Benign Cysts Research Articles

P-57 POST-OPERATIVE DYSPHONIA FOLLOWING SISTRUNK PROCEDURE IN A 43-YEAR-OLD FEMALE WITH THYROGLOSSAL DUCT CYST: A CASE REPORT

Abstract Introduction Thyroglossal duct cysts are congenital cervical anomalies that present as midline neck lumps, typically connected to the hyoid bone. Although common in children, they are less frequently observed in adults. The global prevalence of thyroglossal cysts is approximately 7%, with an equal distribution between males and females. Most of these cysts are benign, with only about 1% associated with malignancy. Recurrence is the most common postoperative complication, but dysphagia and dysphonia, as observed in our case, are also potential complications. Clinical Case We reported a case of a 43-year-old Omani woman who presented with a four-month history of neck swelling, pain, and difficulty eating. Her medical history included an incidental pituitary adenoma diagnosed two years prior, resolved childhood asthma, and a family history of hyperthyroidism. On examination, a 3 x 3 cm non-tender, mobile midline neck swelling was noted, with no lymphadenopathy. Initial laboratory tests showed a white blood cell count of 3.57 x 10³/µL, hemoglobin of 10.2 g/dL, hematocrit of 32.3%, mean corpuscular volume of 78.6 fL, mean corpuscular hemoglobin of 24.9 pg, and red cell distribution width of 15.6%. Fasting blood glucose was 5.6 mmol/L. The differential count revealed decreased neutrophils at 38.60% and increased lymphocytes at 50.80%. Thyroid function tests and pituitary profile were normal. Ultrasound confirmed an infected thyroglossal duct cyst. Histopathological evaluation identified a benign cyst lined with respiratory epithelium, featuring a thick fibrous wall, thyroid follicles, lymphoid aggregates, and mature bone with cartilage. The pathology report was negative for malignancy. The patient underwent an uneventful Sistrunk procedure. Postoperatively, she developed hoarseness and dysphonia, but no dysphagia or breathing difficulties. Auditory perceptual assessment indicated whispering aphonia, and indirect laryngoscopy showed bilateral mobile vocal folds with a minimal glottic gap. She was started on voice therapy. Post-surgery, the patient was referred to the endocrinology clinic, where her the patient’s thyroid function tests and bone profile were normal, and she exhibited no symptoms of thyroid dysfunction. All other blood results were within normal ranges. Follow-up MRI showed no increase in pituitary adenoma size compared to two years prior. There were no recurrences or complications, and follow-up visits to ENT, surgical, and endocrinology clinics were satisfactory with no new complaints. Conclusion Thyroglossal duct cysts are rare in adults, but age or cyst size should not preclude their diagnosis. While these cysts typically range from 1.5 to 2.4 cm, larger cysts can pose challenges for diagnosis and surgical management or lead to various complications. To prevent postoperative dysphonia following a Sistrunk procedure, it is essential to ensure adequate voice rest after surgery, and initiate speech therapy early if needed.Figure 1Ultrasound showing a midline cystic lesion with internal echoes measuring 15 x 14 mm.

Thy1c Cytology Is a Reliable Method of Excluding Thyroid Cancer in Dominant Cystic Nodules.

Traditional teaching dictated that patients with recurrent thyroid cysts undergo excision owing to a 12% risk malignancy. Ultrasound evaluation now determines management of these patients augmented by fine needle biopsy. In UK, a non-diagnostic category for thyroid cysts (Thy1c) exists, whereas the Bethesda system combines 'non-diagnostic-cyst fluid only' into Category I along with paucicellular and acellular results. The aim was to assess the ability of Thy1c cytology to exclude malignancy. We undertook a retrospective study of patients undergoing thyroidectomy with Thy1c cytology from analysis of the Unit database. Additionally, we made a retrospective search in our pathology database for reports combining 'papillary thyroid carcinoma' with 'cyst' or 'cystic' and compared histology with cytology. Between 2003 and 2023 115 patients (97 women, median age 44y, range 16-72) underwent thyroidectomy following Thy1c cytology. Indications for surgery included recurrent cyst (90%); compressive symptoms (9%) and one thyrotoxicosis. In no patient was the primary diagnosis malignant; multinodular goitre was commonest (87.76%); benign cyst (19.16%); follicular adenoma (5.4%) and coincidental pT1a classical papillary thyroid carcinoma (PTC) (4.3%). In the retrospective audit, 61 pathology reports contained 'PTC' and 'cyst'/'cystic'. The cystic element was in primary tumour (31.51%); nodal metastasis (17.28%) and adjacent benign disease (13.21%). Only 5 (8%) patients had Thy1c cytology; 4 had pT1a tumours and one a benign cyst and a 19 mm PTC. Thy1c category reliably excludes significant malignancy. For patients with symptomatic cysts, ultrasound assessment and Thy1c cytology can guide the clinician to treat with either ablation or resection without the fear of mistreating a thyroid cancer.

Disparities in the Way Radiologists, Referring Physicians, and Patients See the Language Used to Report Incidental Findings

Background: Incidental findings on cross-sectional imaging are common, often causing concern due to the possibility, however remote, that they could indicate malignancy. While radiologists aim to document these findings thoroughly, the language used may lead to varying interpretations by referring physicians and patients, potentially resulting in unnecessary follow-up tests, increased costs, and patient anxiety. The language radiologists use to describe low-risk incidental findings, especially those with minimal clinical significance, is underexplored, particularly from the perspectives of radiologists, referring physicians, and patients. Methods: This study involved three anonymous surveys administered to radiologists, referring physicians, and patients at a large academic medical center. The surveys assessed how each group interprets 10 expressions used to describe a 5-mm incidental liver lesion, based on its perceived likelihood of malignancy. Radiologists, referring physicians, and patients rated their perceived likelihood of malignancy for these expressions and provided feedback on whether follow-up imaging was warranted. Data were analyzed using median responses for malignancy likelihood, follow-up imaging decisions, and descriptive statistics. Results: A total of 13 radiologists (93%), 59 referring physicians (6% response rate), and 51 patients participated. Referring physicians and patients consistently rated the likelihood of malignancy higher than radiologists, particularly for phrases like "tumor not excluded," which were associated with the highest perceived likelihood of malignancy. Regarding follow-up imaging, 75-83% of referring physicians indicated they would order follow-up for phrases with uncertainty about malignancy, while only 2-46% chose to do so for phrases indicating benign findings. Radiologists favored "cyst" to describe the lesion, while referring physicians favored "benign cyst." Radiologists unanimously agreed that no follow-up was necessary for the benign lesion. Conclusion: Both referring physicians and patients expressed greater concern than radiologists regarding incidental findings, especially when the language used suggested uncertainty about malignancy. Ambiguous terms such as "tumor not excluded" increased anxiety and the likelihood of follow-up tests. This highlights the need for radiologists to refine their terminology to improve communication clarity and reduce unnecessary patient anxiety and healthcare costs

АНАЛИЗ ВЛИЯНИЯ ЭЛЕКТРОКОАГУЛЯЦИИ И ОВАРИАЛЬНОГО РЕЗЕРВА У ЖЕНЩИН ПОСЛЕ ЛАПАРОСКОПИЧЕСКОГО УДАЛЕНИЯ КИСТ ЯИЧНИКОВ: СТРАТЕГИИ СНИЖЕНИЯ РИСКОВ ДЛЯ ФЕРТИЛЬНОСТИ

This article examines the effect of using bipolar and ultrasound coagulation on ovarian reserve in women who have undergone laparoscopic ovarian cyst removal. The introduction highlights the urgency of the problem posed by the increasing number of surgical interventions to treat benign ovarian cysts and their potential effects on reproductive function. Materials and methods include a randomized study of patients who underwent various types of surgery to stop bleeding. The results show a significant reduction in ovarian reserve measured through follicle-stimulating hormone levels and ultrasound examination. The findings indicate the importance of careful selection of surgical techniques to minimize adverse effects on fertility, which has practical implications for reproductive health planning of female patients.

Trends in pulmonary function in patients with Birt-Hogg-Dubé syndrome: a retrospective cohort study

ABSTRACT Background Birt-Hogg-Dubé syndrome (BHD), a rare genetic disease characterized by multiple pulmonary cysts, can lead to spontaneous pneumothorax, cutaneous hamartomas, renal cysts, and renal cell cancer. The overall aim of this study was to assess clinical characteristics of patients with BHD-emphasizing on trends in pulmonary function patterns. Methods By use of data from electronic patient journals, we conducted a retrospective cohort study on clinical characteristics and pulmonary function tests (PFT) from patients with BHD, who were clinically followed-up in a Danish tertiary referral center for rare and interstitial lung diseases. Results A total of 101 patients (44 men (43.6%); mean age 48.4 years (SD ± 15.9 years)) with BHD were included. Chest HRCT scans revealed pulmonary cysts in 82.2% of whom 38.6% had experienced at least one pneumothorax (median 2; IQR1–4). Baseline PFT showed FEV1/FVC ratio and RV% within normal values of predicted. In 28.7% of the patients, a slight decrease in DLco below 80% of predicted was observed (mean 86.9% ± SD 15.8%). At two years follow-up, there were no significant declines in FEV1 and FVC, nor after accounting for age, gender, and smoking. At baseline cutaneous manifestations were found in 58.4% of the patients, 47.5% had benign renal cysts, and 11.9% had renal tumours. Conclusion More than 80% of patients with BHD presented with pulmonary cysts, but consistent with other studies all had normal PFTs at two years follow-up. We conclude that routine monitoring of pulmonary function and pulmonary follow-up may not be necessary in patients with BHD.

CYSTIC LESIONS OF THE SALIVARY GLANDS(Report of 3 cases)

At least one-third of cystic salivary gland lesions are neoplastic. Cystic lesion of the salivary gland requires only surgery, because regardless of the type and location, drug therapy is not possible with this diagnosis.. If the cystic neoplasm is localized in a hard-to-reach place and if it is localized in the parotid gland, the surgical manipulation is performed from the outside, it is removed simultaneously with the parenchyma of the salivary gland. The FNA specimens from salivary gland cystic lesions can be no informative very often, because FNA of these lesions demonstrates hypocellular mucinous material contents, possibly with inflammatory cells and also scant epithelial cells. For example, the presence of mucin and admixed lymphocytes in cyst fluid can be demonstrated both in the benign inflammatory cysts and cystic neoplasms. A definitive diagnosis of cystic neoplasms of the salivary glands is possible only through histological examination of the neoplastic tissue. Prevention of cystic neoplasms of the salivary gland consists of preventing injuries and inflammations of the oral cavity, careful hygiene and regular visits to the dentist. This article presents cases of the salivary glands cystic neoplasms, which are the clinical interest.

How to identify cystic lateral neck mass from CUP-like lesions: a diagnostic challenge

A cystic lateral neck mass in adults represents a major challenge, as it can be difficult to distinguish between benign and malignant lesions. The incidence of carcinoma in initially benign treated neck cysts is estimated to be as high as 24%. The objective of this study was to ascertain the malignancy rate of cystic cervical masses and to provide a differentiation of cervical metastases in comparison to benign cervical cysts, utilising current guidelines.Between 2013 and 2023, a total of 155 patients with a suspected diagnosis of lateral neck cyst were recruited at the Department of Otorhinolaryngology at our University Hospital. All patients underwent cyst removal, either alone or in conjunction with panendoscopy.A histologically confirmed ipsilateral lymph node metastasis was identified in 21.9% of patients. The mean age of patients with malignant neck masses was significantly higher than that of patients with benign neck masses (64.0±12.8 versus 41.0±15.8; p<0.001). The probability of malignancy was low in patients younger than 54 years (11%), but increased markedly to 80% in the age group of 60-69 years. The clinical sensitivity for initial suspicion of a benign neck cyst was 60.3%, while the specificity was 48.7%.An individualized approach is necessary for the early diagnosis and treatment of unilateral neck cysts, as this condition requires a multifaceted assessment based on the patient's medical history, clinical findings, imaging, and clinical expertise. We advise that patients over the age of 40 years undergo image morphological staging, a "no-touch" panendoscopy, and histological confirmation.

The DETECTION project part 1: An international Delphi survey about diagnostics and treatment of anterior mediastinal cystic lesions.

Differentiating benign anterior mediastinal cysts from malignancies is challenging in clinical practice. International guidelines on optimal diagnostics and treatment for anterior mediastinal cystic lesions are lacking. The first part of the DETECTION project focuses on possible heterogeneity in diagnostics and treatment of anterior mediastinal cystic lesions among international thoracic medical experts. A Delphi-survey was created by 14 multidisciplinary panel members, affiliated with three Dutch tertiary referral hospitals for thymic tumours. The survey contained 55 questions and was reviewed by international experts of the International Thymic Malignancy Interest Group (ITMIG) and Réseau tumeurs THYMiques et Cancer (RYTHMIC). The survey was launched online for members of the ITMIG and RYTHMIC from May 26th, 2023 till July 18th, 2023. The survey was completed by 21 thoracic surgeons, 15 radiologists, 15 medical oncologists, 11 pathologists, 9 pulmonologists, and 4 radiation oncologists from 24 countries. Heterogeneity was observed in performed diagnostic radiological imaging, laboratory tests, indications for surgery and follow-up of anterior mediastinal cysts. Cystic wall thickness of anterior mediastinal cysts was reported as clinical relevant in decision making more frequently by thoracic surgeons (76.2%) than pulmonologists (44.4%) and medical oncologists (15.4%) (p=0.015). The survey outcomes showed heterogeneity in the diagnostics and indication for resection of anterior mediastinal cysts among thoracic medical experts. A large variation in radiological imaging, laboratory tests, surgery, pathological analyses, and follow-up of anterior mediastinal cysts was observed. The development of evidence-based clinical practice guidelines may guide clinicians.

Evaluation of the Value of Fine Needle Aspiration Cytology and Cell Morphology in Determining the Histogenesis of Pancreatic Lesions With Review of Literature, Overview and Cytological Experience of 25 Years: Original Research.

Benign lesions, inflammation, cysts and pseudocysts, as well as neoplasms of the exocrine and endocrine parts of the pancreas can be easily identified using cytological methods. The sensitivity and specificity can be increased with the help of additional examination methods. The sensitivity of intraoperative rapid cytology reaches about 99%. In the literature, the sensitivity reaches an average of about 85% for biopsies. The method is easy to use, has very low complication rates (1%-2%) and is safe for the patient. 1290 cytological samples from pancreatic lesions were processed in the institute of pathology at Hannover Medical School (MHH), as cytological smears and stained with Giemsa and PAS stains as conventional methods. They were compared with the histological specimens that were processed at the same institute. Immunocytochemistry and molecularpathology have been processed only in selected cases. In general, it is routine in the university that the patients give their written consent to participate in clinical studies. The local ethics committee has stated that there is no need for approval due to the retrospective nature of the study. In this work, we detected 20.077% malignant lesions, 63.333% benign findings and inflammation, 7.441% pseudocysts and cysts. About 9.147% samples were unrepresentative due to insufficient number of cells. This work will highlight the importance of fine aspiration cytology (FNAC) of suspicious pancreatic lesions, its possibilities and limitations in routine diagnostics with discussing the differential diagnoses, pointing to its great value and safety for patients. FNAC is the gold standard, its power is strongly associated with high specificity and sensitivity in the diagnosis of pancreatic lesions, and is very useful in the differential diagnosis between malignant and inflammatory lesions in pancreas.

Comparisons of integrated slice-specific dynamic shimming EPI and single-shot EPI diffusion-weighted imaging of the liver.

To compare the quality of DWI images, signal loss of left hepatic lobe and diagnostic performance of apparent diffusion coefficient (ADC) values between SS-EPI and iShim-EPI in liver lesions. Totally 142 patients were involved, images using SS-EPI and the prototype iShim-EPI were acquired before injection of gadoxetic acid-enhanced liver MRI.Image quality of demarcation of liver capsule, resolution, lesion distortion, artifacts, lesion confidence score, and signal loss in left hepatic lobe was assessed by two radiologists. Mean ADC values of the largest lesions were measured, and the correlations, agreements, and diagnostic performances were compared between the two sequences. Image quality of the iShim-EPI was significantly improved over that of SS-EPI (ICC 0.843 to 0.991, p<0.05), the signal loss in the left hepatic lobe was greatly reduced. The ADC values were highly correlated (r=0.93, p<0.001) and had good agreement (CI -475.5∼722.1×10-6 mm2/s) between the two sequences. Compared with SS-EPI,iShim-EPI had better performance in detecting benign (hepatic haemangioma and cyst) and malignant (primary liver cancer and hepatic metastases) diseases. Furthermore, iShim-EPI had a significantly larger AUC in differentiating cancer from benign lesions (both hepatic haemangioma and cyst) (p<0.05). IShim-EPI DWI is a promising method for differentiating benign and malignant liver lesions with better image quality, less signal loss of left hepatic lobe and could enhance the confidence of diseases diagnosis compared with SS-EPI.

Advanced Imaging and Preoperative MR-Based Cinematic Rendering Reconstructions for Neoplasms in the Oral and Maxillofacial Region.

This case study highlights the use of cinematic rendering (CR) in preoperative planning for the excision of a cyst in the oral and maxillofacial region of a 60-year-old man. The patient presented with a firm, non-tender mass in the right cheek, clinically suspected to be an epidermoid cyst. Conventional imaging, including dental magnetic resonance imaging (MRI) protocols, confirmed the lesion's size, location, and benign nature. CR reconstructions, combining advanced algorithms and novel skin presets, allow for the generation of highly realistic, three-dimensional visualizations from conventional imaging datasets. CR provided an enhanced, detailed depiction of the lesion within its anatomical context, significantly improving spatial understanding for surgical planning. The surgical excision was performed without complications, and histological analysis confirmed the diagnosis of a benign epidermoid cyst with no evidence of dysplasia or malignancy. This case demonstrates the potential of CR to refine preoperative planning, especially in complex anatomical regions such as the face and jaw, by offering superior visualization of superficial and deep structures. Thus, the integration of CR into clinical workflows has the potential to lead to improved diagnostic accuracy and better surgical outcomes.

Advances for Managing Pancreatic Cystic Lesions: Integrating Imaging and AI Innovations.

Pancreatic cystic lesions (PCLs) represent a spectrum of non-neoplasms and neoplasms with varying malignant potential, posing significant challenges in diagnosis and management. While some PCLs are precursors to pancreatic cancer, others remain benign, necessitating accurate differentiation for optimal patient care. Conventional approaches to PCL management rely heavily on radiographic imaging, and endoscopic ultrasound (EUS) guided fine-needle aspiration (FNA), coupled with clinical and biochemical data. However, the observer-dependent nature of image interpretation and the complex morphology of PCLs can lead to diagnostic uncertainty and variability in patient management strategies. This review critically evaluates current PCL diagnosis and surveillance practices, showing features of the different lesions and highlighting the potential limitations of conventional methods. We then explore the potential of artificial intelligence (AI) to transform PCL management. AI-driven strategies, including deep learning algorithms for automated pancreas and lesion segmentation, and radiomics for analyzing heterogeneity, can improve diagnostic accuracy and risk stratification. These advanced techniques can provide more objective and reproducible assessments, aiding clinicians in decision-making regarding follow-up intervals and surgical interventions. Early results suggest that AI-driven methods can significantly improve patient outcomes by enabling earlier detection of high-risk lesions and reducing unnecessary procedures for benign cysts. Finally, this review emphasizes that AI-driven approaches could potentially reshape the landscape of PCL management, ultimately leading to improved pancreatic cancer prevention.

Transumbilical laparoendoscopic single-site surgery vs. multiport laparoscopic surgery for benign ovarian cysts: a retrospective cohort study

BackgroundTransumbilical laparoendoscopic single-site surgery (TU-LESS) has gained increasing attention due to the potential to maximize the benefits of laparoscopic surgery. This study aimed to compare outcomes of TU-LESS and multiport laparoscopic surgery (MLS) for the treatment of benign ovarian cysts.MethodsThis retrospective cohort study included patients with benign ovarian cysts that were admitted to the Second Hospital of Hebei Medical University between September 2010 and September 2022. Inverse probability of treatment weighting (IPTW) approach weighting were used to compare outcomes of TU-LESS and MLS for benign ovarian cysts. The primary outcome was the rate of cystic content spillage.ResultsA total of 528 patients with benign ovarian cysts were included and 236 (44.6%) patients underwent TU-LESS. The risk of cystic content spillage [relative risk (RR) = 4.37, 95% confidence interval (CI): 2.59–7.38), P < 0.001] and operation time (β = 4.94, 95% CI: 1.40–8.48, P = 0.017) during TU-LESS was significantly higher than that during MLS. While hospital stay (β=-0.10, 95% CI: -0.198 - -0.004, P = 0.043) during TU-LESS was significantly shorter. IPTW analyses yielded similar patterns of results. For ovarian cysts < 10 cm, the risk of cystic content spillage, operation time and EBL during TU-LESS was significantly higher than that during MLS (all P < 0.05). On the contrast, for ovarian cysts ≥ 10 cm, the risk of cystic content spillage, operation time and EBL during TU-LESS was significantly lower than that during MLS (all P < 0.05).ConclusionsTU-LESS had a significantly higher risk of cystic content spillage, longer operation time than MLS. While for ovarian cysts ≥ 10 cm, TU-LESS had a lower risk of cystic content spillage, shorter operation time, and less EBL than MLS. More experienced surgeons are needed to perform TU-LESS in benign ovarian cysts.

Size threshold as a risk for malignant transformation in typical ovarian dermoid lesions: a scoping review.

The O-RADS malignancy risk stratification of typical ovarian dermoid cysts by using a 10cm threshold is based on expert consensus rather than analysis of objective clinical data. This comprehensive scoping review consolidated all currently available studies evaluating typical benign ovarian dermoid cyst size and risk for malignant transformation. A systematic review of MEDLINE, Embase, Scopus and the Cochrane library was performed from inception to January 14, 2024, using PRISMA-ScR guidelines. A grey literature search and forward searching of reference lists from included studies were performed. Case reports and case series evaluating dermoid cyst size and malignant transformation as defined by a pathological reference standard were included. Data synthesis was provided as a qualitative review of the existing literature. Twenty-five studies were included in qualitative synthesis comprising 6 case reports and 19 retrospective studies with a total of 15,295 dermoid cysts. Of these, 215 lesions demonstrated malignant transformation. Studies reporting dermoid size with malignant transformation ranged from 1 to 32cm with 46/173 (27%) total malignant transformation lesions measuring < 10cm. Solid enhancing components were infrequently reported but all measured > 1cm when described. More than 25% of dermoid cysts with malignant transformation may be classified as "almost certainly benign" with the current 10cm O-RADS malignancy risk threshold. Although surveillance of O-RADS 2 dermoid cysts may improve sensitivity, modifying a caveat recommendation for MRI O-RADS +/- gyn-oncologist referral when potentially solid components are present in otherwise typically benign dermoid cysts may be appropriate.

Symptomatic Giant Skene’s Gland Cyst During Second Trimester Pregnancy and Surgical Excision: A Case Report

Introduction: A Skene’s gland cyst is a rare gynecological disorder, and the cause of an adult onset is largely unknown. However, periurethral and perineal cystic lesions are common, causing often indistinguishable symptoms. Therefore, accurate diagnosis is crucial because it can significantly alter clinical management. Methods: A 27-year-old woman was gravida 2 para 1 with the onset of a unique, progressively large vulvar mass that began at approximately 6 weeks of gestation. At 22 weeks of gestation, the mass became more symptomatic and measured approximately 9 cm × 7 cm × 6 cm in size, with some areas of excoriation on the lateral surface. Results: The patient had a pelvic MRI without contrast, and it showed that the mass was most likely a giant Skene’s gland cyst. At 24 weeks, the mass was surgically removed under spinal anesthesia and followed by vulvar reconstruction. Histopathology showed a benign cyst lined by transitional and squamous epithelium cells, which was consistent with a benign Skene’s gland cyst. She recovered fully, continued with the pregnancy and delivered vaginally at 39 weeks and 3 days without complications. Conclusions: A case of excoriating giant Skene’s gland cyst in pregnancy that caused significant discomfort to the patient. To this day, there has been no reported literature of a Skene’s gland cyst this large, especially during pregnancy. Hence, Skene’s gland cysts should be part of the differential diagnosis of a large vulvar mass of this magnitude during pregnancy.

A Case of a Clinically Proliferating Trichilemmal Cyst Following the Take of Febuxostat and Calcium Carbonate

Trichilemmal cysts or pilar cysts are keratin-filled cysts that originate in the outer root sheath. They are typically found on the scalp of middle-aged women. They are inherited as an autosomal dominant trait. Trichilemmal cysts range from simple trichilemmal cysts to benign and malignant proliferative trichilemmal cysts. Proliferation can be clinical or histological. Clinically, it may present as an increase in size with the onset of an ulceration. Histologically, it translates as the acquisition of certain features which are the dermal proliferation of a squamous epithelium that arranges in a lobular fashion with clear cells containing glycogen in some areas surrounded by a somewhat cellular and glassy stroma; and especially the trichilemmal keratinization in the centre of lobules. There are also certain histopathological criteria to distinguish benign from malignant proliferating trichilemmal cysts. A malignant trichilemmal cyst is characterized by a high mitotic index, atypical mitoses, significant nuclear polymorphism, and tumor invasion of adjacent tissues. Immunohistochemistry can also confirm the benign character by expression of cytokeratin 10 and involucrin. We report here a case of a clinically proliferating trichilemmal cyst following the introduction of calcium carbonate and febuxostat in a patient undergoing treatment for hypertension and renal failure, but retaining a typically simple and benign character on histology.

Radiomics for differential diagnosis of Bosniak II-IV renal masses via CT imaging

Rationale and ObjectivesThe management of complex renal cysts is guided by the Bosniak classification system, which may be inadequate for risk stratification of patients to determine the appropriate intervention. Radiomics models based on CT imaging may provide additional useful information.Materials and MethodsA total of 322 patients with Bosniak II-IV cysts were included in the study from January 2010 to December 2019. Contrast-enhanced CT scans were performed on all patients. ITK-snap was used for segmentation, and the PyRadiomics 3.0.1 package was used for feature extraction. The radiomics features were screened via the least absolute shrinkage and selection operator (LASSO) regression method. After feature selection, a logistic regression (LR) model, support vector machine (SVM) model and random forest (RF) model were constructed.ResultsIn the present study, 217 benign renal cysts (67.4%) and 105 cystic renal cell carcinomas (32.6%) were identified. According to the Bosniak classification, the sample included 179 (55.6%) Bosniak II cysts, 38 (11.8%) Bosniak IIF cysts, 44 (13.7%) Bosniak III cysts and 61 (18.9%) Bosniak IV cysts. A total of 1334 radiomics features were extracted from both unenhanced and cortical CT scans. After LASSO regression, all the models (LR, SVM and RF) showed satisfactory discrimination and reliability in both unenhanced and cortical CT scans (AUC > 0.950). In the Bosniak IIF-III subgroup analysis, the diagnostic accuracy of the LR model was very low for both the unenhanced and cortical scans. In contrast, the SVM model and RF model showed excellent and stable performance in classifying Bosniak IIF-III cysts. The AUCs of the models were all > 0.85, with a maximum of 0.941. The sensitivity, specificity, accuracy, and AUC of the RF model were 0.889, 0.913, 0.902, and 0.941, respectively.ConclusionOur data indicate that radiomics models can effectively distinguish between cystic renal cell carcinoma (cRCC) and complex renal cysts (Bosniak II-IV). Radiomics models may still have high diagnostic accuracy even for Bosniak IIF-III cysts that are clinically difficult to distinguish. However, external validation of these findings is still needed.

High Diagnostic Yield of Fine Needle Biopsy for Pancreatic Serous Cystadenomas - a Multi-Center Study.

Distinguishing serous cystadenoma, a benign pancreatic cyst, from potentially malignant mucinous pancreatic cystic lesions carries significant clinical and prognostic implications; and while endoscopic ultrasound-guided fine needle aspiration is the standard diagnostic tool, its low diagnostic yield often results in additional workup. This study evaluates diagnostic yield of fine needle biopsy (FNB) on lesions suggestive of serous cystadenoma on endoscopic ultrasound. Patients with microcystic EUS appearance were identified through retrospective chart review in two institutions. Prior cross sectional imaging diagnosis was also obtained. All microcystic lesions with classic "honeycomb" appearance for serous cystadenoma on EUS were targeted for FNB and their pathology evaluated. Patients were identified through database search from 2015 to 2022 and procedure information was obtained through a retrospective chart review from two large academic centers. Thirty-one patients with suspected serous cystadenoma who underwent EUS-FNB were included. EUS FNB was successful in obtaining diagnosis in 96.8% of patients. Serous cystadenoma was diagnosed via EUS FNB in 27 of 31 patients (87.1%). Of the remaining four patients, there was one invasive pancreatic ductal adenocarcinoma, one pancreatic neuroendocrine tumor, one intraductal papillary mucinous neoplasm, and one nondiagnostic sample. EUS-FNB sampling for histopathology is a safe and accurate diagnostic tool for pancreatic serous cystadenoma. When microcytic lesions are found on endoscopic ultrasound, our study results suggest that fine needle biopsy for histopathology should be considered as the initial diagnostic evaluation tool given the demonstrated improved diagnostic yield for serous cystadenoma.

Giant benign mesenteric cysts (mesothelioma and lymphangioma): A report of two cases

Introduction and importanceMesenteric cysts are a rare group of intra-abdominal tumors located in the mesentery or omentum, most of this lesion are asymptomatically but occasionally presents with non-specific symptoms, which makes diagnosis difficult. Case presentationWe present two cases of giant mesenteric cyst in our Institution, the first case is a women of 23 years with previous gynecologic surgery with chronic abdominal pain and large abdominal mass CT showed a giant intraabdominal 30 × 25 × 15 cm, the patient went to laparotomy and a large mesenteric tumor found. The Histopathology reported a Benign cyst mesothelioma (BCM). The second case is a 47 year male with intermittent abdominal pain and abdominal CT shows a 20x21x15 cm tumor. Laparotomy was performed. Histopathology reported a large lymphangioma. Clinical discussionBCM tumors are rare intrabdominal lesions often diagnosed in premenopausal women. Its etiopathogenesis is still unclear, associated risk factors are endometriosis, pelvic inflammatory disease and previous pelvic surgery. Lymphangiomas are an infrequent cyst tumors. It results from a failure in the evolutionary development of the lymphatic system, often localized in the head and neck and its localization in the abdomen is even rare. The definitive diagnosis is made by histopathology. ConclusionMesenteric cysts diagnosis if often challenge due to nonspecific symptoms and significant overlap in imaging appearance between the different entities, its diagnosis should be in mind when encounter a cystic abdominal tumor, surgical complete removal of this tumors is the optimal treatment to prevent recurrence and complications.

Metastasis to an odontogenic cyst: case report and review of literature

Metastatic disease to the jawbone is relatively uncommon. However, its occurrence within a pre-existing odontogenic cyst or tumor is extremely rare. We present a case of a 61-year-old woman experiencing fatigue and nocturnal diaphoresis with an otherwise asymptomatic radiolucent lesion of the mandible. Radiographic features were suggestive of a benign odontogenic cyst. A biopsy revealed a metastatic nidus within the wall of a benign odontogenic cyst. Further investigations confirmed the presence of a primary pulmonary adenocarcinoma. Diagnosis of metastases to the orofacial region may be challenging because of their various clinical and radiographic features. Thorough histopathological analysis of any routine cystic tissue from the maxillofacial structures, even seemingly benign, is necessary to rule out more aggressive disease.