrity of the cortical bone, soft tissue components, infiltration of a joint or neurovascular bundle. The use of contrast agents provides important additional information but can also give rise to misinterpretations. Thus, all features of a tumor have to be observed in order to establish a final diagnosis. Particular difficulties can occur with the interpretation of MR images of osteomyelitis, osteoid osteoma, stress and insufficiency fractures, bone infarcts, myositis ossificans, hemangiomas, and aneurysmal bone cysts.     

Aneurysmal bone cyst of clavicle

Two aneurysmal bone cysts are described. They presented difficulties in diagnosis because the patients were rather older than usual for this lesion and because of the uncommon location of the cysts. The nature of aneurysmal bone cysts is discussed.     

Aneurysmal bone cyst of the fibula

Aneurysmal bone cysts are benign, expansile lesions that are not at all uncommon in the lower extremity. These lesions are difficult to recognize clinically. This paper is a thorough review of the current literature regarding aneurysmal bone cysts. After this review, one should be able to diagnose and appropriately treat aneurysmal bone cysts. Also provided is a case report with classic histologic, clinical, and radiographic findings that was treated by en bloc resection.     

Primary mediastinal tumors: part II. Tumors of the middle and posterior mediastinum

Lymphoma, mediastinal cysts, and neurogenic neoplasms are the most common primary middle and posterior mediastinal tumors. Lymphoma may involve the anterior, middle and/or posterior mediastinum, frequently as lymphadenopathy or as a discrete mass. Foregut cysts are common congenital mediastinal cysts and frequently arise in the middle mediastinum. Pericardial cysts are rare. Schwannoma and neurofibroma are benign peripheral nerve neoplasms, represent the most common mediastinal neurogenic tumors, and rarely degenerate into malignant tumors of nerve sheath origin. Sympathetic ganglia tumors include benign ganglioneuroma and malignant ganglioneuroblastoma and neuroblastoma. Lateral thoracic meningocele is a rare cause of a posterior mediastinal mass.     

Failure of the polyethylene after bipolar hemiarthroplasty of the hip. A report of five cases

Due to the difficulties in separating malignant and benign ovarian cysts by transvaginal ultrasound and other techniques, there is a need for biochemical markers in serum or cyst fluids. In the present study we have evaluated the levels of the chemokine interleukin-8 (IL-8) in ovarian cysts. IL-8 is known to be expressed in the normal ovary and to influence proliferation and angiogenesis of several nonovarian types of tumors. Cyst fluids from benign (n = 15) and malignant (n = 13) ovarian tumors were analyzed. The levels of IL-8 were found to be significantly (13-fold) higher in cyst fluids from malignant tumors (18.1 +/- 7.5 ng/ml; mean +/- SE) compared to benign cysts (1.3 +/- 0.7 ng/ml). The plasma levels of IL-8 were considerably lower (2.9 and 0.3% of levels in benign and malignant cyst fluids, respectively) than in cyst fluids. No difference in the plasma levels of patients with benign or malignant tumor could be detected. In contrast, the levels of CA 125 were significantly higher in plasma of patients with malignant disease with the inverse relation in cyst fluids. In conclusion, the levels of IL-8 are markedly elevated in cyst fluid from malignant tumors compared to benign. This specific increase indicates a role for this cytokine in ovarian tumor biology.     

Female genital mutilation

The purpose of this communication is to describe atypical simple bone cysts of the femoral neck seen in adult patients. Two patients, aged 56 and 49, having cystic lesions which did not conform to a typical simple bone cyst, are reported. Common features including eccentric location, and thick lining tissue and sclerotic margin are not those of typical simple bone cysts seen in children. Local mechanical characteristics might be related to the atypical presentations.     

Investigations on the distribution of HBs antigen subtypes

The localisations of bone cysts known under the title of "intraosseous ganglion, synovial cyst of bone and solitary unicameral cyst" are summarised from the literature. Two of the authors' patients are added to the few cases of talar cysts recorded up to the present. In addition, a patient with a calcaneal cyst is described. The cysts can be traumatic or non-traumatic in origin. The various theories concerning their etiology are discussed. The clinical findings, differential diagnosis and therapy of subchondral bone cysts particularly in the region of the foot are considered.     

Image analysis of naso-sinusal pathology with computerized tomography

Imaging analysis has been applied to study typical cases of nasosinusal diseases, in an attempt to determine its capabilities for CT scan interpretations. Thus, polyps with sinusitis, cerebrospinal fluid occupying sinuses, cysts and bone tumors may be compared in order to obtain objective results that may help in the differential diagnosis in these conditions.     

Aneurysmal bone cyst and giant cell tumor of the foot

From 1950 to 1994, 257 cases of benign bone tumors of the foot were treated at the Bone Tumor Center of the Rizzoli Institute. Aneurysmal bone cysts (ABC) and giant cell tumors (GCT) are rare and often they are misdiagnosed. To define the clinical and radiographic features useful for diagnosis, x-rays of 24 ABCs and 21 GCTs of the foot were reviewed. Adding our series to the cases reported in the literature, the only important clinical data that emerged was the average age of patients affected by ABC and GCT (15 and 27 years, respectively). ABCs localized in small tarsal bones were rare (6%), whereas 19% of GCTs were found in this site. The eccentric, round shape of a lytic lesion was more characteristic of GCT. An aggressive pattern of radiographic bone destruction was observed more frequently in GCT than in ABC (P = 0.01). Septation was seen in both tumors. Typical of ABC was a sharp and trabeculated margin, whereas GCT had an ill-defined edge with normal cancellous bone (P = 0.007). The growth of ABCs often expanded the cortex, while GCTs eroded, thinned, and broke the cortical bone (P = 0.001). A saucerized cortex was observed only in ABCs. A bony shelf was more characteristic of ABC than of GCT (P = 0.002). Pathologic fractures (67%) and joint involvement, evaluated by computed tomography and magnetic resonance imaging (83%), were more frequent in GCTs, whereas fluid levels were more frequently observed in ABCs (47%). The majority of the tumors were stage 2, but GCTs represented 70% of stage 3 aggressive lesions.     

Maxillofacial surgery

Maxillofacial surgery in dogs includes the management of jaw fractures various palatal surgical procedures, the management of oral tumors, and the surgical management of miscellaneous maxillofacial problems. Miscellaneous maxillofacial problems that may require surgical intervention include dentigenous cysts, bone sequestra or osteomyelitis, and an inability to open or close the month. Careful perioperative planning of maxillofacial surgical procedures will help ensure a successful outcome.     

Lymphangiomatous cysts of the spleen: report of 3 cases and review of the literature

Splenic cysts are very uncommon entities. The majority of these cysts are solitary and asymptomatic. They are mainly seen in children or young adults; and, they are usually seen either as solitary or multiple. For all splenic cysts, surgical intervention is advantageous, as the risk of splenic rupture is very high, even from minor abdominal injury. This report presents a summary of 3 cases with lymphangiomatous splenic cyst that were treated at the Gastroenterology Surgical Center, Mansoura University, Egypt from 1993 to 1996. Lymphangiomatous cyst of the spleen is considered a rare type of cyst that is usually found as a single or multi-cystic lesion.     

Biochemical and genetic analysis of variant C of caprine alpha s2-casein (Capra hircus)

Occurrence of any pubertal sign before eight years of age defines premature sexual development but does not always mean precocious puberty (PP); one should distinguish borderline physiological situations which need only a follow-up and frankly pathological situations which need very precise investigations and suitable treatment. The first situations are premature thelarche, pubarche and menarche in which the height and bone maturation, pelvic ultrasonography (US) are normal for age, avoiding hormonal investigations. Conversely in the second situation, the bone age is more advanced than the height age and the pelvic US displays ovarian activity and uterine development. The next step is the characterization of the level of the mechanism of puberty: hypothalamohypophysal or ovarian: in the first case gonadotropin levels are elevated after GnRH infusion, in the second case, depressed. The aetiological diagnosis are in true PP: brain tumors malformations or hamartoma even if negative idiopathic. At ovarian level: ovarian tumors or McCune Albright syndrome or recurrent cysts. The first etiology leads to use GnRH analog in the second the treatment is more delicate.     

The likelihood of finding occult histopathology in routine third molar extractions

Patients had their third molars extracted for reasons unrelated to concerns about the presence of pathologic entities. The preoperative differential diagnosis for a pericoronal radiolucent lesion was hyperplastic follicle, dentigerous cyst, odontogenic keratocyst, and remotely, ameloblastoma. The study involved 42 patients with 101 bony or soft tissue impacted teeth. The most significant microscopic histopathology observed was dentigerous cysts. Of the 101 teeth evaluated, 46 (45.5 percent) were dentigerous cysts. The male to female ratio was 1:1, and the average age was 23.3 years. Frequently, a pericoronal radiolucent width of 2.0 mm on the pantomograph is associated with the presence of microscopic histopathology. The range of widths of the radiolucency associated with the dentigerous cysts in the present was 0.1 to 3.0 mm with 33 (72 percent) displaying a radiolucent widths of 1.0 mm. In the present study, dentigerous cysts were frequently observed, and aggressive histopathologic entities were not identified.     

Special diagnostic problems in primary malignant bone tumors

The diagnosis of primary malignant bone tumors, which only account for 1% of malignancies in humans, represents quite a challenge for the pathologist. Apart from the often overlapping morphology between different entities, heterogeneity within one and the same tumor has to be kept in mind. Furthermore, in most cases the diagnosis must be established based on small biopsy specimens and occasionally even on frozen sections. In this context detailed clinical information including the patient's age and exact localization of the tumor, as depicted by X-ray or MRI, are essential requirements for a correct diagnosis. In addition, multiple biopsies from different tumor sites may be of help. For example, 25% of osteogenic sarcomas (OSA) are chondroplastic. Others may contain areas similar to fibrosarcoma (FSA) or malignant fibrous histiocytoma (MFH). Since 90% of OSA occur in the second decade of life whereas chondrosarcomas, FSA and MFH usually manifest after the age of 40 years, a biopsy solely composed of malignant chondromatous tissue obtained from a tibial lesion of a 10-year-old child should most likely be considered as part of an OSA. In the differential diagnosis of the so-called small, round cell tumors, which include Ewing sarcoma, malignant lymphoma and small-cell OSA, immunohistochemical staining of the paraffin-embedded material and a molecular biological/genetic work-up of frozen material are most helpful. In this paper the histomorphological characteristics and criteria for differential diagnosis of the most common primary malignant bone tumors are discussed.     

Ovarian cysts. Diagnostic and therapeutic aspects

The methods used to carry out exeresis of ovarian cysts by celioscopy are now familiar. Today, the main concern is the selection of annexial tumors appropriate for celiosurgical treatment in order to limit their use to benign organic cysts only. By comparing the results of a sery of 200 cysts which were treated surgically with cases in the literature, the authors conclude that the three-pronged use of clinical, ultrasound and macroscopic data in the diagnosis of malignant tumors is reliable. Progress remains to be made however in identifying functional cysts which are sometimes mistaken for an organic structure and all too often are still dealt with surgically. In order to reduce the incidence of such errors, new perspectives are envisaged, knowing that diagnostic error is often related to change in their ultrasound structure or their persistence despite conventional estro-progestogen treatment.     

Surgically excised primary mediastinal tumors and cysts: a report of 43 cases

Forty-three primary mediastinal tumors or cysts were surgically treated in 41 patients during a 10-year period. These tumors consisted of 20 thymic tumors, 10 neurogenic tumors, 5 teratomas, 3 lymphoid tumors, 2 congenital cysts, 2 mediastinal thyroid tumors, and 1 chondroma. There were 16 male and 25 female patients. The mean age was 44 years with a range of 6 to 79 years. Sixteen patients (39%) were symptomatic. There were 20 thymic tumors including 13 thymomas, 5 thymic cysts, and 2 hyperplasia with myastenia. Additional radiation therapy was recommended for all but stage I thymomas. Only 1 of the 10 neurogenic tumors was malignant. Eight teratomas were all cystic and matured. Early operative intervention is mandatory in these cases.     

Cytokine levels in cystic renal masses associated with renal cell carcinoma

PURPOSE: We compared cytokine levels in fluid from renal cysts with and without renal cell carcinoma. MATERIALS AND METHODS: Fluid was aspirated from 18 renal cysts without (benign) and 21 with renal cell carcinoma (malignant). Serum from patients with renal cell carcinoma and healthy controls was collected and cytokines were measured by enzyme-linked immunosorbent assay. RESULTS: Interleukin-6 (IL-6) and basic fibroblast growth factor concentrations were higher in malignant than benign cysts or serum (p <0.006). Epidermal growth factor levels were significantly higher in malignant cysts and serum than in benign cysts (p <0.01). IL-6 levels in malignant cysts positively correlated with the erythrocyte sedimentation rate (R=0.80) and C-reactive protein (R=0.86), and they were higher in grade 3 than in grade 2 tumors. Basic fibroblast growth factor levels were significantly higher in malignant cysts associated with hypervascular than hypovascular tumors (p=0.029). CONCLUSIONS: Cytokine levels in aspirated fluid may help to identify malignant renal cysts and indicate the characteristics of coexisting tumors.