Benign Cystic Tumors Research Articles

Giant biliary cyst rupture during pregnancy. A case report

Biliary-hepatic cyst is a rare benign cystic neoplasm that in most cases occurs inside the intrahepatic bile ducts. Clinical signs and symptoms are non-specific, and there is no single treatment strategy. Modern highly informative imaging methods, such as ultrasound, computed tomography and magnetic resonance imaging, in most cases allow the diagnosis of biliary cysts, however, during pregnancy, especially in the second and third trimesters, diagnosis can be significantly complicated due to the large size of the uterus. The article presents a rare case of biliary cyst rupture in a pregnant woman diagnosed during laparotomy. The patient was admitted for emergency surgery with a preliminary diagnosis of a rupture of a giant ovarian cyst. During the surgery, it was found that a biliary cyst emanating from the liver had ruptured, followed by the development of biliary peritonitis, which required the involvement of an abdominal surgeon to excise the cyst capsule along with the gallbladder. For further treatment, the patient was transferred to a specialized surgical department of a multidisciplinary hospital. The course of the postoperative period passed without complications. The patient was discharged from the hospital in a satisfactory condition on the 10th day.

Imaging of pancreatic serous cystadenoma and common imitators.

Pancreatic cystic neoplasms are lesions comprised of cystic components that show different biological behaviors, epidemiology, clinical manifestations, imaging features, and malignant potential and management. Benign cystic neoplasms include serous cystic neoplasms (SCAs). Other pancreatic cystic lesions have malignant potential, such as intraductal papillary mucinous neoplasms and mucinous cystic neoplasms. SCAs can be divided into microcystic (classic appearance), honeycomb, oligocystic/macrocystic, and solid patterns based on imaging appearance. They are usually solitary but may be multiple in von Hippel-Lindau disease, which may depict disseminated involvement. The variable appearances of SCAs can mimic other types of pancreatic cystic lesions, and cross-sectional imaging plays an important role in their differential diagnosis. Endoscopic ultrasonography has helped in improving diagnostic accuracy of pancreatic cystic lesions by guiding tissue sampling (biopsy) or cyst fluid analysis. Immunohistochemistry and newer techniques such as radiomics have shown improved performance for preoperatively discriminating SCAs and their mimickers.

Retroperitoneal lymphangioma in a tertiary care hospital of North India

Less than 200 cases of retroperitoneal lymphangiomas (RL), a rare type of benign cystic tumour of the lymphatic system that makes about 1% of all lymphangiomas, have been documented to date. Their rarity makes preoperative diagnosis challenging. 95% of lymphangiomas are found in the head, neck, and axilla where they are most frequently found. We are presenting a 30 years old woman, who presented to outpatient department (OPD) of general surgery with symptoms of recurrent left lumbar pain, radiating towards inguinal region for one month. The contrast computed tomography (CT) scan of abdomen and pelvis defined a large thin walled homogenous non enhancing hypodense cystic lesion in left side of abdomen in retroperitoneal location from left lobe of liver till pelvis on left side craniocaudally. The patient was planned for exploratory laparotomy. Midline laparotomy was performed. A cystic lymph-filled tumour was detected in the abdominal cavity adjacent to the bowel loops. Histologically the mass contained variable-sized cystic spaces lined by flattened endothelium consistent with lymphatic vessels, which on immunostaining were positive for CD31 and negative for Pan CK. The patient was discharged satisfactorily. In conclusion, retroperitoneal lymphangioma presents vaguely as abdominal pain or mass and grown to large sizes without causing any significant symptom. Tumour markers for the excised tissue are important for diagnosis. Laparotomy or laparoscopy are the two surgical excision methods used to treat retroperitoneal cystic lymphangioma and it responds well to excision.

β-cell dedifferentiation in HOMA-βlow and HOMA-βhigh subjects.

β-cell dedifferentiation ratio is increased in type 2 diabetes; but its direct link to in vivo β-cell function in human remains unclear. The present study was designed to investigate whether β-cell dedifferentiation in situ was closely associated with β-cell function in vivo and to identify targets crucial for β-cell dedifferentiation/function in human. We acquired HOMA-β values, calculated the number of hormone-negative endocrine cells and evaluated important markers and novel candidates for β-cell dedifferentiation/function on paraneoplastic pancreatic tissues from 13 patients with benign pancreatic cystic neoplasm (PCN) or intrapancreatic accessory spleen. Both β-cell dedifferentiation ratio and dedifferentiation marker (Aldh1a3) were inversely related with in vivo β-cell function (HOMA-β) and in situ β-cell functional markers Glut2 and Ucn3 in human. Moreover, the islets from HOMA-βlow subjects were manifested as 1) increased β-cell dedifferentiation ratio, 2) enriched dedifferentiation maker Aldh1a3, and 3) lower expression of Glut2 and Ucn3, compared to those from HOMA-βhigh subjects. We found that basic leucine zipper transcription factor 2 (Bach2) expression was significantly induced in islets from HOMA-βlow patients and was positively correlated with the ratio of β-cell dedifferentiation in human. Our findings emphasize the contribution of β-cell dedifferentiation to β-cell dysfunction in human. The Bach2 induction in β-cells with higher frequency of dedifferentiation observed in HOMA-βlow subjects reinforce its distinctive role as a pharmaceutical target of β-cell dedifferentiation for the treatment of human diabetes.

IgG4-related disease with subcutaneous involvement and the associated diagnostic challenges with MRI.

IgG4-related disease is a rare fibroinflammatory disorder characterized by the infiltration of IgG4-rich plasma cells. Herein, we report a case of IgG4-related disease of the subcutaneous tissue with atypical MRI findings and difficulties in the histopathological examination using needle biopsy. Based on the clinical presentation and MRI findings, the patient was diagnosed with a benign myxoid or cystic tumor. Additionally, histopathological findings from a needle biopsy suggested a myxoma. Therefore, the correct diagnosis of IgG4-related disease was not made preoperatively. The resected specimens confirmed IgG4-related disease with an IgG4/IgG ratio > 80%. Previous reports have shown that the MRI findings of IgG4-related disease mimic both malignancy and inflammation; surprisingly, the features of subcutaneous IgG-related disease, including tail sign, unclear border, and heterogeneous enhancement, were similar to those found in sarcoma. Therefore, histopathological findings are needed for a correct diagnosis. Furthermore, careful examination is essential because the neoplasm and inflammation may overlap with IgG4-related disease, and needle biopsy is not fully reflective of the tumor. As is highlighted in the present case, IgG4-related disease is often misdiagnosed; therefore, clinicians should adequately recognize that even if the histopathological findings in biopsy were consistent with those observed in the MRI, misdiagnosis may occur.

Seromucinous tumors of ovary: A case series

Seromucinous neoplasms are new category of ovarian epithelial tumor in the 2014 revised World Health Organization classification. Surface epithelial neoplasms are the most common ovarian tumors. Based on the degree of stratification and the presence or absence of invasion, these epithelial proliferations are further divided into benign, borderline, and malignant categories. Benign tumors are divided into three subtypes: cystadenoma (cystic areas), cystadenofibroma (cystic and fibrous areas), and adenofibroma (predominantly fibrous sections). Serous adenofibromas are rare variant of serous surface epithelial tumors. They affect females between the ages of 15 and 65 and make up 1.7% of all benign ovarian tumors. Serous tumor with a solid, fibrous component is designated as serous cystadenofibroma in which both serous and mucinous components are closely intermixed. Seromucinous adenofibroma is a benign cystic neoplasm composed of glands and cysts lined by an admixture of bland mullerian type epithelium which includes ciliated, endocervical type mucinous, and endometroid. They have a characteristic prominent fibromatous hypocellular stroma which helps differentiate it from the commoner cystadenoma. Seromucinous borderline tumors is 10% -20% of all epithelial ovarian tumors. Develops in younger age, usually bilateral in upto 40%, associated with endometriosis. We discuss about four different cases of seromucinous tumor reported in our institute.

Novel diagnostic biomarkers for pancreatic cancer: assessing methylation status with epigenetic-specific peptide nucleic acid and KRAS mutation in cell-free DNA.

Pancreatic ductal adenocarcinoma (PDAC) is an aggressive tumor with a poor prognosis that poses challenges for diagnosis using traditional tissue-based techniques. DNA methylation alterations have emerged as potential and promising biomarkers for PDAC. In this study, we aimed to assess the diagnostic potential of a novel DNA methylation assay based on epigenetic-specific peptide nucleic acid (Epi-sPNA) in both tissue and plasma samples for detecting PDAC. The study involved 46 patients with PDAC who underwent surgical resection. Epi-TOP pancreatic assay was used to detect PDAC-specific epigenetic biomarkers. The Epi-sPNA allowed accurate and rapid methylation analysis without bisulfite sample processing. Genomic DNA extracted from paired normal pancreatic and PDAC tissues was used to assess the diagnostic efficacy of epigenetic biomarkers for PDAC. Subsequent validation was conducted on cell-free DNA (cfDNA) extracted from plasma samples, with 10 individuals represented in each group: PDAC, benign pancreatic cystic neoplasm, and healthy control. The combination of seven epigenetic biomarkers (HOXA9, TWIST, WT1, RPRM, BMP3, NPTX2, and BNC1) achieved 93.5% sensitivity and 96.7% specificity in discerning normal pancreatic from PDAC tissues. Plasma cfDNA, analyzed using these markers and KRAS mutations, exhibited a substantial 90.0% sensitivity, 95.0% specificity, and an overall 93.3% accuracy for discriminating PDAC. Notably, cancer antigen 19-9 and carcinoembryonic antigen both had an accuracy of 90.0%. Our study suggests that analyzing seven differentially methylated genes with KRAS mutations in cfDNA using the novel Epi-TOP pancreatic assay is a potential blood-based biomarker for the diagnosis of PDAC.

Reassessment of EUS features in preoperative diagnosis of pancreatic serous cystic neoplasm: Lessons to avoid misdiagnosis.

Pancreatic serous cystic neoplasm (SCN) is a benign cystic neoplasm that is likely to be surgically resected due to preoperative misdiagnosis or tentative diagnosis even using endoscopic ultrasonography (EUS). We aimed to analyze EUS findings of SCN associated with misdiagnosis. Between January 2012 and September 2023, histologically confirmed pancreatic SCN were included and EUS features were reviewed. Overall, 294 patients with 300 surgically resected SCNs were included. The median age of the patients was 51 years and 75.9% were females. The lesions were predominantly located in the body/neck/tail of the pancreas (63.0%). The overall preoperative diagnostic rate of SCN was 36.3%, with the most common misdiagnosis being intraductal papillary mucinous neoplasm (IPMN) (31.3%), while 16.3% remained undefined. The preoperative diagnostic rate of SCN varied across different endosonographic morphologies, with oligocystic, macrocystic, microcystic, and solid patterns yielding rates of 12.8%, 37.9%, 76.5%, and 19.2%, respectively. Notably, the presence of central scar and vascularity improved the diagnostic accuracy and correctly identified 41.4% and 52.3% of thelesions. While mucus or pancreatic duct (PD) communication significantly increased the likelihood of misdiagnosis, particularly as IPMN. Multivariate analysis revealed a morphological pattern, mucin-producing signs, wall thickening, vascularity, and PD communication were independent factors related to preoperative misdiagnosis, with an overall accuracy of 82.3%. Preoperative diagnosis of SCN remains challenging. The microcystic pattern emerged as a reliable feature, while mucin-producing signs, including mural nodules, mucus, and PD communication, pose diagnostic pitfalls despite the presence of typical central scar or vascularity commonly in SCN.

Fragmentomics of cell-free DNA as a sensitive biomarker for early detection of pancreatic cancer.

4173 Background: Pancreatic ductal adenocarcinoma (PDAC) is one for the most lethal types of cancer. Nearly 80% of the PDAC patients are diagnosed at advanced unresectable stages. Therefore, an accurate early diagnosis assay is urgently needed for reducing PDAC related mortalities. In this study, we aim to utilize cfDNA fragmentomics and machine learning techniques for sensitively detecting PDAC patients. Methods: Total647 cases were prospectively enrolled in this study. Plasma samples were collected from each participant for shallow WGS (~5X). After quality control process, 166 PDAC patients and 167 healthy controls were enrolled as a training cohort. Additional 112 PDAC patients and 111 healthy controls were included as an independent validation cohort. Additional 67 cases with pancreatic benign cystic tumors were also enrolled for model validation including IPMN (Intraductal papillary mucinous neoplasms), MCN (Mucinous cystic neoplasms) and SCN (Serous cystic neoplasms). Four fragmentomics profiles, including copy number variation, fragment size, mutation signatures, and FRAGmentomics-based Methylation Analysis (FRAGMA) were utilized by a machine learning algorithm for developing a predictive model. Results: The predictive model showed an exceptional performance to distinguish PDAC patients from healthy controls, yielding Area Under the Curve (AUC) of 0.993 in the training cohort (5-fold cross validation) and 0.990 in the validation cohort. In the training cohort, our model was capable of detecting PDAC patients at sensitivity of 95.8% and specificity of 95.2% while using 0.49 as cutoff. The validation cohort achieved 99.1% sensitivity at 91.0% specificity while applying the same cutoff. Conclusions: Our model was able to accurately detect PDAC at early stages, by incorporating fragmentomics features through machine learning. It can potentially be used for PDAC early screening, and therefore reducing PDAC related mortalities.

Optimizing the kidney donor pool: transplanting donor kidneys after partial nephrectomy of masses or cysts.

A limiting factor in expanding the kidney donor pool is donor kidneys with renal tumors or cysts. Partial nephrectomy (PN) to remove these lesions prior to transplantation may help optimize organ usage without recurrence of malignancy or increased risk of complications. We retrospectively analyzed all recipients of a living or deceased donor graft between February 2009 and October 2022 in which a PN was performed prior to transplant due to the presence of one or more concerning growths. Donor and recipient demographics, perioperative data, donor allograft pathology, and recipient outcomes were obtained. Thirty-six recipients received a graft in which a PN was performed to remove suspicious masses or cysts prior to transplant. Majority of pathologies turned out to be a simple renal cyst (65%), followed by renal cell carcinoma (15%), benign multilocular cystic renal neoplasm (7.5%), angiomyolipoma (5%), benign renal tissue (5%), and papillary adenoma (2.5%). No renal malignancy recurrences were observed during the study period (median follow-up: 67.2 months). Fourteen complications occurred among 11 patients (30.6% overall) during the first 6mo post-transplant. Mean eGFR (± standard error) at 36 months post-transplant was 51.9 ± 4.2 ml/min/1.73 m2 (N = 23). Three death-censored graft losses and four deaths with a functioning graft and were observed. PN of renal grafts with suspicious looking masses or cysts is a safe option to optimize organ usage and decrease the kidney non-use rate, with no observed recurrence of malignancy or increased risk of complications.

Long-Term Oncologic Outcome following Duodenum-Preserving Pancreatic Head Resection for Benign Tumors, Cystic Neoplasms, and Neuroendocrine Tumors: Systematic Review and Meta-analysis

BackgroundPancreatoduodenectomy (PD) has a considerable surgical risk for complications and late metabolic morbidity. Parenchyma-sparing resection of benign tumors has the potential to cure patients associated with reduced procedure-related short- and long-term complications.Materials and MethodsPubmed, Embase, and Cochrane libraries were searched for studies reporting surgery-related complications following PD and duodenum-preserving total (DPPHRt) or partial (DPPHRp) pancreatic head resection for benign tumors. A total of 38 cohort studies that included data from 1262 patients were analyzed. In total, 729 patients underwent DPPHR and 533 PD.ResultsConcordance between preoperative diagnosis of benign tumors and final histopathology was 90.57% for DPPHR. Cystic and neuroendocrine neoplasms (PNETs) and periampullary tumors (PATs) were observed in 497, 89, and 31 patients, respectively. In total, 34 of 161 (21.1%) patients with intraepithelial papillar mucinous neoplasm exhibited severe dysplasia in the final histopathology. The meta-analysis, when comparing DPPHRt and PD, revealed in-hospital mortality of 1/362 (0.26%) and 8/547 (1.46%) patients, respectively [OR 0.48 (95% CI 0.15–1.58); p = 0.21], and frequency of reoperation of 3.26 % and 6.75%, respectively [OR 0.52 (95% CI 0.28–0.96); p = 0.04]. After a follow-up of 45.8 ± 26.6 months, 14/340 patients with intraductal papillary mucinous neoplasms/mucinous cystic neoplasms (IPMN/MCN, 4.11%) and 2/89 patients with PNET (2.24%) exhibited tumor recurrence. Local recurrence at the resection margin and reoccurrence of tumor growth in the remnant pancreas was comparable after DPPHR or PD [OR 0.94 (95% CI 0.178–5.34); p = 0.96].ConclusionsDPPHR for benign, premalignant neoplasms provides a cure for patients with low risk of tumor recurrence and significantly fewer early surgery-related complications compared with PD. DPPHR has the potential to replace PD for benign, premalignant cystic and neuroendocrine neoplasms.

Pathogenesis of EMA negative PR negative Microcystic Meningioma: A Case Report

A patient, aged 35 years female complained of headache. CT examination revealed a non-succable tumor at anterolateral aspect of dura. Tumor extended from the right cervicomedullary junction upto C7 level. Tumor was excised and multiple soft tissue pieces, together measuring 1.5×1×1 cm were cellected. All the pieces were sectioned. Tumor had a sieve-like and cyst-like appearance. Section showed a circumscribed globular tumor which consisted of proliferated bland spindle cells. Tumor had an edematous stroma and presented a microcystic appearance. The cells had elongated ovoid nuclei and mild eosinophilic cytoplasm. Several thin-walled vascular spaces were also seen in the tumor. Strong positive reaction was obtained with an anti-S100 antibody, suggesting a neural origin of tumor cells. Further, anti-Ki 67 antibody gave mild reaction (Ki67 index was 12%) suggesting benign neoplasm. Anti-CD 34 and anti-D2.40antibodies gave positive reactions (2+) with small blood vessels of the tumor. Keywords: Benign cystic neoplasm with similar behavior among various subtypes.

Voluminous Amygdaloid Cyst: A Case Report

Amygdaloid cysts also known as lymphoepithelial cysts or branchial cleft cysts are rare and benign dysembryological cystic tumors that develop in the antero-lateral part of the neck; they represent 2% of laterocervical tumors of the neck. Originating from the second branchial cleft, due to the persistence of the cervical sinus during the differentiation of the branchial apparatus. We report the case of a 34-year-old man who consulted for a huge right laterocervical swelling that had been gradually increasing in volume for 8 months without any other associated symptoms. A cervicotomy and a complete resection of the cyst was performed, histopathological examination of the surgical specimen confirmed the diagnosis of the amygdaloid cyst without signs of malignancy. The aims of this study are to analyze the anatomo-clinical features and to discuss the modalities of care and the therapeutic indications of this affection.

Natural history and growth prediction model of pancreatic serous cystic neoplasms

ObjectiveSerous cystic neoplasms (SCN) are benign pancreatic cystic neoplasms that may require resection based on local complications and rate of growth. We aimed to develop a predictive model for the growth curve of SCNs to aid in the clinical decision making of determining need for surgical resection. MethodsUtilizing a prospectively maintained pancreatic cyst database from a single institution, patients with SCNs were identified. Diagnosis confirmation included imaging, cyst aspiration, pathology, or expert opinion. Cyst size diameter was measured by radiology or surgery. Patients with interval imaging ≥3 months from diagnosis were included. Flexible restricted cubic splines were utilized for modeling of non-linearities in time and previous measurements. Model fitting and analysis were performed using R (V3.50, Vienna, Austria) with the rms package. ResultsAmong 203 eligible patients from 1998 to 2021, the mean initial cyst size was 31 mm (range 5–160 mm), with a mean follow-up of 72 months (range 3–266 months). The model effectively captured the non-linear relationship between cyst size and time, with both time and previous cyst size (not initial cyst size) significantly predicting current cyst growth (p < 0.01). The root mean square error for overall prediction was 10.74. Validation through bootstrapping demonstrated consistent performance, particularly for shorter follow-up intervals. ConclusionSCNs typically have a similar growth rate regardless of initial size. An accurate predictive model can be used to identify rapidly growing outliers that may warrant surgical intervention, and this free model (https://riskcalc.org/SerousCystadenomaSize/) can be incorporated in the electronic medical record.

Pancreatic Serous Cystadenoma: A Continuing Diagnostic Challenge.

Objective: To understand the natural history of serous cystadenoma. To understand the diagnostic accuracy of serous cystadenoma and identify possible factors that lead to the correct diagnosis. Summary Background data: Serous cystadenoma (SCA) is a benign cystic pancreatic neoplasm of the pancreas, accounting for approximately 15% of resected pancreatic cysts. Current recommendations are to proceed with surgical resection in symptomatic patients or when there is uncertainty regarding diagnosis. The latter continues to be a challenge since intentional resection of a serous cystadenoma account for only a minority of resected of cases. Methods: Retrospective single-institution review of patients who on final pathology had a diagnosis of pancreatic serous cystadenoma and of patients who had this diagnosis and were managed non-operatively. Demographic data, cyst characteristics, and growth rate were collected for analysis. Results: A total of 250 patients were analyzed. Median age was 62 (range 22 – 89), 65% were female, and 34% had symptoms. Tumor size ranged from 0.6 to 20, with a median of 3.4 cm. The morphological appearance was microcystic in 58%, macrocystic in 16%, mixed-type in 23%, and solid in 3%. Pancreatic duct dilation and pancreatic atrophy were found in 22% and 14%, respectively. The average growth rate was 1.8 mm/year regardless of tumor size. Of the 172 patients who underwent surgery, serous cystadenoma was the preoperative diagnosis in only 33%. A correct diagnosis was independently associated with large tumors and cyst fluid CEA analysis. Pancreatic duct dilation was independently associated with an in-growing cyst and presence of calcification. Conclusion: SCA is a slow-growing pancreatic cystic neoplasm that is mostly asymptomatic but can lead to pancreatic duct dilation and atrophy in some patients. A surprisingly small number of correct preoperative diagnoses confirms that this entity continues to be a diagnostic challenge. A more thorough preoperative workup that includes EUS should improve the rate of mis-diagnosis.

Retroperitoneal cystic lymphangioma in adult female

Abstract One percent of all lymphangiomas are retroperitoneal lymphangiomas, which are uncommon benign cystic lymphatic tumors. Lymphangioma mainly occurs in the age group of &lt;2 years. This report describes retroperitoneal cystic lymphangioma in a 29-year-old female. She had a complaint of abdominal pain in the right lower region. The provisional diagnosis based on computed tomography scan was retroperitoneal mass. By en bloc, resection cyst was completely removed.

Dermoid cysts masquerading as pilonidal sinus disease

BACKGROUND: Dermoid cysts (DC) are benign cystic tumors formed because of impaired embryogenesis processes when ectodermal rudiments are immersed in tissues and organs along the lines of their embryonic fusion. DC is most often localized in the head and neck (84%). Rarer localizations areas are as follows: 1) ovaries; 2) retroperitoneal space; 3) mediastinum; 4) pancreas and spleen; 5) spinal canal. In case of retroperitoneal localization of DC, the presacral location occurs more often, then location in soft tissues of the sacrococcygeal region. Moreover, the clinical pattern may be similar to that of pilonidal disease, which may cause difficulties in diagnosis at the preoperative diagnostics and further determination of the surgical techniques.&#x0D; CLINICAL CASES DESCRIPTION: In the Clinic of colorectal and minimally invasive surgery, two clinical cases of dermoid cysts masquerading as pilonidal sinus disease were encountered. In both cases, Bascom II surgery was performed. Macroscopic examination of the specimens revealed pathognomonic signs of dermoid cysts: a hair growth site on the epithelial lining of the cyst in the first case and the presence of sebum in the cyst cavity in the second case. The early postoperative period in both patients proceeded smoothly, and no data were obtained for recurrence in the 6- and 18-month follow-up period.&#x0D; CONCLUSION: Because of the similar clinical picture of pilonidal cysts and DC of the sacrococcygeal region, differential diagnosis is crucial. A wide range of minimally invasive methods are available for treating pilonidal disease; however, they are not appropriate for the treatment of DC. At present, the only radical method of treating DCs of the sacrococcygeal region is excision of the cyst without rupturing the capsule to prevent disease recurrence.

Apocrine cystadenoma: A long-standing apocrine hidrocystoma with an adenomatous proliferation.

Apocrine cystadenoma is a rare, benign adenomatous cystic neoplasm, the pathogenesis of which is not fully understood. We sought to characterize the clinical, dermatoscopic, and histopathologic features of apocrine cystadenoma and its relationship to hidrocystoma. We retrospectively analyzed cases of apocrine cystadenoma and hidrocystoma retrieved from the dermatopathology laboratory information system. Of the 350 cases apocrine cystic lesions, 13 cases of apocrine cystadenomas met the inclusion criteria. The age ranged from 20 to 84 years with an average of 64 years. They were long-standing (duration 3-15 years), slow-growing, large tumors usually found on the scalp. Dermatoscopy accentuated translucent light to dark blue color and prominent vessels that were present more at the periphery. All lesions were multilocular with columnar to cuboidal lining and decapitation secretion. A large portion of the lesion consisted of a simple nonproliferative epithelial lining, identical to that observed in apocrine hidrocystomas, while the proliferative adenomatous component made up a smaller portion with two patterns: (1) tubular proliferation, which either protruded into the cystic cavity or expanded outward peripherally, or (2) papillary projections, which were multiple layers thick with fibrovascular core, sometimes accompanied by tubular proliferation. Immunohistochemical stains showed strong staining for p40 and a sparse number of cells stained for Ki-67 and p53. The long duration of the lesion and the large areas of simple apocrine epithelial lining suggest that apocrine cystadenomas arise from long-standing apocrine hidrocystomas. However, the retrospective nature of the study from a single institution is a limitation.

Sclerotherapy as a primary or salvage procedure for aneurysmal bone cysts: A single-center experience.

Aneurysmal bone cysts (ABC) are benign cystic bone tumors of an osteolytic and locally aggressive nature. As an alternative to the primary treatment of choice, which consists of curettage with bone grafting, alternative treatment methods with promising results have been described. At our department, we have, in recent years, used percutaneous sclerotherapy with polidocanol. The objective of this study was to identify the healing rate and safety of sclerotherapy with polidocanol. To identify the efficacy and safety of sclerotherapy with polidocanol in primary and recurrent ABC. Twenty-two consecutive patients (median age 12.5 years; range 1-27) with 23 ABCs treated with sclerotherapy with polidocanol from 2016-2021 were included retrospectively. Eleven patients (48%) had undergone different forms of previous treatment with recurrence. Under general anesthesia and fluoroscopic guidance, repeated percutaneous injections of 4mg polidocanol/kg body weight were performed. Through review of the electronic medical records, the following were identified: healing and recurrence rate, number of treatments, gender, age, comorbidity, location of the tumor and side effects / complications, as well as any previous surgery for ABC. The median length of radiographic follow-up was 19.5 mo. All ABCs except one (96%) showed healing or stable disease after a median of 4 (range 1-8) injections. Complete clinical and radiographic healing was observed in 16 cysts (70%), while partial radiographic healing with resolution of pain was seen in 6 cases (26%) and considered as stable disease. The cyst that failed to heal had previously undergone curettage twice with recurrence. One patient with a large pelvic ABC experienced, right after two injections, a sudden drop in blood pressure, which could quickly be reversed. One patient with a juxtaphyseal ABC in the femoral neck showed a minor limb length discrepancy because of deformity. Beyond that, no complications were observed. Percutaneous sclerotherapy with polidocanol appears to be a safe alternative for treatment of aneurysmal bone cysts. In our series of both primary and recurrent cysts, it showed the ability to achieve healing or stable disease in 22 of 23 cases (96%). Further studies are needed to decide if this provides a long-lasting effect.

Vallecular Cholesterol Granuloma: Case Report

Introduction. Cholesterol granuloma is a rare benign cystic neoplasm characterised by a fibrous capsule, and a cystic fluid containing cholesterol crystals, multinucleated giant cells, erythrocytes and haemosiderin. Cholesterol granulomas are usually found in diverse parts of the temporal bone, most commonly – petrous apex. Very few cases of cholesterol granulomas in other organs have been reported, to our knowledge none are reported in the larynx. The main purpose of this case report is to highlight this extremely rare laryngeal lesion and its unique macroscopic appearance. Case report. A 55-year-old man is referred to the Ear, Nose and Throat Centre because of persistent hoarseness, globus sensation and complicated intubation due to a mass in the larynx. Videolaryngoscopy showed a large cyst-like mass in the vallecula, epiglottis was displaced towards the posterior pharyngeal wall and erythema of interarytenoid notch and arytenoid tubercle was present. A computerized tomography scan confirmed a cystic mass on the lingual surface of the epiglottis. On the basis of the examination and clinical symptoms, a diagnosis of chronic laryngitis, gastro-oesophageal reflux and an unspecified benign tumour of the respiratory system was made, surgical treatment was planned. The patient underwent microlaryngoscopy and surgical extirpation of the cyst using a CO2 laser, as the cyst was opened a yellowish, shiny, viscous fluid was observed. Two days later, laryngoscopy revealed fibrin plaque at the site of the cyst. Final diagnosis of cholesterol granuloma was formed based on histological examination of the mass. Conclusions. Cholesterol granulomas and masses in vallecula are extremly rare, but this case shows that cholesterol granuloma can be included in the differential diagnosis of cystic neoplasms of the larynx.