Cysts In Pediatric Patients Research Articles

Giant hemorrhagic omental cyst mimicking ascites in an 8-month-old infant: a case report

Introduction: Omental cysts are rare congenital lymphatic lesions in children, presenting as a palpable mass, abdominal distension, or acute abdomen. Complications include hemorrhage, rupture, and torsion. Diagnosis is challenging due to nonspecific symptoms, often requiring imaging. Surgical excision is the definitive treatment. This case highlights a unique presentation of a large hemorrhagic cyst, initially misdiagnosed as ascites. Case presentation: An 8-month-old male presented with irritability for 1 week, abdominal distension, poor feeding, and no stools for 3 days. Examination revealed fever, tachycardia, pale appearance, and distended abdomen with shifting dullness. Investigations showed severe anemia, leukocytosis, and complex ascites on imaging. Surgical exploration identified a 25 × 15 cm hemorrhagic omental cyst, resected alongside herniotomy for a left inguinal hernia. Histopathology confirmed cystic lymphangioma. Recovery was uneventful, with normal follow-up ultrasound at 6 months. Discussion: Omental cysts, rare in children, arise from ectopic lymphatic tissue and present variably as abdominal distension, pain, or intestinal obstruction. Misdiagnosed as ascites in this case, imaging often identifies cystic masses, though definitive diagnosis can be challenging. This infant’s severe anemia was unusual, requiring pre- and postoperative transfusions. Treatment typically involves complete excision; here, open resection was chosen due to the cyst’s size and hemorrhagic nature. This case underscores diagnostic challenges and emphasizes tailored management for rare abdominal cysts in children. Conclusion: This case highlights the diagnostic challenges of omental cysts in pediatric patients with atypical presentations. It underscores the importance of considering rare entities like omental cysts in acute abdomen cases and utilizing comprehensive diagnostic and surgical approaches.

Eruption Cyst: A Case Report

An eruption cyst (EC) is a benign, nonodontogenic lesion. It appears as a Semi-spherical swelling in the mucosa overlying an erupting tooth. This condition occurs when the dental follicle separates from the crown, leading to the formation of a fluid-filled space. Eruption cysts usually have an epithelial lining and are encased in fibrous connective tissue. In a case involving an eleven-year-old girl, a painless, dome-shaped swelling was observed in the lower left posterior region of her jaw. This was diagnosed as an eruption cyst associated with tooth 35. An inferior alveolar nerve block was administered under local anesthesia. An access opening on tooth 75 was made and horizontal incision was given to drain the cystic fluid. Post-operative care included antibiotics and pain management. Follow-up visits showed significant healing, and subsequently pulpectomy and placement of a stainless-steel crown on tooth 75 was carried out. This case highlights the importance of conservative management for eruption cysts in pediatric patients, ensuring effective treatment while minimizing discomfort.

Technical Feasibility and Outcome of Cryoablation of Aneurysmal Bone Cysts in Pediatric Patients

PurposeTo evaluate the clinical and imaging outcome of aneurysmal bone cysts (ABCs) in children using percutaneous cryoablation as the sole treatment. Materials and MethodsThis retrospective study included 7 children with a mean age of 8.7 years (range, 3.0–11.9 years) who underwent at least 1 cryoablation for ABC. Cryoablation needles were placed and guided by computed tomography (CT). Imaging follow-up and clinical examination were performed by radiography 1 and 6 months after the procedure and magnetic resonance (MR) imaging was performed 3 and 12 months after the procedure. Additional cryoablation was performed in case of MR imaging–detected recurrence. Data were analyzed by anatomical location, measurement of lesion volume, numbers of intralesional cysts, grade of mineralization (5-point Likert scale), pain (0 [none] to 4 [severe]), and grade of fluid-fluid levels (FFLs; 4-point Likert scale). ResultsFourteen cryoablations were performed. Patients showed volume reduction, with 1 showing a complete response and 6 showing partial response. Following treatment, there was a substantial reduction in lesion volume compared with baseline, leading to a mean volume decrease of 81.9% (range, 66.8%–100%). The grade of mineralization (3.2 [SD ± 1.2] after therapy vs 1.1 [SD ± 0.3] at baseline), grade of FFL (1.6 [SD ± 0.5] after therapy vs 3.4 [SD ± 1.1] at baseline), and pain (0.29 [SD ± 0.4] after therapy vs 1.86 [SD ± 0.7] at baseline) significantly improved after therapy (all P < .05). One severe adverse event occurred. ConclusionsCryoablation is an effective treatment option for ABC in children. Further research is needed to compare it with other techniques.

Surgical outcomes of proximal femoral bone cysts in pediatric patients: a retrospective study of 41 cases.

The aim of this study was to evaluate the surgical outcomes of proximal femoral bone cysts in pediatric patients. We retrospectively analyzed 41 pediatric patients (31 males and 10 females, mean age 7.47 ± 2.67 years, range 2.03-14.67 years) diagnosed with proximal femoral bone cysts treated at a single institute between March 2009 and November 2021. Data included demographics, preoperative details, intraoperative conditions, surgical techniques, postoperative outcomes, recurrence, and complications. Of the participants, 68% presented with simple bone cysts and 32% with aneurysmal bone cysts. Prior to surgery, 32% exhibited pathological fractures. Surgical methods included lesion curettage, defect filling using allograft bone and Minimally-Invasive Injectable Graft ×3, and varied fixation techniques. Postoperative recurrence (17%) was associated with cyst location between the capital femoral epiphysis and the linea intertrochanterica (P = 0.010). At the final assessment (mean follow-up: 26.51 ± 18.99 months), all showed radiological bony union with 93% rated as "good" and 7% as 'fair' based on Ratliff hip scores. Complications arose in 20% of patients, significantly correlated with prior pathological fractures (P = 0.007) and their association with the linea intertrochanterica (P = 0.004). Those with fractures reported higher intraoperative blood loss (P = 0.015) and longer surgery durations (P = 0.012) compared to those without. Treating pediatric proximal femoral bone cysts using techniques such as lesion curettage, defect filling, and selective internal fixation yields favorable outcomes. The presence of pathological fractures can prolong surgical time, increase intraoperative blood loss, and elevate postoperative complication risks. Hence, early surgical intervention for these cysts is recommended to prevent fractures.

Surgical Approach of Maxillary Cysts in Pediatric Patients: Report of Two Clinically Similar Cases with Different Diagnosis

Surgical Approach of Maxillary Cysts in Pediatric Patients: Report of Two Clinically Similar Cases with Different Diagnosis

Primary Mesenteric Hydatid Cyst in Pediatric Patients: Case Report and Literature Review

Mesenteric hydatid cyst in children is not common, even in endemic areas. The primary or secondary origin of this site, especially in children, remains controversial. Secondary peritoneal hydatid cyst mainly results from spontaneous or traumatic rupture of concurrent liver cysts or leakage of cystic contents during surgery. The aim of our study is to present a mesenteric hydatid cyst in children. Our study focuses on a single case of a child with peritoneal hydatid cyst, who underwent surgery in 2021 in the pediatric surgery department of the Mohammed VI hospital in Marrakech. The diagnosis is based on abdominal ultrasound, computed tomography and hydatidosis serology. The treatment is surgical by open or laparoscopic excision, which can be associated with medical treatment.

Treatment of Dentigerous Cyst in Pediatric Patients: Two Case Reports

Treatment of Dentigerous Cyst in Pediatric Patients: Two Case Reports

Surgical management of Rathke cleft cysts in pediatric patients: a single institution experience

ObjectiveRathke cleft cysts (RCCs) are benign, epithelial-lined sellar lesions that arise from remnants of the craniopharyngeal duct. Due to their rarity in the pediatric population, data are limited regarding the natural history and optimal management of growing or symptomatic RCCs. We present our institutional experience with the surgical management of RCCs.MethodsWe performed a retrospective study of consecutive RCC patients ≤ 18 years old treated surgically at our institution between 2006 and 2022.ResultsOverall, 567 patients with a diagnosis of pituitary mass or cyst were identified. Of these, 31 had a histopathological diagnosis of RCC, 58% female and 42% male. The mean age was 13.2 ± 4.2 years. Presenting symptoms included headache (58%), visual changes (32%), and endocrinopathies or growth delay (26%); 13% were identified incidentally and subsequently demonstrated growth on serial imaging. Six percent presented with symptomatic intralesional hemorrhage. Surgical approach was transsphenoidal for 90% of patients and orbitozygomatic for 10%. Preoperative headaches resolved in 61% of patients and preoperative visual deficits improvement in 55% after surgery. New pituitary axis deficits were seen in 9.7% of patients. Only two complications occurred from a first-time surgery: one cerebrospinal fluid leak requiring lumbar drain placement, and one case of epistaxis requiring cauterization. No patients experienced new visual or neurological deficits. Patients were followed postoperatively with serial imaging at a mean follow-up was 62.9 ± 58.4 months. Recurrence requiring reoperation occurred in 32% of patients. Five-year progression-free survival was 47.9%. Except for one patient with multiple neurological deficits from a concurrent tectal glioma, all patients had a modified Rankin Scale score of 0 or 1 (good outcome) at last follow-up.ConclusionDue to their secretory epithelium, pediatric RCCs may demonstrate rapid growth and can cause symptoms due to local mass effect. Surgical management of symptomatic or growing pediatric RCCs via cyst fenestration or partial resection of the cyst wall can be performed safely, with good neurologic outcomes. There is a nontrivial risk of endocrinologic injury, and long-term follow up is needed due to high recurrence rates.

Spontaneous recovery of underlying bony erosion following surgical removal of craniofacial dermoid cysts in periatric patients: A prospective study

This study aimed to evaluate the spontaneous recovery of bone deformity after surgical excision of craniofacial dermoid cysts in pediatrics.Pediatric patients who underwent excision of a dermoid cyst were included in the study. A prospective analysis was conducted to evaluate the amount of bone recovery by comparing the depth of bony concavity in the preoperative and postoperative (6 months) ultrasonography.In 145 of 187 patients with preoperative imaging available, the mean size of dermoid cysts was 1.4 cm3 (range, 0.1 to 9.5), and 41.4% (60/145 cases) showed cranial bone depression. In the comparison of preoperative and postoperative ultrasonography of 30 patients, the mean depth of bony cavity decreased significantly from 4.0 to 0.9 mm (p<0.001) after a mean of 6.7 months postoperatively. There was 13.3% (4/30) of mild (≤2.0 mm), 40.0% (12/30) of moderate (>2.0 to ≤4.0 mm), and 46.7% (14/30) of severe (>4.0 mm) depression, and the concavity depth significantly decreased in all groups (p = 0.028, mild; p<0.001, moderate; p<0.001 severe).Within the limitations of the study it seems that significant recovery of cranial bone depression does take place within 6 months after excision of craniofacial dermoid cysts in pediatric patients, saving the need for immediate reconstruction.

Treatment of symptomatic sacral arachnoid cysts in the pediatric population.

Symptomatic sacral arachnoid cysts are extremely rare in pediatric patients, resulting in a lack of consensus regarding optimal treatment measures. The current study evaluated the clinical symptoms and surgical indications, techniques, and outcomes of pediatric patients who underwent treatment for sacral arachnoid cysts with the aim of developing recommendations for follow-up and treatment. This retrospective study included pediatric patients who underwent surgical treatment for sacral arachnoid cysts between January 2000 and December 2020 at the Department of Pediatric Neurosurgery, Acıbadem University Faculty of Medicine. Thirteen patients were included in the study, 9 of whom were girls and 4 were boys. Five patients presented with urinary incontinence, 2 of whom also exhibited constipation. Other chief complaints included recurrent urinary tract infections (UTIs) and low-back pain (n = 4 patients each). Urological evaluation was performed in all patients, followed by urodynamic examination in those with urinary symptoms. Spinal MRI showed extra- and intradural sacral cysts in 12 patients and 1 patient, respectively. The latter patient exhibited recurrence during follow-up and underwent reintervention. Samples from the excised cyst walls were sent for pathological examination. Five patients with urinary incontinence, 2 with constipation, 4 with recurrent UTIs, and 3 with low-back pain exhibited resolution of symptoms after treatment. However, 1 patient with low-back pain did not show any improvement in symptoms. No postoperative complications were observed in the current study. The patients were followed-up regularly after surgery, and the mean follow-up duration was 4 years. Sacral arachnoid cysts in pediatric patients may be associated with urinary system dysfunction and low-back pain. Surgery is the treatment of choice for symptomatic patients and those with enlarged cysts with radiological evidence of compression, and the morbidity and mortality rates associated with surgery are low.

Decompression of odontogenic cyst involving the unerupted permanent teeth through removable space maintainer : case report

Treatment of odontogenic cyst in pediatric patients should be considered to preserve adjacent anatomical structures, especially developing permanent teeth. Decompression can prevent damage to surrounding permanent teeth and induce spontaneous eruption of permanent teeth. Removable space maintainer with rubber tube for decompression is used to maintain the patency of the cyst and space for the eruption.These are four case reports of odontogenic cyst involving maxillary canine and mandibular premolars. Due to preserving permanent teeth, all cases were treated with decompression. This case report shows that mandibular premolar spontaneously erupted into the proper position. While maxillary canine may need additional treatment intervention, such as orthodontic traction or surgical extraction.

Rare giant adrenal cyst in pediatric patient

Giant adrenal cysts represent very rare clinical cases that are normally incidentally discovered and occur extremely rarely among pediatric patients. This case reports a patient who presented with generalized intestinal complaints and GI bleeding. Ultrasound and MRI were performed and identified a giant right retroperitoneal cyst (9.2 cm × 10.5 cm x 11.7 cm). The patient underwent laparoscopic surgery with complete removal of the cyst from the right adrenal gland. Pathologic evaluation confirmed a benign adrenal cyst.

The treatment of different odontogenic cysts in children only using acrylic appliance-guided decompression: A long-term clinical study

Aim: Various odontogenic cysts may rarely occur in the jawbones during childhood, including radicular cysts, dentigerous cysts, and odontogenic keratocysts. Treatment for such cysts ranges from conservative approaches to radical surgical procedures. The present study evaluates the effect of the decompression alone method for treating various odontogenic cysts in children.Methods: A retrospective cohort study was performed that included pediatric patients who applied to the pedodontics clinic between 2014 and 2016. Data such as age, gender, anatomical location, reasons for admission, histopathological diagnosis and dimensions of the cysts, and associated teeth were recorded. All odontogenic cysts were treated using the decompression method with an acrylic obturator. All patients were evaluated clinically and radiologically one, three, six, and 12 months after the operation and annually thereafter.Results: As a result of the pathological examination, it was determined that 10 of the 16 odontogenic cysts were dentigerous cysts, 5 were radicular cysts and 1 was an odontogenic keratocyst. The patients consisted of 4 girls and 12 boys, with a mean age of 108.68±21.01 months. The average duration of the decompression was 7.3±1.41 months and the average follow-up was 9.6±2,56 years. In four patients, spontaneous eruption of the impacted permanent teeth was not observed; these were erupted using orthodontic treatment. In two cases of dentigerous cysts, the impacted teeth were extracted and the cyst was enucleated. In the remaining 14 cases, the permanent teeth erupted (spontaneous+orthodontic guided) successfully (87.5%), and the cysts healed completely after decompression treatment. Conclusion: To avoid developmental problems, conservative procedures should be preferred for the treatment of odontogenic cysts in children. Decompression therapy using an acrylic obturator is an effective treatment for odontogenic cysts in pediatric patients; this approach protects and maintains permanent teeth. However, new clinical studies with larger sample sizes are needed to support these results.

Atypical presentation of thyroglossal cyst in pediatric patient: a case report

&lt;p class="abstract"&gt;Thyroglossal duct cysts are the most common cause of congenital neck swelling that may present at any age. Classically, it presents as an anterior midline neck swelling that moves with protrusion of the tongue. The usual treatment of choice is Sistrunk operation. It can have atypical presentation requiring a thorough preoperative assessment before intervention. Here we discussed a case of atypical presentation of thyroglossal duct cyst in a 4 year old child.&lt;/p&gt;

Ocular manifestations of ruptured arachnoid cysts in pediatric patients

Arachnoid cysts are intra-arachnoidal collections of cerebrospinal fluid, which can rupture spontaneously or secondary to trauma, resulting in subdural hemorrhage and increased intracranial pressure. However, there is little published data examining the ocular manifestations of ruptured arachnoid cysts. By examining the records of children treated for ruptured arachnoid cysts who also underwent an ophthalmologic examination, we sought to characterize ocular manifestations of ruptured arachnoid cysts in children.

Exclusively endoscopic management of complicated pineal cysts in young children: Definitive treatment through single burr-hole technique.

Background: The management of complicated symptomatic pineal cysts in the pediatric population is challenging and variable. Surgical management may include treatment of hydrocephalus alone, or direct treatment of the cyst with or without direct hydrocephalus management. This is typically done through craniotomy-based microsurgical approaches to the pineal region or an endoscopic transventricular approach.Methods: We present a stepwise minimally invasive technique to treat complicated pineal cysts in young children associated with an obstructive hydrocephalus in a single procedure through third ventriculostomy combined with an intraventricular marsupialization of the pineal cyst through a single burr-hole using stereotactic navigation.Results: Two young patients with over 2 years of follow-up have done well without complication using this technique. Other literature reports for complex pineal cysts in pediatric patients are reviewed and this technique is not previously described for this population.Conclusion: Endoscopic third ventriculostomy and cyst marsupialization using a single burr-hole and stereotactic navigation for symptomatic or enlarging pineal cysts in children allow for minimally invasive management, a rapid recovery, short hospital stay, and durable outcome owed to redundant CSF flow pathways.

Minimally invasive management of peritoneal inclusion cysts in paediatric patients

Minimally invasive management of peritoneal inclusion cysts in paediatric patients

The clinical course of Rathke's cleft cysts in pediatric patients: impact on growth and pubertal development.

.Rathke’s cleft cysts (RCCs) are non-neoplastic epithelial lesions in the sellar or suprasellar regions. RCCs are usually asymptomatic; however, some patients experience headaches, visual disturbances, and endocrine disorders. The best treatment for associated endocrinopathy remains elusive. We aimed to investigate the clinical course, magnetic resonance imaging findings, and response to therapy in 10 pediatric patients with RCCs and endocrinopathy. Growth impairment and precocious puberty were observed to be prevalent. One patient with suprasellar extension of RCC underwent surgery, while the others were treated medically. Of the nine patients, seven patients showed stable cyst size, while two patients displayed reduction in cyst size. Hormone replacement and gonadotropin suppression therapy were found to be effective. Imaging and endocrine follow-ups are warranted because of the potential for changes in the cyst size and hormonal changes.

Surgical management of intracranial arachnoid cysts in pediatric patients: radiological and clinical outcome.

Congenital intracranial cysts account for a significant portion of intracranial lesions in the pediatric population. The efficiency of surgical treatment in a pediatric cohort with intracranial arachnoid cysts (ACs) at different locations regarding clinical symptoms and mass effect was evaluated. A retrospective study of all children who underwent surgical treatment of an intracranial AC during an 11-year period (2007-2018) was performed. Demographics, clinical symptoms, and radiological cyst size pre- and postoperatively, as well as the reoperation rate and possible treatment complications, were analyzed. A total of 116 intracranial cysts at 8 different anatomical locations were surgically treated in 113 children (median age 5 years and 10 months) predominantly by endoscopic technique (84%). The complication rate was 3%, and the reoperation rate was 16%. Preoperative cyst enlargement was significantly more common in infants (p < 0.0001), as was the need for reoperation (p = 0.023). After a median radiological follow-up of 26 months, > 50% reduction of cyst volume was seen in 53 cysts (46%), and 47 cysts (40%) showed a 10%-50% reduction. Acute clinical symptoms improved: nausea and vomiting, accelerated head growth, and headaches improved at 100%, 92% and 89%, respectively. However, chronic symptoms responded less favorably after a median clinical follow-up of 26 months. The strategy of predominantly endoscopic treatment with navigation planning is efficient to alleviate clinical symptoms and to significantly reduce the mass effect of pediatric intracranial cysts at different anatomical locations. The subgroup of infants requires close pre- and postoperative monitoring.

Pediatric cerebral cysts: comparison of early complications following fenestration versus shunting procedures

ABSTRACT Objective: Characterize practice patterns and acute (30-day) surgical complications following fenestration and shunt procedures for the treatment of cerebral cysts in pediatric patients. Methods: This study utilized the American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) Pediatric database. Patients were identified by International Classification of Disease codes for cerebral cysts and Current Procedural Terminology codes for shunting or fenestration. Demographic data, preoperative comorbidities, and postoperative complications were compared between the two procedures. Results: 741 patients were included in the data analysis, with a majority aged 4 years or younger (55.9%) and a male predominance (62.6%). Fenestration was performed in 590 (79.6%) patients. Primary shunting was performed in 151 (20.4%) patients. Patients who received shunts were more commonly aged 0–4 years and had proportionately worse preoperative health status. No statistically significant differences in postoperative complications were detected. Reoperation rate was 7.9% and 8.6% in the shunt and fenestration groups, respectively. Common reasons for reoperation were shunt revision or replacement and shunt placement after fenestration. Patients requiring shunting after a failed fenestration tended to be younger with higher American Society of Anesthesiologists (ASA) classification. Discussion: Fenestrations are performed more often than shunting. Generally, children who receive shunts are younger than those who undergo fenestration. Acute surgical risk appears to be similar for both operations.