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.     

Arachnoid cysts on computed tomography

The appearances of arachnoid cysts on computed tomography are presented. They are well defined lesions with the same density as cerebrospimal fluid and are not contrast enhanced. Superficial lesions are biconvex or semicircular and may have a characteristic straight inner margin. Deep lesions and cysts between the cerebellar hemispheres are spherical and some may be difficult to differentiate from cystic neoplasms. The etiology and clinical manifestations of arachnoid cysts are also briefly discussed.     

Observations on two cases of apparent submandibular gland cysts in HIV positive patients: MR and CT findings

OBJECTIVE: To present two cases of probable lymphoepithelial cysts of the submandibular glands in patients who were human immunodeficiency virus (HIV) positive and who also had lymphoepithelial cysts of the parotid glands. MATERIALS AND METHODS: Computed tomography and MRI of two HIV positive patients with lymphoepithelial cysts of the parotid glands and cysts in the submandibular glands were correlated with the histories and the possible presence of other known causes of submandibular gland multiple cysts. RESULTS: Because of the present treatment philosophy regarding HIV positive patients with major salivary gland cysts, surgical resection of these glands was not performed. All other known causes of multiple submandibular gland cysts were excluded by either history or laboratory data. CONCLUSION: Computed tomography and MRI on two patients with known HIV infection and bilateral parotid lymphoepithelial cysts are presented. Both patients also had bilateral multiple submandibular gland cysts and no evidence of obstructive glandular disease, autoimmune disease, or other organ system cysts. These cases of presumed submandibular gland lymphoepithelial cysts are rare in the literature. They are presented in the hope that other radiologists will be stimulated to document the occurrence of this entity.     

Laparoscopy for ovarian pathology in infancy and childhood

INTRODUCTION: Nonparasitic splenic cysts are a rare finding: they can be distinguished into true cysts (epidermoid or epithelial) cysts or false (pseudocysts), depending on the presence/absence of an inner epithelial lining. They are usually found during the second and third decade of life, although they can also appear during childhood. They grow bigger in children, becoming clinically apparent due to the symptoms of compression of adjacent structures. The diagnosis is radiological, made with ultrasonography (US) and computed tomography (CT). We report the US and CT patterns of splenic cysts to differentiate true from false cysts. MATERIAL AND METHODS: Our series consists of 5 patients, aged 5-17 years, all examined with US and CT; one of them was also submitted to plain abdominal radiography. Conventional CT was used in 2 cases and helical CT in the extant 3. RESULTS: All examinations yielded useful clinical informations. The only radiograph showed the rightward displacement of the gastric gas bubble US always identified the cyst and its pertinence to splenic parenchyma, although failing to assess the liquid/solid nature of a highly echogenic cyst in one case. CT confirmed the cystic nature of all masses and showed the lack of contrast enhancement of cyst walls and the presence of septa or parietal calcifications. DISCUSSION: Radiological examinations, particularly US and CT, can diagnose splenic cysts unquestionably, correctly defining the relationships with adjacent organs. CT is more sensitive than US in detecting septa or calcifications, which are definitely useful findings to distinguish true from false cysts, since internal septa are more frequent in true cysts while parietal calcifications are typical of pseudocysts. The final diagnosis, however, is made at histology.     

Cervical thymic cysts

A review of cervical thymus cysts and a case report are presented. This benign lesion was, as in most cases previously reported, situated laterally on the neck, deep to the anterior border of the sternocleidomastoid muscle and thus simulating a common branchial cyst preoperative.y. But unlike the latter most cases of cervical thymus cysts are recognised during childhood. They are believed to develop in remmants of thymic tissue which have failed to descend from the third branchial pouch into the mediastinum in the 6th to 8th week of embryonic life.     

Isotretinoin: which dosage?

Milia are small subepidermal keratin cysts. They may arise either spontaneously or in the course of bullous diseases or trauma. We describe an unusual case of multiple eruptive milia on the posterior neck and back and review the classification of milia.     

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.     

Arachnoid cysts: histologic, embryologic and physiopathologic review

Arachnoid cysts form a cavity containing a cerebrospinal-like fluid, the wall of which is composed of arachnoidal cells. Other types of intracranial cysts have been described, they differ from arachnoid cysts by the histological characteristics of their wall. To analyze homogeneous series, it is thus necessary to differentiate arachnoid cysts from the other types of cysts. Several localizations of these lesions have been described: the most frequent being the temporo-sylvian area. Arachnoid cysts are considered as resulting from congenital malformations that can change during postnatal life. They can no longer be considered as resulting from cerebral atrophy. This arachnoid malformation could be the primary event or be explained by an impairment of the cerebrospinal fluid drainage generated by venous agenesis. Several mechanisms could account for the inflation of these cysts: secretion by the cells forming the cyst walls, unidirectional valve, liquid movements secondary to pulsations of the veins.     

Cyst of the ligamentum flavum of the lumbar spine: description of 6 cases

Cysts of the ligamentum flavum of the lumbar spine have seldom been described. They are clearly visible in computed tomography as well as nuclear magnetic resonance, but are frequently wrongly diagnosed as ganglion or synovial cysts. The correct diagnosis is not feasible until after surgery. Such space occupying lesions can most often lead to uniradicular pain due to compression of a root. These cysts should be viewed as part of the degenerative process of the spine but not as tumor lesions. They need to be removed only in case of root entrapment. On the basis of six of our cases treated by surgery we describe the symptoms, imaging findings, operative techniques and pathological investigations.     

Endodermal cysts of the posterior fossa. Report of three cases and review of the literature

The pathogenesis of endodermal cysts of the posterior fossa is still incompletely understood. The authors reviewed three new cases and those reported in the literature to clarify the clinical, pathological, radiological, and surgical characteristics of these lesions. A total of 49 cases were reviewed. Details on demographic profiles, clinical characteristics, histopathological and radiological features, and surgical methods were collected. These cysts have a predominance in male patients (61%) and can occur at any age (birth-77 years). In patients with posterior fossa endodermal cysts there is a bimodal age distribution and headache is the most frequent complaint. On immunohistopathological examination, endodermal cysts were reactive for epithelial membrane antigen and for keratin immunostains whenever the latter were tested. The cysts were reactive for carcinoembryonic antigen in nine of 11 cases. Endodermal cysts were located anterior to the brainstem in 51% of cases and in the fourth ventricle in 21% of cases. They frequently appeared hypodense on computerized tomography scans, and in five cases, the lesion was missed. The cyst's appearance on magnetic resonance imaging is variable. Resection was complete in 19 cases and partial in 11; marsupialization was achieved in two cases. Three recurrences have been reported. Total excision with preservation of neurological function should be the goal. Cranial base approaches are helpful for surgical access in selected examples of these lesions.     

Choledochal cysts in adults: a report of two cases and review of the literature

A choledocal cyst is a dilation of some component of the biliary tract that may include both intra- and extra-hepatic sites. They are classified into six types, all of which are relatively rare. Previously, choledochal cysts were treated with biliary-enteric bypass procedures. The current recommendation is to attempt complete excision to minimize the known risk of malignancy and the development of recurrent cholangitis or pancreatitis that may occur in patients with these cystic lesions. Two cases are discussed in which type I choledochal cysts presented. One was removed from a 31-yr-old man who presented with vague abdominal complaints the other from a 32-yr-old man who presented with pancreatitis. The epidemiology, diagnosis, surgical treatment, and risk of cancer in choledochal cysts is described.     

Epidermoid splenic cysts

Five young women were treated by splenectomy for epidermoid cysts of the spleen. They all had vague abdominal symptoms, and had a mass palpable in the left upper quadrant of the abdomen. The hematologic indices were unremarkable. The diagnosis was suggested by routine radiologic examinations (including chest roentgenogram, upper gastrointestinal x-ray series, barium enema, and excretory urogram). It was confirmed in one patient by gray-scale ultrasonography, and in another by selective splenic arteriography. Of the true cysts of the spleen, the epidermoid cyst is the rarest, representing 10% of the benign, nonparaslitic cysts. The symptoms are completely relieved by splenectomy, and this remains the treatment of choice.     

Phonosurgical treatment of vocal cord cysts

INTRODUCTION: Functional-traumatic lesions of the vocal folds include mucous stranding, "nodular" lesions, polyps, cysts, contact hyperplasia and haematoma [1]. They all appear at the predilection sites of the vocal fold, at the junction between the anterior and middle thirds, slightly below the free edge. Vocal fold cysts are also located at the predilection site. They interfere with the glottic closure and vibration process. The treatment consists of surgical enucleation. This paper is aimed to present our results with direct and indirect surgical procedures. MATERIAL AND METHOD: A series of 63 vocal fold cysts was operated by the use of direct microlaryngoscopy (DML), indirect microlaryngoscopy (IMS) and videostroboscopy (IVCS). RESULTS: Over a 10-year period 1550 surgical procedures were performed for benign lesions of the vocal folds, including 63 cases of vocal fold cysts (4.1%). A very satisfactory phonusurgical result was obtained. Recovery of the vibration pattern was after DML procedures within 3 weeks in 66.6% of patients, while it was apparently faster after indirect operations. The latter were performed only for minor cystic lesions, and therefore direct and indirect procedures cannot be compared to vibration recovery. DISCUSSION: A careful surgical manipulation is required for the enucleation of vocal fold cysts, sparing the local tissue. DML is used in the majority of cases, while indirect procedures can be used only in minor lesions, where enucleation is not possible.     

Intrathyroidal lymphoepithelial cyst. A report of two cases not associated with Hashimoto's thyroiditis

Two cases of intrathyroidal lymphoepithelial cyst are described. Both of them were solitary, one being found incidentally in a patient operated on for a multinodular goiter, the other being clinically obvious as a cold nodule. They exhibited features of cysts of branchial cleft origin, i.e. squamous cell lining epithelium and abundant lymphoid tissue with reactive germinal centers. The thyroid gland parenchyma showed a discrete lymphoid infiltration consistent with the diagnosis of focal lymphocytic thyroiditis. In the first case a single epidermoid solid cell nest was found. The histogenesis of intrathyroidal lymphoepithelial cysts remains unclear, but their origin from cystically degenerated ultimobranchial body remnants (solid cell nests) seems to be most probable. This assumption is supported by a similar immunohistochemical profile of solid cell nests and epithelial cells lining the cysts and also by the presence of one solid cell nest in the proximity to the cyst in one of our cases.     

Can measures of coronary dynamics explain chest pain without coronary artery disease?

There is reason to believe that clear parathyroid cysts are a separate pathologic entity distinct from degenerative cystic tumors of the parathyroid. They probably derive from enlargement of vestigial tubules or canals associated with parathyroid embryogenesis and they are rarely, if ever, hyperfunctioning. Indeed, if a clear parathyroid cyst is encountered in the clinical setting of primary hyperparathyroidism, then it is important to exclude a concomitant tumor in one of the other parathyroid gland, as in the case presented here. If the ionized serum calcium level is normal then clear parathyroid cysts can be diagnosed and treated definitively by percutaneous needle aspiration of their crystal clear fluid contents.     

Laparoscopic splenic cystectomy: a case report

Congenital epidermoid splenic cysts are very rare. They are known to become symptomatic as a consequence of enlargement, hemorrhage, rupture, or infection. Recent options in the treatment of splenic cysts have included percutaneous drainage, partial splenectomy, or open splenic cystectomy. The authors present the first report of a pediatric patient with a large epidermoid cyst of the spleen treated by laparoscopic partial cyst excision and omental packing. Follow-up at 1 year confirms no recurrence. Laparoscopy provides a minimal access method of obtaining pathological confirmation of diagnosis, reduction of cyst complications, and a short hospital stay, while preserving splenic function.     

Nonparasitic splenic cysts. Ultrasonographic features and follow-up

Sixty-three patients with splenic cysts, multiple in 7 cases, were reviewed. Only 3 patients had a history of previous abdominal trauma. The cysts ranged in size from less than 1 cm to 15 cm. They were anechoic in 40 patients, hypoechoic in 16, isoechoic in 4, mixed in one, and in 2 cases the echogenicity could not be assessed due to thick marginal calcifications. The echogenic cysts were larger than the anechoic ones and frequently calcified, and the findings at surgery, fine-needle aspiration biopsy and follow-up suggested the echogenicity to be related to a fresh or previous episode of intracystic hemorrhage. Initially, surgical treatment was undertaken on 10 patients, electively in 9 cases and due to cyst rupture in one. At follow-up (n = 37), the size of the cyst had increased markedly over several years in only 2 patients, necessitating delayed surgery in one. Routine follow-up of asymptomatic splenic cysts was of no clinical value.     

Bilateral lutein cyst in normal single-child pregnancy

A rare case of bilateral multiple lutein cysts in pregnancy is reported. They do not require a radical operation because of spontaneous regression after delivery.     

Dental hygiene screening reveals childhood neck mass

A benign neck mass was discovered in a young child which, based on presentation, was diagnosed as a thyroglossal duct cyst. Thyroglossal duct cysts normally appear in childhood and are usually asymptomatic. They are a congenital neoplasm resulting from incomplete resorption of the thyroglossal duct following the embryonic descent of the thyroid gland and are often found attached to the hyoid bone. They may or may not have exterior fistulae and are slow growing. Other types of neck masses should be included in a complete differential diagnosis, as this case verified. Masses such as the dermoid cyst may be misdiagnosed as TGDC. While also slow growing, and presenting similarly to the TGDC, dermoid cysts may enlarge and compromise airways and interfere with eating and swallowing. Treatment of choice for these neck masses is excision including ductal remnants. Care must be taken not to remove ectopic thyroid tissue if that is the entire extent of the patient's thyroid gland. This case presentation exemplifies the role of the dental hygienist in identifying lesions of the head and neck and seeking appropriate referral when indicated. The dental hygienist if ideally suited to perform complete extraoral and intraoral examinations by virtue of education and training. Routine examinations must extend beyond the intraoral structures to include the head and neck regions. One must not assume that pathology exists only in the older population.     

Dermoid cysts of the oral cavity

The authors describe ethiology, clinical picture, diagnosis and treatment of the dermoid cyst of oral cavity floor. They show the advantages after using ultrasonography and computer tomography in treatment of these cysts.