Syringomyelia associated with posterior fossa cyst: a case report

We report a case of a 47-year-old woman with a posterior fossa cyst associated with syringomyelia and hydrocephalus. Her birth was traumatic and she had suffered a fractured skull. About 10 years prior to coming to our department she had occipitalgia and a pain had developed over a month from her right shoulder to hand. Shortly before presenting occasional electric-like shocks were felt in her right hand associated with coughing and hiccuping. Magnetic resonance imaging (MRI) revealed a large midline posterior fossa cyst, hydrocephalus and syrinx (C1-Th11). Cisternography could not demonstrate communication between the cyst and the subarachnoid space and the 4th ventricle was present but without communication with the cyst. The cyst was tentatively diagnosed as an arachnoid cyst. One week after placement of a cyst-peritoneal shunt, CT scans showed a decrease in cyst and ventricle size and 2 months later a follow-up MRI revealed resolution of the syringomyelia. We suspected that cyst-peritoneal shunt was effective for this patient who had syringomyelia associated with incommunicated posterior fossa cyst.     

Percutaneous treatment of a congenital splenic cyst with alcohol: a new therapeutic approach

Percutaneous treatment of a huge congenital splenic cyst in a 23-year-old man is presented. The cyst had been catheterized and drained two times within a 3-month period without injecting any sclerosing agent into the cavity. On the third attempt, catheter drainage and injection of alcohol into the cyst cavity were performed because of insufficient response to drainage alone. He was discharged symptom-free after the procedure. The cyst diminished in size considerably 9 months after the treatment with alcohol. The volume of the cyst was reduced from 5200 to 8 ml. Although percutaneous treatment of a congenital splenic cyst with tetracyclin has been reported, to our knowledge this is the first case of a congenital splenic cyst treated with alcohol as a sclerosing agent. Percutaneous treatment of splenic cyst can obviate the need for partial or total splenectomy and may be an alternative to surgical treatment.     

Maculopapular and urticarial eruption from cetirizine

Cardiac hydatid cyst is a rare parasitic disease. Since it may be associated with fatal complications, early diagnosis and treatment of a cardiac hydatid cyst is very important. We present a case with hydatid cyst localized in the right atrium and bilaterally in the lungs, and embolized pulmonary arteries bilaterally. The right atrial cyst localized on the interatrial septum was removed using cardiopulmonary bypass and the cyst in the right pulmonary artery was extracted by an embolectomy catheter. The patient died of pulmonary hypertension and pulmonary insufficiency three months postoperatively.     

Treatment and histopathology of a congenital vitreous cyst

OBJECTIVE: This study aimed to evaluate the treatment efficacy of a congenital vitreous cyst and to examine the cyst histopathologically to determine its cellular makeup and possible origin. STUDY DESIGN: The study design was a case report, including a clinicopathologic correlation. INTERVENTION: A 35-year-old woman with a known vitreous cyst since childhood became increasingly troubled by its symptoms. The cyst was treated initially with argon laser photocoagulation. Vitrectomy subsequently was performed because the deflated cyst remained near the visual axis. Histopathologic studies included light and electron microscopy; immunocytochemistry for actin and glial fibrillary acidic protein (GFAP); and enzyme histochemistry for carbonic anhydrase (CA). RESULTS: The cyst was composed of a single layer of heavily pigmented cells with a thick basement membrane along the internal borders of the cells. Ultrastructurally, the cells were connected with tight junctions, had microvillous processes at their apices, and contained numerous large melanosomes in various stages of maturity, including premelanosomes. Immunochemistry showed the cells were positive for actin but negative for GFAP. Enzyme histochemical staining for CA also was strongly positive. CONCLUSIONS: The confinement of this cyst to the region of Cloquet's canal, the presence of a Mittendorf's dot, the cyst's existence for many years, and the finding of pigment epithelial-type cells having immature melanosomes (a feature not seen after birth in normal pigment epithelium) lead the authors to believe that this cyst was a congenital remnant of the primary hyaloidal system. Because pigmented cells are not normally present in this part of the eye, the cyst was a choristoma of the primary hyaloidal system.     

The effects of chronic beta-blocker administration on respiratory sinus arrhythmia]

Bronchogenic cysts are common cystic lesions in the mediastinum. Most are located in the middle or posterior ares of the mediastinum, especially around the carina. We encountered a patient with a mass in the superior and anterior areas of the mediastinum, where bronchogenic cysts are not usually found. The mass was therefore, thought to be a thymic cyst. The cyst was located just behind the sternum and in front of the left brachio-cephalic vein, and was 5.5 x 3.5 x 1.2 cm. It originated in the upper and median part of the thymus, and was not attached to the respiratory tract. Histological examination showed ciliacted epithelium and a layer of smooth muscle in the wall of the cyst. The cyst contained viscid, yellowish, turbid fluid. Preoperative computed tomography and magnetic resonance imaging showed findings characteristic of bronchogenic cysts, except for the location. We know of no previous reported case of a thymic cyst resembling a bronchogenic cyst.     

A case of a lumbar spinal synovial cyst located on the midline]

We report a case of lumbar spinal synovial cyst located on the midline. A 72-year-old man was admitted to our hospital with the chief complaint of low back pain radiating to the left buttock and posterior thigh. An MR image revealed an extradural cystic lesion adjacent to the dorsal side of the dural sac at the L4-5 level. The cyst was remote from the facet joints and existed on the midline just in front of the L4 lamina. A CT scan showed a concave deformity of the ventral aspect of the L4 lamina because of compression by the cyst. The patient underwent L4 laminectomy and total removal of the cyst. The cyst was in contact with the anterior surface of the ligamentum flavum and it had no connection with the facet joint. In the histological examination, the cyst was multilobular and lined with synovial epithelium. Therefore the cyst was diagnosed as a synovial cyst. After the operation, the pain radiating to the buttock and thigh completely disappeared. Intraspinal synovial cysts are usually located in the lower lumbar spine and most of them are adjacent to the facet joint. The cysts that are located on the midline are very rare. We review previous reports and discuss clinical and pathological features of spinal synovial cysts.     

Effect of mebendazole on free amino acid composition of cyst wall and cyst fluid of Echinococcus granulosus harbored in mice

Eighteen and 23 FAA components were detected in the cyst wall and cyst fluid of E granulosus, respectively, by using automatic amino acid analyzer. The concentrations of most of the determined FAA were higher in the cyst fluid than those in the cyst wall, especially the taurine was 5-fold higher. Mebendazole treatment resulted in an increase in the concentration of alanine, valine, lysine, and taurine in both cyst wall and cyst fluid, the most notable being the alanine in the cyst wall. The results are interpreted as a coupling of glycolysis and amino acid metabolism, suggesting an involvement of FAA metabolism in the mechanism of Meb action.     

Glioependymal and arachnoid cysts: unusual causes of early ventriculomegaly in utero

In this report we describe two cases of fetal midline intracranial cyst presenting with ventriculomegaly at routine detailed second-trimester scan. In the first case, additional findings included a banana-shaped hypoplastic cerebellum and macrocephaly; autopsy after termination of the pregnancy revealed a glioependymal cyst. In the second case, subsequent follow-up examination revealed a progressive increase in cyst size and worsening of ventriculomegaly; termination of pregnancy was performed at 24 weeks and autopsy confirmed an arachnoid cyst. These cases document interhemispheric cyst as a cause for early ventriculomegaly in utero.     

Supratentorial arachnoid cyst and associated subdural hematoma: neuroradiologic studies

CT and MR images of 8 patients with supratentorial arachnoid cyst complicated by subdural hematoma were studied and compared with those of 8 patients who developed nontraumatic subdural hematoma without arachnoid cyst. Of the 8 patients with supratentorial arachnoid cyst, CT and MR disclosed temporal bulging and/or thinning of the temporal squama in all 6 patients with middle fossa arachnoid cysts, and the thinning of the calvaria was evident in another patient with a convexity cyst. Calvarial thinning at the site corresponding to interhemispheric arachnoid cyst was clearly depicted on coronal MR images. In contrast, none of the 8 young patients with nontraumatic subdural hematoma without arachnoid cyst had abnormal calvaria. Temporal bulging and thinning of the overlying calvaria were identified as diagnostic CT and MR features of arachnoid cyst with complicating intracystic and subdural hemorrhage. Radiologists should be aware of this association and should evaluate the bony structure carefully.     

Immunological aspects of endocarditis

A case is described in which exact localization of a cystic lesion associated with the apices of the maxillary central incisor teeth was sought to aid diagnosis and presurgical planning. The area was imaged using cross-sectional tomographic slices in the sagittal plane produced by a Scanora multimodal tomographic unit (Orion Corporation Soredex, Helsinki, Finland). The images demonstrated the cystic lesion arising within the incisive canal, conforming a diagnosis of naso-palatine duct cyst. Surgery was therefore performed via a palatal approach giving direct access to the cyst. Histological examination of the enucleated cyst confirmed a nasopalatine duct cyst.     

Development of vimentin filaments in the cells of the articular disc of the rat squamosomandibular joint with age

The organochlorines, dichloro-diphenyl-trichloroethane and polychlorinated biphenyl (PCB) are pervasive environmental contaminants. Results from previous studies have been conflicting regarding the relationship between the internal dose of these organochlorine residues and breast cancer risk. To determine whether these compounds are present in breast cyst fluids and whether cyst fluid and plasma concentrations are correlated, we analyzed organochlorines in paired cyst fluid and plasma samples from 24 subjects using gas chromatography and electron capture detection. All but one of the women had a history of multiple cysts, suggesting that they were at elevated risk for future breast cancer. DDE (a metabolite of dichloro-diphenyl-trichloroethane) was present in 22 of the cyst samples and PCB was detected in 19 of the cyst samples. Organochlorine levels were more concentrated in the plasma than in breast cyst fluids. Levels of DDE in plasma were significantly correlated with those in cyst fluid (r = 0.73; P < 0.001); in contrast to PCB levels in cyst and plasma (r = 0.37; P = 0.12). Congener specific analysis of the PCBs showed that some individual congeners were preferentially excluded from or concentrated in the cyst fluid. To our knowledge, this study is the first to demonstrate that PCB and DDE are present in cyst fluids and thus in contact with the ductal epithelium of the breast. These results support the use of plasma DDE as a proxy for DDE in the target tissue in research on the role of environmental factors in breast cancer.     

Pneumo-orbital cyst after orbital fracture repair

PURPOSE: To report a case of a respiratory epithelial-lined, air-filled orbital cyst as a late complication of orbital fracture repair. METHOD: Case report. RESULTS: Recurrent episodes of diplopia and hyperophthalmia developed secondary to pneumatic inflation of a respiratory epithelial-lined orbital cyst 6 months after orbital fracture repair. This cyst remained in communication with an ethmoidal air cell and became inflated during pressurization of the ethmoid sinus. Removal of the cyst and orbital implant was curative. CONCLUSION: Air-filled, respiratory epithelial-lined orbital cyst is a rare cause of episodic diplopia and globe displacement after orbital trauma.     

A case of functioning parathyroid cyst

A case of functioning parathyroid cyst is reported. A 63-year-old woman consulted our hospital with the chief complaint of neck and joint pain. At that time, laboratory data showed a serum calcium level of 12.8 mg/dl and a phosphorus level of 2.2 mg/dl. Plasma levels of intact PTH were elevated to 278 pg/ml. Computerized tomography, ultrasonography and magnetic resonance imaging suggested parathyroid cyst on the left side of the thyroid gland. We performed left superior parathyroidectomy. The cyst measured 30 x 40 x 30 mm and was chocolate colored. The histopathological diagnosis was a functioning parathyroid cyst. Her postoperative course was uneventful and she was discharged on the 10th postoperative day without symptoms. To our knowledge, only 38 cases of functioning parathyroid cyst have been reported in the Japanese literature.     

Acute abdominal aorta embolism caused by primary cardiac echinococcus cyst

Embolism of the abdominal aorta by an echinococcus cyst is extremely rare and is due to rupture of an intracardiac hydatid cyst. We report a case of abdominal aortic embolism by a primary intracardiac echinococcus cyst which was treated successfully with bilateral femoral embolectomy followed by direct aortotomy. We found only 16 previous cases reported and only one caused by a primary cyst.     

Congenital mediastinal bronchogenic cyst with malignant transformation: an autopsy report

A rare autopsy case of mediastinal bronchogenic cyst with malignant transformation is presented. The cyst had been located in the anterior mediastinum for at least 28 years in a 52 year old male. Chest X-ray findings showing rapid enlargement of the cyst and biopsy of the spine for lumbago made a clinical diagnosis as suspicious mediastinal cystic teratoma with malignant transformation metastasizing to the spine. Postmortem examination revealed that the cyst was located in the anterior mediastinum extending to the left pulmonary hilum and had no connection with the tracheobronchial tree. The cyst wall consisted of bronchus-like tissue including ciliated epithelium, hyaline cartilage, smooth muscle and mucoserous glands. There were no teratomatous components in the wall. Malignant tumor predominantly consisting of round cells occurred in the thickened cyst wall and grew into the cyst cavity with direct invasion of the lung and metastases to the liver, adrenal glands, bone marrow of the lumbar spine and lymph nodes. An immunohistochemical study showed that the tumor cells frequently expressed cytokeratin, epithelial membrane antigen and carcino-embryonic antigen, occasionally CA19-9, vimentin and neuron-specific enolase. From these findings, the tumor was diagnosed as undifferentiated carcinoma arising in the mediastinal bronchogenic cyst.     

The diagnostic value of discography

BACKGROUND: Conjunctival cyst formation following enucleation may occur in 3% to 7% of patients receiving orbital implants, especially secondary implants. We present a patient with a giant epithelial inclusion cyst of the anophthalmic orbit 50 years after enucleation without orbital implant. PATIENT: A 54-year-old male presented with increasing proptosis of the ocular prosthesis, shallowing of the inferior fornix, a palpable orbital mass, and difficulty in retaining the ocular prosthesis. At the age of 1 year enucleation of the right eye without orbital implant was performed following perforating ocular trauma. Results of examination of the other eye were unremarkable. Transillumination of the orbital mass was possible. The clinical diagnosis of an epithelial inclusion cyst was confirmed using ultrasonography and CT scan. An incision of conjunctiva and cyst wall and subsequent marsupialization were performed. Nine months postoperatively there was no evidence of recurrence of the cyst. The ocular prosthesis was well in place. CONCLUSION: Conjunctival cyst formation following enucleation may rarely occur in patients receiving orbital implants, especially secondary implants. The presentation of a conjunctival cyst formation following enucleation without orbital implant 50 years after surgery is noteworthy in comparison to implantation cysts which are known to occur more commonly within the first two years following secondary orbital implants.     

Giant megalo-ureter and duplex kidney in an asymptomatic adult

An abdominal mass was palpated in an asymptomatic adult during a routine medical check-up. Ultrasonography and computed tomography scan diagnosed a simple renal cyst, a mesenteric cyst and a seminal vesicle cyst. At laparotomy a complete ureteral duplication and a giant ectopic megalo-ureter were diagnosed. Other complications were ruled out in the follow-up. Ureterectomy without heminephrectomy was performed and the patient remains asymptomatic 5 years after surgery.     

Cerebral healing after craniotomy to evacuate a Coenurus cerebralis cyst

An 11-month-old ewe developed neurological signs caused by a space-occupying lesion in the left cerebral hemisphere. Successful surgical evacuation of a Coenurus cerebralis cyst was carried out, the neurological signs regressed and the ewe produced twins in the following breeding season. Sixteen months after the surgical treatment the ewe was found dead and necropsy revealed a vegetative endocarditis. In the brain, at the site of cyst evacuation, there was a collapsed subcortical cavity lined by siderotic fibrovascular tissue and surrounded by a modest glial reaction. These observations confirm that the clinical signs of cerebral coenuriasis are related to the space-occupying effect of the parasitic cyst and indicate that partial replacement by gliomesodermal tissue plays a part in healing of the collapsed cyst.     

Morphologic analysis of odontogenic cysts with computed tomography

PURPOSE: The purpose of this study was to analyze the effects of lesion site and epithelial keratinization on the morphologic characteristics of odontogenic cysts and clarify determinate factors for cyst morphology. MATERIAL AND METHODS: Computed tomographic images of 92 odontogenic cysts were analyzed: 31 primordial, 31 dentigerous and 30 radicular. Thirty-four cysts were located in the maxilla (6 primordial, 10 dentigerous, and 18 radicular) and 58 in the mandible (25 primordial, 21 dentigerous, and 12 radicular). Histologically, 31 cysts showed epithelial keratinization (18 primordial and 13 dentigerous). No keratinization was seen in radicular cysts. The morphologic features of cysts were assessed by measuring long length parallel to dental arch and short length vertical to it and calculating the long/short ratio. In addition, the computed tomography pattern of the cyst was classified into unilocular, lobulated, and multilocular patterns. Appearance of the sclerotic rim and surrounding cortex were classified into three and four patterns respectively to evaluate the developmental features of the cyst. RESULTS: As a whole, the long length of the primordial cysts was statistically larger than the other two cyst groups and resulted in a larger long/short ratio. Statistical differences of CT pattern were also seen among cyst groups. There was no preference in any cyst group for the appearance of the sclerotic rim and cortex. There were statistical differences between maxilla and mandible in short axis and long/short ratio. The maxillary cysts generally showed round shapes irrespective of their histologic characteristics. A multilocular pattern was more frequent in the keratinized group of mandibular primordial cysts. In dentigerous cysts, a multilocular pattern was seen only in the keratinized group and the long/short ratio was statistically larger; cyst shape was elliptical along the long axis. CONCLUSION: Our results demonstrated morphologic differences of odontogenic cysts caused by lesion site and keratinization. The dentigerous cyst with predominant keratinization should be included in the primordial cyst (odontogenic keratocyst) group.     

Ethanol sclerosis: one of the best treatments for thymic cyst in very elderly patients?

An 83-year-old female patient with a giant thymic cyst that was successfully treated by percutaneous aspiration and ethanol injection. The patient had complained of coughing and chest discomfort for several years. A chest X-ray film revealed the shadow of a large abnormal mass in the anterior mediastinum. We diagnosed it as a thymic cyst. The patient refused surgery because of her age. We chose a less invasive therapy, namely, ethanol sclerosis of the cyst. The cyst was successfully treated without any complications, and no recurrence was found at the one-year follow-up. This therapy may be one of the best treatments for thymic cysts, especially in very elderly patients.