Benign Cystic Tumors Research Articles

Non-functional thyroid cystadenoma in three boxer dogs

BackgroundThyroid neoplasia is a common endocrine neoplasm in dogs. The boxer is one of the reported breeds predisposed to malignant thyroid neoplasia. However, the association between thyroid neoplasia, malignancy and breed should be considered with caution.Cases presentationThis article describes the presentation, clinical pathological findings, computed tomographic (CT) imaging findings and histopathological features of benign cystic thyroid tumour (cystadenoma) diagnosed in three boxers. These three dogs were presented for investigation of unilateral (n = 2) or bilateral (n = 1) cervical masses with no associated clinical signs of thyroid dysfunction. In each case, post-contrast CT scan identified a large, lateralised, non-invasive, well-defined homogeneous cystic structure with a hyperattenuating contrast-enhancing capsule of suspected thyroid origin displacing the surrounding cervical tissues. Ultrasound-guided fine needle aspiration of the cysts yielded fluid with a high thyroxine concentration in each case. Histopathology was consistent with thyroid cystadenoma in all cases. One dog was concurrently diagnosed with oral melanoma and euthanased. Two dogs underwent surgical excision with one lost to follow-up after 36 months and the other euthanased after 16 months following diagnosis of mast cell tumour.ConclusionsTo the authors’ knowledge, this is the first detailed report of non-functional benign thyroid cystadenoma in dogs and provides relevant information about case management for this type of tumour. The presence of a large cystic structure associated with benign non-functional thyroid neoplasia may be a condition to which boxer dogs are predisposed.

Totally Robotic Excision of Retroperitoneal Lymphangioma

Abstract Introduction: Lymphangiomas are benign congenital cystic tumors. They are rare and occur secondary to failure of lymphatic vessels to form normal connections within the lymphatic system du...

GIANT OVARIAN CYSTADENOMA IN A YOUNG PATIENT – A LAPAROSCOPIC APPROACH

Benign cystic ovarian tumors are frequent in teenagers and young adults due to hormonal imbalance and thanks to the existence of advanced imaging and early diagnosis methods, these tumors are promptly treated (conservative treatment – hormonal treatment). Occasionally, these tumors reach vast dimensions due to some patient’s negligence and only go to the doctor’s office when the tumor becomes visible to the naked eye. Surgical treatment for benign cystic ovarian tumors is laparoscopic because of the short recovery period and also because of a lower risk of developing postoperative eventration.
 We present the case of a 20-years-old patient, with history of right gigantic ovarian cystic tumor (~22 cm cranio-caudal diameter) diagnosed in another medical department (with the use of ultrasound, CT, MRI), presented for admission accusing pollakiuria and abdominal distension. Biohumoral testing had no significant alterations, tumor markers (CA 125 and HE4) and ROMA score within the normal range, suggesting the benign character of the tumor, alongside the CT and MRI results. We operated laparoscopic, using Hasson technique to puncture the cyst. The excision of the tumor was difficult (it was adherent to the uterus, the large ligament, parietal pelvic peritoneum and uterine wall). Postoperative evolution was favorable, histopathological examination showed the tumor was an ovarian serous cystadenoma.
 Conclusion is that periodic ob-gyn consultation and quick medical care in case of genital or abdominal symptoms occurrence could improve the chances of partial or total preservation of the said ovary and better chances of using laparoscopic approach in young patients.

Factors affecting complications after treatment of epidermal cyst.

BackgroundEpidermal cysts are the most common benign epithelial tumors in humans. The curative treatment of epidermal cyst is surgical excision. However, only few studies have investigated the cause and mechanism of postoperative complications of epidermal cysts. Therefore, this study aimed to evaluate the factors affecting complications of epidermal cyst after surgical treatment.MethodsPatients with histologically diagnosed epidermal cysts were selected from among 98 consecutive patients with excised benign cystic tumors from March 2014 to August 2017. Sex, age, size, mobility, site of occurrence, history of infection, history of incision and drainage, complications, history of reoperation, and method of overcoming complications was obtained by analyzing medical records retrospectively.ResultsFive of the 98 patients had wound dehiscence due to surgical infection. Three of them underwent wound healing with conservative treatment without a second operation. The other two patients underwent a second operation and showed signs of preoperative infection. None of the factors showed statistical significance in relation to the occurrence of complications.ConclusionPostoperative complications occurred when the excision of the epidermal cyst was performed at preoperative infection sites or at sites with high tension, so attention should be paid to postoperative care.

Case of Squamous Cell Carcinoma Transformation in Ovarian Mature Cystic Teratoma

Mature cystic teratoma (MCT) is the commonest benign tumour arising in an ovary. Malignant transformation in a MCT of ovary is exceptionallyrare, seen only in1-2% cases.The most common malignant transformation in a benign teratoma of ovary is squamous cell carcinoma. The other malignant transformations in teratoma include adenocarcinoma, melanoma and basal cell carcinoma. The patients having this malignant transformation in teratoma have a very low 5-year survival rate of 20% approximately. Here; we describe a case of advanced-stage squamous cell carcinoma arising in a mature cystic teratoma in a 34-year-old woman.This solid high grade malignancy was missed in the pre-operative imaging which showed a right adnexal mass with echogenic foci within and septations, and was reported as a dermoid cyst. The intraoperative frozen section too taken from the thin portion of the cyst wall was reported as cystic teratoma. However in the staging laparotomy,right salpingo-oophorectomy and left oophorectomy, specimen the patient was reported to have moderately differentiated squamous cell carcinoma arising in a benign mature cystic teratomawith extensive tumour necrosis with omental tumour deposits.In view of initial incomplete surgery and advanced stage, decision of completion cytoreductive surgery was taken. The patients with mature cystic teratoma with high age (post-menopausal), a size of more than 10 cm and increased serum tumour markers should be suspected to have a malignant transformation and should be investigated thoroughly.

Premalignant Lesions of the Biliary Tract.

Although the most common presentation of biliary disorder in North America is secondary to gallstone disease, an awareness of benign biliary cystic neoplasms is important because of the risk of malignant transformation. The incidence of premalignant cystic neoplasms of the bile duct is not well characterized and they often are detected incidentally for suspicion of other abdominal disorders. This article describes the 4 most common premalignant biliary cystic neoplasms: biliary mucinous cystic neoplasms, intraductal papillary mucinous neoplasms of the bile duct, intraductal tubular papillary neoplasms of the bile duct, and choledochal cysts.

A retrospective study on ovarian cystectomy

The ovaries are paired gonads in females and are concerned with germ cell maturation, storage and its release. The ovaries are also concerned with steroidogenesis. Ovary is covered by a single layer of cuboidal cells known as germinal epithelium. As per the clinical features of the benign ovarian tumors, benign tumors predominantly manifest in late reproductive age. Methods: This is a retrospective study, where 64 cases of ovarian cyst during the period of Jan 2017 to Jan 2018 at Department of Obstetrics and Gynaecology, KVG Medical College and Hospital, Sullia were included in the study. Analysis of the ovarian cyst cases during this period was done to know the histopathology and clinical symptoms of patients who required the surgery for ovarian cysts. Another objective was to compare the clinical symptoms, ultrasonographic features and histopathology of patients who required the surgery for ovarian cysts. 46 cases were operated laparoscopically and patients who had large mass and unfit for laparoscopic surgery underwent conventional laparotomy. Results: As we analysed retrospectively these 64 cases, there were 30 (46.8%) cases of benign cystic ovarian tumors, of which 12 (18.75%), cases were serous cystadenoma which was the commonest of all in this study. This was followed by mature cystic teratoma in 11 (17.1%) and mucinous cystadenoma 6 (9.37%). We came across only one (1.23%) case of malignant ovarian tumor, which was found in a postmenopausal woman. Borderline malignancy was encountered in 1 patient (1.56%), which was a borderline mucinous tumor. Conclusions: Benign cystic ovarian tumors were common cause of ovarian cysts and of which serous cystadenoma was the commonest. Patients presented with vague symptoms, hence clinical symptoms could not differentiate between the type of cyst. Ultrasonography and histopathology helps us to arrive to definitive diagnosis but however histopathology gives us the final diagnosis.

Large peri-punctal eccrine hidrocystoma

Eccrine hidrocystoma is a benign cystic tumor. Such benign cystic lesions may be a cosmetic concern, or when large, can cause eyelid malpositions. We report a patient with a peri-punctal hidrocystoma of the eyelid.

Laparoscopic Non Anatomical Hepatectomy

Introduction: Despite advances in field of energy devices and surgical techniques, Performing Hepatectomy is still considered a difficult task. Anatomical Hepatectomy is further difficult compared to Non-Anatomical Hepatectomy. Apart from Inflow Outflow Control & Parenchymal Transection, which are challenges even in Conventional Open Hepatectomy, Laparoscopic Hepatectomy has additional challenges of 1)Risk of massive air embolism during vascular dissection 2)Difficult ergonomics & 3)Accessibility issues. So Anatomical Laparoscopic Hepatectomy is considered a pinnacle . Due to these reasons laparoscopic hepatectomy is facing stiff resistance in making progress by leaps & bounds on par with rest of the laparoscopic procedures. Anatomical Laparoscopic Hepatectomy, though challenging, can be performed in a few select cases. But, in certain benign indications such as hydatid cysts, cystic neoplasms & some hemangiomas, Laparoscopic Non-Anatomical Hepatectomy can avoid large incisions like right subcostal(Kocher’s), bilateral subcostal (Roof-top), Makuchi, Seagull, etc., thereby reducing morbidity due to pain & lung complications with early return to work. Also, Non-Anatomical Hepatectomy is technically easier to perform than Anatomical Hepatectomy, as we can avoid critical steps such as inflow & outflow control. Method: We present a series of 5 cases, which include 2 Right & 3 Left Non-Anatomical Hepatectomies which were done for 3 patients with Hydatid Cysts (2 in left lobe & 1 in right lobe) & 2 Benign cystic neoplasm (1 in left lobe & 1 in right lobe). We present a video of laparoscopic left and right hepatectomy. Result: All patients were discharged with Mean length of hospital stay 2.5 days, Intra-operative blood loss less than 500 ml, Nil port site compilations, Mean pain score 2.8, Nil required drain placement, Nil required re-exploration/resurgery. Conclusion: Hence, small, benign, peripheral located, less vascular lesions can be managed with Laparoscopic Non-Anatomical Hepatectomy,with small incision, good cosmesis, less risks, and less morbidity.

Renal Cystic Nephroma: Histologic and Immunohistochemical Analyses and Review of Literature

Background: A case of renal Cystic Nephroma (CN) was reported in 32 years-old women presenting with an incidental renal mass on radiological imaging. Methods: On CT-scan examination, a renal cell carcinoma was suspected and right nephrectomy was performed. The resected tumor measured 17 × 10 × 7 cm. Macroscopically, the tumor was a multilocular mass with cysts ranging from 0.5 cm to 4.5 cm. The tumor was well delineated relative to non-tumoral renal parenchyma, which was physiological in appearance with a cortex at 1 cm without evidence of infiltration of the tumor. At the hilum, the arterial, venous and ureter were normal. No lymph node was identified. Microscopically, the lesion was well defined by a fibrous capsule, consisting of multiple cystic formations of variable sizes bordered by a mono-stratified epithelium, which ranged from flat to cubic. The lining epithelial cells had a hobnail appearance, abundant cytoplasm and an oval nucleus associated with a nucleolus. No mitosis were founded. The cysts were subtended by cellular fibrous septa of ovarian type. On immunohistochemical examination, the epithelial cells were positive for cytokeratins 7 and 19; stromal cells were positive for estrogen receptors, progesterone receptor and CD10. In the septa, there were some bundles of smooth muscle cells positive for desmin and smooth muscle actin. Conclusion: The patient was alive 8 years after treatment, without metastasis or recurrence. Histologic and immunohistochemical analyses may be helpful in differential diagnosis between benign cystic renal neoplasms, CN, mixed epithelial and stromal tumor (MEST) and malignant tumors such as clear cell renal carcinoma (CCRC) in adults.

Advances in diagnosis and treatment of intrahepatic biliary cystadenoma

Intrahepatic biliary cystadenoma (IBC) is a rare benign cystic neoplasm of liver, with malignant potential to transform into intrahepatic biliary cystadenocarcinoma. IBC predominantly occurs in women up to 85%, showing no special clinical symptoms and a polycystic lesion inside the liver on image examination. It is difficult to differentially diagnose from other cystic lesions of the liver such as simple liver cyst, intraductal papillary neoplasm of the bile duct, etc. The missed diagnosis and misdiagnosis rate were rather high in IBC, which is accurately diagnosed by pathological examination. Complete surgical removal of the tumor is the best way to cure it, and also can bring a satisfactory outcome to patients. Key words: Intrahepatic biliary cystadenoma; Intrahepatic biliary cystadenocarcinoma; Liver mucinous cystic neoplasms; Etiology; Pathogenesis; Clinical manifestation; Therapy

Benign Tumors of the Pancreas – Limited Local Surgical Treatment for Cystic Neoplasms and Neuroendocrine Tumors – an Overview

Background. Benign tumors of the pancreas are intraductal papillary mucinous neoplasia, mucinous cystic neoplasia, serous cystic adenoma, solid pseudopapillary neoplasia and endocrine tumors, most frequently insulinomas. The evolution of limited local surgical procedures for benign pancreatic lesions like enucleation (EN), pancreatic middle segment resection (CP) and duodenum-preserving total or partial pancreatic head resection (DPPHRt/p) shifted options of surgical treatment to application of local techniques. Objectives. Surgical treatment of benign cystic neoplasms and neuroendocrine tumors using local surgical extirpation techniques are evaluated based on present knowledge about indication to surgery, early postoperative complications and late outcome perspectives. Results. Tumor enucleation is recommended for all symptomatic neuroendocrine adenomas of a size up to 3 cm and non-adherence to pancreatic main ducts. EN was applied predominantly for neuroendocrine tumors and less frequently for cystic neoplasms. About 20% of enucleations are performed as minimal invasive procedures. Surgery-related severe postoperative complications with the need of reintervention are observed in 11%, pancreatic fistula in 33%, but hospital mortality was below 1%. Major advantages of EN are low procedure-related early postoperative morbidity and a very low hospital mortality. CP is applied in two thirds for symptomatic cystic neoplasms and in one third for neuroendocrine tumors. The high level of pancreatic fistula and severe postoperative complications are associated with management of the proximal pancreatic stump. Hospital mortality of 0.8% is a benefit of this procedure. DPPHRt/p has been applied in about 50% as total pancreatic head resection with segment resection of the peripapillary duodenum and the intrapancreatic common bile duct. Two thirds of patients suffered symptomatic or asymptomatic cystic neoplasms and 10% neuroendocrine tumors. Major advantages of local pancreatic head resection compared to Whipple type pancreatico duodenectomy are highly significant preservation of the exo- and endocrine functions and a low hospital mortality below 0.5%. The level of evidence for EN and CP is low, because of retrospective data evaluation and absence of results from controlled studies. For DPPHRt/p results of 9 prospective controlled studies, 3 case controlled studies and 2 retrospective controlled studies underline the advantages of DPPHRt/p compared to partial pancreaticoduoden ectomy. Conclusion. The application of tumor enucleation, pancreatic middle segment resection and duodenum-preserving total or partial pancreatic head resection are associated with low level of surgery-related early postoperative complications and a very low hospital mortality. The major advantages of the limited procedures are preservation of exo- and endocrine pancreatic functions and maintenance of peripancreatic GI-tract tissue

Major complications following pancreatectomy for small pancreatic neuroendocrine and cystic neoplasms less than 2-cm: an argument for selective observation or resection

Background: Increased utilization of high-quality cross-sectional imaging has resulted in more patients with incidental pancreatic lesions. However, the decision to observe or to operate on asymptomatic small lesions has remained controversial. We aim to identify factors associated with major complications following resection for small pancreatic neuroendocrine and cystic neoplasms. Methods: ACS-NSQIP Pancreatectomy database was used to identify patients who underwent pancreatectomy for benign pancreatic neoplasms <2 cm, including non-invasive intraductal papillary mucinous neoplasms (IPMN), mucinous cystic neoplasms (MCN), neuroendocrine tumors (PNET), and serous cystadenomas (SCA). Logistic regression was used to identify predictors of major complications. Results: A total of 414 patients with benign pancreatic lesions <2 cm were identified (48% IPMN, 25% PNET, 15% MCN, and 12% SCA). Operations include distal pancreatectomy (54%), pancreaticoduodenectomy (28%), and enucleation (9%). Overall morbidity and major complications were 27% and 20%, respectively, while the 90day mortality was 0.7%. These were similar whether lesions were greater or less than 2cm. Readmission rate was 19%, most often for abscesses or venous thromboembolism. Pancreatic morbidities include 22% fistula (14% required percutaneous drainage) and 9% delayed gastric emptying. On multivariate analysis, postoperative drain amylase >10,000 U/L and extent of pancreatectomy were independent predictors of major complications. Conclusion: Patients with benign lesions undergoing pancreatectomy are subject to considerable morbidity with difficult to measure oncologic benefit. In patients with asymptomatic, benign pancreatic neuroendocrine and cystic neoplasms, the risk of major complications may exceed the risk of malignancy. Patient counseling and radiographic surveillance may be appropriate in select patients.Tabled 1Multivariate logistic regression predicting major complications for patients undergoing pancreatectomy for benign pancreatic endocrine and cystic neoplasms less than 2-cm.OR95% ClP valueAge (per year)1.120.605–2.060.724ASA class >30.8410.472–1.4990.558BMI1.0160.971–1.0630.484Female0.4920.292–0.8310.008Type of pancreatectomy EnucleationReference Distal pancreatectomy5.5130.187–25.5960.029 Pancreaticoduodenectomy11.572.433–55.0510.002 Pancreatectomy NOS4.1090.721–23.4090.111Drain amaylase <10,000 U/LReference >10,000 U/L5 5512.120–14.538<0.001 Not reported1.1800.5855–2.3790.643 Open table in a new tab

De novo papillary carcinoma in a thyroglossal duct cyst

Introduction Thyroglossal duct cysts (TGDC) account for 70% of congenital neck masses.Majority (70%) is diagnosed during childhood and only 7% in adulthood. Only 1% of thyroid carcinomas evolve from a TGDC. It’s essential to differentiate primary papillary carcinoma in a TGDC from a metastatic papillary carcinoma of thyroid. Objective A 23 year old girl presented with a painless lump over the anterior neck for one month. Examination revealed a non-tender firm midline neck lump just above the hyoid bone with no palpable thyroid nodules or cervical lymphadenopathy. Ultrasound revealed a suprahyoid TGDC and a sub-centimeter solitary thyroid nodule (STN) in right lobe with no cervical lymphadenopathy. FNAC of TGDC showed a benign cystic neoplasm. Ultrasound guided FNAC of the STN showed benign cells only. Thyroid functions were normal. A Sistrunk operation was performed. Histology revealed a papillary carcinoma (with CTF1 nuclear and CK19 positivity in cells lining the papillae). A Total Thyroidectomy was performed after an oncological consultation to exclude a possible primary focus in the STN and to facilitate adjuvant treatment. Histology of the STN was a papillomatous focus likely to be hyperplastic (CK19 negative) and rest of the thyroid normal Conclusion De novo papillary carcinoma in a TGDC is rare. The diagnosis in most cases is incidental after surgical resection. Total thyroidectomy would be indicated, if the carcinomatous component is > 1 cm or <1 cm but with enlarged cervical lymph nodes, tumour invasion of the cyst wall or an abnormal thyroid gland

Risk of borderline ovarian tumors among women with benign ovarian tumors: A cohort study

ObjectiveA growing number of studies suggest that some ovarian cancers can arise from benign and borderline ovarian tumors. However, studies on the association between benign and borderline ovarian tumors are lacking. We studied the overall- and histotype-specific risk of borderline ovarian tumors among women with a benign ovarian tumor. MethodsThis nationwide cohort study included all Danish women diagnosed with a benign ovarian tumor (n=139,466) during 1978–2012. The cohort was linked to the Danish Pathology Data Bank and standardized incidence ratios (SIR) with 95% confidence intervals (CI) were calculated. ResultsWomen with benign ovarian tumors had increased risks for subsequent borderline ovarian tumors (SIR 1.62, 95% CI 1.43–1.82), and this applied to both serous (SIR 1.69, 95% CI 1.39–2.03) and mucinous (SIR 1.75, 95% CI 1.45–2.10) histotypes of borderline ovarian tumors. The risk for borderline ovarian tumors was primarily increased for women diagnosed with a benign ovarian tumor before 40years of age. The risk remained increased up to 9years after a benign ovarian tumor diagnosis. Finally, the associations did not change markedly when analyzed for the different histotypes of benign (solid and cystic tumors) and borderline (serous and mucinous tumors) ovarian tumors. ConclusionsWomen with benign ovarian tumors have a long-term increased risk for borderline ovarian tumors. However, as all associations in this study were only adjusted for age and calendar period of diagnosis, more studies that are able to adjust for additional potential confounding variables are required to further understand these associations.

A Case of Giant Hydronephrosis Hidden by Obesity in an 11-year-old Boy

Giant hydronephrosis (GH) is a rare urological entity and usually presents with more than a liter of fluid in the collecting system. It may mimic a progressive and benign abdominal cystic tumor. We report a case of GH in an 11-year-old obese boy who presented with abdominal distension and dyspnea on exercise. Hydronephrosis was caused by ureteropelvic junction obstruction, with 2,300 mL of fluid in the collecting system. Diagnostic and therapeutic features of this case are discussed, with reference to current literature. Key words: Giant hydronephrosis; Obesity; Dyspnea; Abdominal distension

Cardiac Tumors: Clinical Perspective and Therapeutic Considerations.

Cardiac tumors rare cardiac disorders with an overall incidence rate < 0.33%. Cardiac tumors can be classified as primary or secondary depending on the origins of tumors. Primary cardiac tumors (5% incidence) are rare compared with the secondary (95%, metastases of the heart) cardiac tumors. Given that cardiac tumors exhibit some nonspecific symptoms compared with other heart diseases, clinical diagnosis of cardiac tumors is rather challenging. Thus we will try to review the classification and pathogenesis of cardiac tumors. Current evidence revealed that 75% of cardiac tumors are considered benign (myxoma, fibromas, lipomas, rhabdomyomas, hemangiomas, teratomas, papillary fibroelastomas, pericardial cysts or cystic tumor of atrioventricular node). Clinical differential diagnosis of cardiac tumors is mainly based on imaging techniques including transthoracic and transesophageal echocardiograms, computed tomography (CT) scans and magnetic resonance imaging (MRIs). This mini-review tries to summarize recent understanding of the pathogenesis and therapeutics of cardiac tumors.

MAXILLARY CALCIFYING CYSTIC ODONTOGENIC TUMOR ASSOCIATED WITH COMPLEX ODONTOMA: CASE REPORT

The calcifying cystic odontogenic tumor (CCOT) or Gorlin cyst is a rare lesion, described as a benign cystic odontogenic neoplasm. It usually occurs in young adults, between the third and fourth decade of life and presents variable clinical behavior. It may also be associated with odontoma, ameloblastoma or impacted teeth. Recurrences are uncommon and malignant behavior is rare. In this study, it is reported a case of a 35-year-old male patient, presenting with an intraosseous lesion in an occasional panoramic radiograph in the anterior maxilla. Lesion was asymptomatic and the radiograph showed a radiolucent unilocular image, as well as multiple radiopaque structures within the lesion, located between teeth 13 and 15. Teeth were unharmed and were not associated with the lesion. Histopathologic analysis from excisional biopsy pointed to the diagnosis of CCOT associated with Odontoma complex. The patient is currently under active follow-up.

Endoscopic management of pancreatic pseudocyst

Background: Pancreatic pseudocyst is a well-known complication of acute or chronic pancreatitis, with a higher incidence in the latter. It represents 80-90% of cystic lesions of the pancreas. Benign and malignant cystic neoplasms constitute 10-13%, congenital and retention cysts comprising the remainder. Diagnosis is accomplished most often by computed tomographic scanning, by endoscopic retrograde cholangiopancreatography, or by ultrasound, and a rapid progress in the improvement of diagnostic tools enables detection with high sensitivity and specificity. Endoscopic drainage provides a good alternative or supplement to a surgical treatment of pancreatic pseudocysts.Methods: This is a prospective study of 26 patients diagnosed to have Pancreatic Pseudocyst and treated by endoscopic drainage from 1st June 2008 to 30th September 2010 in St. John’s Medical College and Hospital, Bangalore. Transabdominal and endoscopic ultrasound, CT scan were used to determine the number, size, volume, wall thickness, location of pancreatic pseudocysts, the extent of pancreatic parenchymal disease, the nature of the main pancreatic duct and its relationship to the cyst, the presence of portal hypertension, venous occlusion, arterial anomalies and pseudoaneurysm. The indications for endoscopic drainage were symptomatic and/or bigger than 6 cm in major diameter pancreatic pseudocysts with a close opposition to the gastric or duodenal wall.Results: There were 26 patients with pancreatic pseudocyst and all of them are located in lesser sac. It mainly affects the middle-aged males with alcohol as the main etiology. Out of 26 patients 24 underwent endoscopic drainage and 2 patients were abandoned in view of vessel between the cyst wall and stomach which was picked up by EUS. Out of 26 patients, 5 developed infection which was proven by culture. Endoscopic cystogastrostomy was performed in 21 patients (80.8%), endoscopic cystogastrostomy with nasocystic drainage performed in 3 patients (11.5%), and abandoned in 2 patients. 2 patients developed bleeding, and managed conservatively. No intervention done. 5 patients underwent re-procedure (3 underwent nasocystic drainage, 1 aspiration, and the other cystogastrostomy), in view of recollection.Conclusions: Endoscopic drainage is safe and effective in experienced hand, less morbidity, cost effective, short hospital stay, can be repeated.

Genetic basis of calcifying cystic odontogenic tumors.

Calcifying cystic odontogenic tumors (CCOTs) are benign cystic tumors that form abnormally keratinized ghost cells. Mutations in CTNNB1, which encodes beta-catenin, have been implicated in the development of these tumors, but a causal relationship has not been definitively established. Thus, mutational hot spots in 50 cancer genes were examined by targeted next-generation sequencing in 11 samples of CCOT. Mutations in CTNNB1, but not in other genes, were observed in 10 of 11 cases. These mutations constitutively activate beta-catenin signaling by abolishing the phosphorylation sites Asp32, Ser33, or Ser37, and are similar to those reported in pilomatrixoma and adamantinomatous craniopharyngioma. In contrast, BRAF or NRAS mutations were observed in 12 and two control samples of ameloblastoma, respectively. In HEK293 cells, overexpression of mutated CTNNB1 also upregulated hair keratin, a marker of ghost cells. Furthermore, ghost cells were present in two cases of ameloblastoma with BRAF and CTNNB1 mutations, indicating that ghost cells form due to mutations in CTNNB1. The data suggest that mutations in CTNNB1 are the major driver mutations of CCOT, and that CCOT is the genetic analog of pilomatrixoma and adamantinomatous craniopharyngioma in odontogenic tissue.