Cyst Size Research Articles

P.140 Illustrated case report: CSF shunt peritoneal catheter obstruction due to omental adhesion and fat stranding

Background: CSF shunt obstruction secondary to omental adhesion alone, without cyst or pseudocyst formation, is rarely reported in the literature. Here we present a case of distal catheter obstruction due to omental wrapping with an atypical presentation of shunt failure. CT imaging demonstrated omental stranding. The shut revision was entirely laparoscopic. The case is supplemented with intraoperative images. Methods: Chart review and literature search. Results: 33-year-old female with right-sided cystoperitoneal shunt for posterior fossa arachinoid cyst who presented to ED with a picture of a surgical abdomen suggestive of acute cholecystitis. Interestingly, this patient had a gallbladder removed a year ago. CT abdomen showed non-specific findings of omental fat stranding around the tip of the catheter. Although this patient had no headache or any neurological symptoms, CT brain was done and showed increase in the cyst size. Diagnostic laparoscopy showed Intraoperative findings suggestive of active omental role in the aetiology of this shunt malfunction. After adequate adhesiolysis, the catheter was noted to be working and dripping CSF and repositioned into the peritoneal cavity. Conclusions: Shunt malfunctions due to omentoperitoneal adhesion is rarely reported but may in fact be under-recognized. This requires high index of suspicion especially in case of equivocal imaging.

Successful use of single-port laparoscopic surgery for ovarian cyst removal during pregnancy: a case series of three cases

Abstract Pregnant patients have an increased risk of torsion compared to that seen in nonpregnant patients, and those with larger cysts undergo torsion more frequently, which can cause obstructions during labor. The risks associated with emergent surgery are higher than those with elective surgery. Laparoscopic surgery can be safely performed during pregnancy. Single-port laparoscopic surgery is reported to be a minimally invasive laparoscopic technique. We report three cases of ovarian dermoid cysts, which were successfully removed during pregnancy through elective single-port laparoscopic surgery. In all cases, imaging showed a dermoid cyst and the cyst size was greater than 6 cm. All patients requested the surgery. The ovarian cysts were successfully removed by single-port laparoscopy without additional ports and without intra- or postoperative complications. All pregnancies progressed well and delivered vaginally at full term. The single-port laparoscopic approach is useful for removing ovarian cysts during pregnancy.

Paediatric pineal region cysts: enigma or impaired neurofluid system?

PurposePineal region cysts (PCs) may affect the tectum and aqueduct and cause deep central vein congestion. Beside headaches, PC often causes a broad range of symptoms, leading to prolonged diagnosis and therapy. The aims of this study are to reveal parameters that might explain the ambiguity of the symptoms and to identify factors in association with the respiration-driven neurofluid system.MethodsThis retrospective study included 28 paediatric patients (mean age 11.6 years) who received surgical treatment and 18 patients (mean age 11.3 years) who were followed conservatively. Symptoms, time to diagnosis, cyst size, ventricular indices, head circumference and postoperative outcome, were analysed. Four patients were investigated for CSF dynamics with real-time MRI. The mean follow-up time was 1.6 years.ResultsThe most common early onset symptoms were headaches (92%), blurred vision (42.8%), sleep disturbances (39.3%) and vertigo (32.1%). Tectum contact was observed in 82% of patients, and MRI examinations revealed that imaging flow void signals were absent in 32.1% of patients. The maximal cyst diameters were 13.7 × 15.6 mm (mean). Together with a postoperative flow void signal, 4 patients recovered their respiration-driven CSF aqueductal upward flow, which was not detectable preoperatively. After surgery the main symptoms improved.ConclusionDespite proximity to the aqueduct with frequently absent flow void signals, hydrocephalus was never detected. Data from real-time MRI depicted a reduced preoperative filling of the ventricular CSF compartments, indicating a diminished fluid preload, which recovered postoperatively.

Supraorbital minicraniotomy for open Ommaya reservoir placement in pediatric craniopharyngiomas: a case series and technical report.

Craniopharyngiomas with a predominant cystic component are often seen in children and can be treated with an Ommaya reservoir for aspiration and/or intracystic therapy. In some cases, cannulation of the cyst can be challenging via a stereotactic or transventricular endoscopic approach due to its size and proximity to critical structures. In such cases, a novel placement technique for Ommaya reservoirs via a lateral supraorbital incision and supraorbital minicraniotomy has been used. The authors conducted a retrospective chart review of all children undergoing supraorbital Ommaya reservoir insertion from January 1, 2000, to December 31, 2022, at the Hospital for Sick Children, Toronto. The technique involves a lateral supraorbital incision and a 3 × 4-cm supraorbital craniotomy, with identification and fenestration of the cyst under the microscope and insertion of the catheter. The authors assessed baseline characteristics and clinical parameters of surgical treatment and outcome. Descriptive statistics were conducted. A review of the literature was performed to identify other studies describing a similar placement technique. A total of 5 patients with cystic craniopharyngioma were included (3 male, 60%) with a mean age of 10.20 ± 5.72 years. The mean preoperative cyst size was 11.6 ± 3.7 cm3, and none of the patients suffered from hydrocephalus. All patients suffered from temporary postoperative diabetes insipidus, but no new permanent endocrine deficits were caused by the surgery. Cosmetic results were satisfactory. This is the first report of lateral supraorbital minicraniotomy for Ommaya reservoir placement. This is an effective and safe approach in patients with cystic craniopharyngiomas, which cause local mass effect but are not amenable to traditional Ommaya reservoir placement stereotactically or endoscopically.

P.107 Endocrine and vision outcomes following 90Yttrium therapy for cystic sellar lesions: a prospective cohort study

Background: Due to high risk of recurrence and complications associated with microsurgical resection or aspiration of enlarging cystic sellar lesions, stereotactic intracavitary irradiation with 90Yttrium (90Yt) has been proposed as an alternative to mitigate these challenges. Long-term efficacy data for this procedure is lacking. Methods: We conducted a Health Canada approved, single-centre, prospective cohort study to assess the effect of 90Yt therapy on cyst volume, visual field (VF) testing and endocrine function. All patients underwent right frontal stereotactic insertion of 90Yt colloid (200 Gy cyst wall). Results: 22 patients [mean age = 63.5 (± 15.4) years] received 90Yt therapy. Mean follow-up was 52 (5-113) months. Cysts included: craniopharyngioma (86%), Rathke’s cleft cyst (9%) and cystic prolactinoma (5%). Mean cyst volume reduction was 77% at 12-months (5.2 ± 4.5 cc to 1.2 ± 1.5 cc; p = 0.002). Rate of pre- and post-op hormonal dysfunction was 59% and 68%, respectively (p = 0.50). Pre-operative VF deficits were found in 68% of patients, of which 32% normalized and 36% remained stable (p = 0.180). Worsened vision was detected in 9% of patients post-operatively. Conclusions: 90Yttrium therapy significantly reduces sellar cyst size without having a deleterious effect on vision and endocrine function.

Extracellular vesicles contribute to early cyst development in autosomal dominant polycystic kidney disease by cell-to-cell communication.

Autosomal dominant polycystic kidney disease (ADPKD) is characterized by the formation of fluid-filled cysts within the kidney due to mutations in PKD1 or PKD2. Although the disease remains incompletely understood, one of the factors associated with ADPKD progression is the release of nucleotides (including ATP), which can initiate autocrine or paracrine purinergic signaling by binding to their receptors. Recently, we and others have shown that increased extracellular vesicle (EVs) release from PKD1 knockout cells can stimulate cyst growth through effects on recipient cells. Given that EVs are an important communicator between different nephron segments, we hypothesize that EVs released from PKD1 knockout distal convoluted tubule (DCT) cells can stimulate cyst growth in the downstream collecting duct (CD). Here, we show that administration of EVs derived from Pkd1-/- mouse distal convoluted tubule (mDCT15) cells result in a significant increase in extracellular ATP release from Pkd1-/- mouse inner medullary collecting duct (iMCD3) cells. In addition, exposure of Pkd1-/- iMCD3 cells to EVs derived from Pkd1-/- mDCT15 cells led to an increase in the phosphorylation of the serine/threonine-specific protein Akt, suggesting activation of proliferative pathways. Finally, the exposure of iMCD3 Pkd1-/- cells to mDCT15 Pkd1-/- EVs increased cyst size in Matrigel. These findings indicate that EVs could be involved in intersegmental communication between the distal convoluted tubule and the collecting duct and potentially stimulate cyst growth.

Surgical management of hydatid cyst disease of the liver: An improvement from our previous experience?

Hydatid liver disease remains an important issue in endemic areas, which may require immediate surgery. Although laparoscopic surgery is on the rise, the presence of certain complications may require conversion to the open approach. To compare the results of laparoscopic treatment and the open approach in the context of a 12-year single institution experience, and to perform a further comparison between results from the current study and those from a previous study. Between January 2009 and December 2020, 247 patients underwent surgery for hydatic disease of the liver in our department. Of the 247 patients, 70 underwent laparoscopic treatment. A retrospective analysis between the two groups was performed, as well as a comparison between current and previous laparoscopic experience (1999-2008). There were statistically significant differences between the laparoscopic and open approaches regarding the cyst dimension, location, and presence of cystobiliary fistula. There were no intraoperative complications in the laparoscopic group. The cutoff value for the cyst size regarding the presence of cystobiliary fistula was 6.85 cm (P = 0.001). Laparoscopic surgery still plays an important role in the treatment of hydatid disease of the liver, with an increase in its usage over the course of years that has shown benefits regarding the postoperative recovery with a decreased rate of intraoperative complications. Although experienced surgeons can perform laparoscopic surgery in the most difficult conditions, there are some selection criteria that need to be maintained for higher quality results.

Progression of pulmonary cysts in Birt-Hogg-Dubé syndrome: longitudinal thoracic computed tomography study with quantitative assessment

BackgroundBirt-Hogg-Dubé (BHD) syndrome is a rare autosomal dominant disorder characterized by fibrofolliculomas, renal tumors, pulmonary cysts, and recurrent pneumothorax. Pulmonary cysts are the cause of recurrent pneumothorax, which is one of the most important factors influencing patient quality of life. It is unknown whether pulmonary cysts progress with time or influence pulmonary function in patients with BHD syndrome. This study investigated whether pulmonary cysts progress during long-term follow-up (FU) by using thoracic computed tomography (CT) and whether pulmonary function declines during FU. We also evaluated risk factors for pneumothorax in patients with BHD during FU.MethodsOur retrospective cohort included 43 patients with BHD (25 women; mean age, 54.2 ± 11.7 years). We evaluated whether cysts progress by visual assessment and quantitative volume analysis using initial and serial thoracic CT. The visual assessment included the size, location, number, shape, distribution, presence of a visible wall, fissural or subpleural cysts, and air-cuff signs. In CT data obtained from a 1-mm section from 17 patients, the quantitative assessment was performed by measuring the volume of the low attenuation area using in-house software. We evaluated whether the pulmonary function declined with time on serial pulmonary function tests (PFT). Risk factors for pneumothorax were analyzed using multiple regression analysis.ResultsOn visual assessment, the largest cyst in the right lung showed a significant interval increase in size (1.0 mm/year, p = 0.0015; 95% confidence interval [CI], 0.42–1.64) between the initial and final CT, and the largest cyst in the left lung also showed significant interval increase in size (0.8 mm/year, p < 0.001, 95% CI; -0.49–1.09). On quantitative assessment, cysts had a tendency to gradually increase in size. In 33 patients with available PFT data, FEV1pred%, FEV1/FVC, and VCpred% showed a statistically significant decrease with time (p < 0.0001 for each). A family history of pneumothorax was a risk factor for the development of pneumothorax.ConclusionsThe size of pulmonary cysts progressed over time in longitudinal follow-up thoracic CT in patients with BHD, and pulmonary function had slightly deteriorated by longitudinal follow-up PFT.

Risk Factors for Progression in Patients Undergoing Surveillance for Pancreatic Cysts.

To identify risk factors associated with the progression of pancreatic cysts in patients undergoing surveillance. Previous studies of intraductal papillary mucinous neoplasms (IPMNs) rely on surgical series to determine malignancy risk and have inconsistently identified characteristics associated with IPMN progression. We conducted a retrospective review of 2197 patients presenting with imaging concerning for IPMN from 2010 to 2019 at a single institution. Cyst progression was defined as resection or pancreatic cancer development. The median follow-up time was 84 months from the presentation. The median age was 66 years, and 62% were female. Ten percent had a first-degree relative with pancreatic cancer, and 3.2% had a germline mutation or genetic syndrome associated with an increased risk of pancreatic ductal adenocarcinoma (PDAC). Cumulative incidence of progression was 17.8% and 20.0% at 12 and 60 months postpresentation, respectively. Surgical pathology for 417 resected cases showed noninvasive IPMN in 39% of cases and PDAC with or without associated IPMN in 20%. Only 18 patients developed PDAC after 6 months of surveillance (0.8%). On multivariable analysis, symptomatic disease [hazard ratio (HR)=1.58; 95% CI: 1.25-2.01], current smoker status (HR=1.58; 95% CI: 1.16-2.15), cyst size (HR=1.26; 95% CI: 1.20-1.33), main duct dilation (HR=3.17; 95% CI: 2.44-4.11), and solid components (HR=1.89; 95% CI: 1.34-2.66) were associated with progression. Worrisome features on imaging at presentation, current smoker status, and symptomatic presentation are associated with IPMN progression. Most patients progressed within the first year of presentation to Memorial Sloan Kettering Cancer Center (MSKCC). Further investigation is necessary to develop personalized cyst surveillance strategies.

A Combined DNA/RNA-based Next-Generation Sequencing Platform to Improve the Classification of Pancreatic Cysts and Early Detection of Pancreatic Cancer Arising From Pancreatic Cysts.

We report the development and validation of a combined DNA/RNA next-generation sequencing (NGS) platform to improve the evaluation of pancreatic cysts. Despite a multidisciplinary approach, pancreatic cyst classification, such as a cystic precursor neoplasm, and the detection of high-grade dysplasia and early adenocarcinoma (advanced neoplasia) can be challenging. NGS of preoperative pancreatic cyst fluid improves the clinical evaluation of pancreatic cysts, but the recent identification of novel genomic alterations necessitates the creation of a comprehensive panel and the development of a genomic classifier to integrate the complex molecular results. An updated and unique 74-gene DNA/RNA-targeted NGS panel (PancreaSeq Genomic Classifier) was created to evaluate 5 classes of genomic alterations to include gene mutations (e.g., KRAS, GNAS, etc.), gene fusions and gene expression. Further, CEA mRNA ( CEACAM5 ) was integrated into the assay using RT-qPCR. Separate multi-institutional cohorts for training (n=108) and validation (n=77) were tested, and diagnostic performance was compared to clinical, imaging, cytopathologic, and guideline data. Upon creation of a genomic classifier system, PancreaSeq GC yielded a 95% sensitivity and 100% specificity for a cystic precursor neoplasm, and the sensitivity and specificity for advanced neoplasia were 82% and 100%, respectively. Associated symptoms, cyst size, duct dilatation, a mural nodule, increasing cyst size, and malignant cytopathology had lower sensitivities (41-59%) and lower specificities (56-96%) for advanced neoplasia. This test also increased the sensitivity of current pancreatic cyst guidelines (IAP/Fukuoka and AGA) by >10% and maintained their inherent specificity. PancreaSeq GC was not only accurate in predicting pancreatic cyst type and advanced neoplasia but also improved the sensitivity of current pancreatic cyst guidelines.

Presentation and management outcome of symptomatic epididymal cysts in children: A case series

IntroductionEpididymal cysts usually develop in adults with rare occurrence in children. There is a shortage concerning our knowledge about this rare pathology in children. We present our experience with the presentation and management outcome of symptomatic epididymal cysts in children. MethodsA retrospective analysis of 7 patients with symptomatic epididymal cysts during the period from October 2017 to June 2022 was conducted. Recorded data included age and mode of presentation, findings on physical examination and scrotal U/S, spontaneous resolution and its duration, indications of surgical intervention, and post management follow up. All patients underwent an initial plan of conservative management. Surgical intervention was indicated in patients with persisting symptoms and/or failure of lesion's resolution on periodic follow up of 3 months interval. ResultsThe average age of patients was 7.9 years. Scrotal pain was the leading presenting symptom in 4 (57.1%) patients. The diagnosis was confirmed in all patients by scrotal ultrasonography. Spontaneous resolution was reported in 5 (71.4%) patients with an average duration of 9 months. Surgical excision was indicated in 2 (28.6%) patients. Recurrence was not recorded in all patients who developed complete lesion's resolution, and patients were symptom free for 6 months of post management follow up. ConclusionThe majority of epididymal cysts in children can be managed conservatively. Resolution duration is directly proportional to the cyst size. Cysts larger than 10 mm less likely involute, and surgical excision may be indicated. Larger volume studies are needed to establish a more solid therapeutic regimen.

Endoscopic Aspiration and Marsupialization for Colloid CYST

Background: Colloid cyst is a benign intracranial tumor found in the anterior third ventricle. Due to location of this tumor, it has propensity to cause obstruction to CSF flow causing hydrocephalus. Treatment options include excision or aspiration of cyst through open or endoscopic procedures or CSF diversion procedures. Recent years have seen a shift towards endoscopic approach to treatment of colloid cyst due to its relative simplicity among endoscopic procedures and other favorable patient related factors. We share our experience with endoscopic aspiration and marsupialization of colloid cyst. Methods: This descriptive retrospective study was done at Neuro surgery department of Neurosurgery, SMBB Institute of Trauma, Dow University of Health Sciences, Dr. Ruth K. M. Pfau Civil Hospital Karachi, Pakistan. Data of patients who had endoscopic aspiration and marsupialization of colloid cyst between February 2017 and October 2020. Patient demographics, clinical presentation, radiological features, operative course and post-operative course was recorded. Clinical or radiologic recurrence was noted on follow-up. Results: Ten patients were operated during the study period. Headache was most common presenting symptom. Mean size of cyst was 21mm. There was incomplete aspiration in 3 patients as observed per-operatively and by residual cyst content on immediate post-operative CT scan which disappeared completely on subsequent scans. CSF leak was observed in 3 patients and 2 developed meningitis. No symptomatic recurrence occurred. Conclusion: Endoscopic aspiration with marsupialization of cyst wall is a safe and effective technique for treatment of colloid cyst. Incomplete aspiration of cyst contents may not require further intervention as the radiological resolution of cyst is observed over time. Further follow-up and larger sample size is needed to further establish the safety and efficacy of this procedure. Keywords: colloid cyst, endoscopic, follow-up studies

Use of indocyanine green in the resection of renal cysts in children

Fluorescent imaging technology with indocyanine green (ICG) is used to improve intraoperative visualization of the anatomical structures of the affected organs and increase the efficiency of laparoscopic or robotic operations. Recently, ICG imaging has been used in pediatric gastroenterology, oncology, and urology.&#x0D; In this study, we present laparoscopic treatment of two cases of simple renal cysts in two male patients aged 10 and 12 years. Resection of the extrarenal portion of the kidney cyst was performed using fluoroscopic control by intravenous administration of ICG. The intrarenal residue was subjected to argon-plasma coagulation. Treatment outcomes were assessed over a follow-up period of 6 and 12 months. The cyst sizes measured before surgery using ultrasound and computed tomography were 50 and 70 mm. Both cysts were located in the lower pole of the right kidney. The operation times were 40 and 45 min. During the surgical intervention, no complications such as bleeding from the kidney parenchyma or damage to neighboring organs occurred. In all cases, the cyst contained a clear liquid without pathological impurities. The cytological examination revealed a low cell content, which was represented by single macrophages and urothelial cells. Histological analysis revealed that the lining of the cyst wall was represented by the transitional epithelium without signs of malignancies. The hospital length of stay was 3 days. Ultrasound examinations performed 1, 3, 6, and 12 months after the operation did not detect signs of disease recurrence. Thus, based on the presented clinical case, the main advantage of using fluorescent technology during kidney cyst resection include a clear definition of the demarcation line between the avascular wall of the cyst and the perfused kidney tissue, which helps prevent bleeding from the renal parenchyma.

Homoeopathic Treatment of Chocolate Cyst: A Case Report

AbstractChocolate cysts of the ovary come under the subgroup of endometriosis. The prevalence of chocolate cyst in the reproductive age group is 8% and in the postmenopausal age group it is 18%. Its defining symptoms include dyspareunia, pelvic pain, irregular periods and menstrual pain. A cyst size of more than 4 cm indicates the need for surgical treatment. The typical therapies for this condition include hormone therapy and operations like hysterectomy. In this case report, we have shown a positive curative role of homeopathic medicine in the management of chocolate cyst of the ovary.A 31-year-old woman complaining of weakness came to the OPD, painful irregular menses with large clots and stitching pain in the right inguinal region. She was diagnosed with a case of chocolate cyst of the ovary. She had been on hormonal therapy for a year without any relief, and the report showed that the cyst has grown bigger. The patient was treated successfully with individualised homoeopathic medicine Lachesis in centesimal potency, which showed significant improvement in patient – and post-treatment outcome was corroborated with follow-up and laboratory investigation which showed complete regression of cyst.Causal attribution for changes in the condition of patients after homoeopathic medication was assessed by modified Naranjo criteria. However, this is a single case in which chocolate cyst of the ovary associated with variable and unpredictable remission was found.

Comparison of the Effect of Honey, Olive, Propolis Combined Vaginal Cream With OCP in the Treatment of Functional Ovarian Cysts in Women of Reproductive Age Referring to Health Centers, Hamadan, Iran 2020-2021

Background: The prevalence of functional ovarian cysts in women is high, and choosing an appropriate, and uncomplicated treatment is necessary. Objective: Compare the effectiveness of honey, olive, and propolis combined vaginal cream with OCP in the treatment of functional ovarian cysts in women of reproductive age in Iran. Methods: This randomized clinical trial study was performed on 40 women of reproductive age referred to Hamadan health centers in 2020. Patients were randomized into two groups, A and B. Group A received oral contraception pills for two consecutive cycles from the seventh day of the menstrual cycle tablets for 21 days after the end of menstruation until the beginning of the next menstruation. Group B received honey, olive, propolis combined vaginal cream. In both groups, the treatment continued for two consecutive cycles. Data was collected through a checklist that included clinical symptoms and ultrasound results. The results were analyzed by Stata-13 and the significance level cut-off was considered less than 0.05. Results: Intra-group comparisons showed that there was a statistically significant (P &lt; 0.05) decrease in cyst size after the intervention in both groups. Intergroup differences were not statistically significant (P ˃ 0.05). Conclusion: Honey, olive, propolis combined vaginal cream (Nika) can be effective like oral contraceptive pills in reducing the size of ovarian cysts. It can be recommended for the treatment of functional ovarian cysts. Clinical Trial Registration Number: IRCT20120215009014N384

Evaluation of the factors influencing the choice of laparoscopic echinococcectomy in liver echinococcosis (LE) and its impact on postoperative outcomes.

The aim of this article is to evaluate the factors influencing the choice of laparoscopic echinococcectomy (LapEE) in liver echinococcosis (LE) and its impact on postoperative outcomes. The article presents a retrospective analysis of the effectiveness of LapEE depending on gender, age, cyst location, size and stage of echinococcal cysts (EC) development, also taking into account the performance of drainage or abdominal interventions in relation to the residual cavity (RC). The study included patients with the primary form of LE - 46 patients who underwent LapEE at the State Institution "Republican Specialized Scientific and Practical Medical Center for Surgery, named after the academician V. Vakhidov", between 2019 and 2020. Taking into account the stage of cyst development, various difficulties with aspiration or removal of the cyst contents occurred in only 14 (30.4%) cases, more often with type II-IV cystic echinococcosis (CE). Another problem was the difficulty with adequate revision and treatment of RC (in 6 (13.0%) patients) with predominantly intraparenchymal localization. Difficulties with performing percytectomy with sufficient excision of the fibrous capsule were noted in 9 (19.6%) cases. In the period up to a week after the operation, the drainage was removed for cysts up to 8cm in 11 (36.7%) cases, with more than 8cm - in 5 (31.3%). By 3 weeks of observation, the drains were removed in all cases with cysts up to 8cm, while with large sizes in 12.5% (2 patients) cases, the drainage was removed on days 21-28 and in 1 (6.3%) patient at a later period. In general, in the group, complications from the RC on days 9-27 after LapEE were noted in 10 (21.7%) of 46 patients, fluid accumulation in 8 (17.4%) and suppuration in 2 (4.3%). Most complications were resolved conservatively - 13.0% (in 6 patients), a minimal invasive drainage of the RC was performed in 6.5% (3 patients), 1 (2.2%) patient was operated on with a RC abscess. Among the main factors that technically complicate LapEE, in addition to localization, difficulties with aspiration or removal of cyst contents in CE II, III, and IV are highlighted due to the presence of many daughter cysts that completely fill the maternal membrane (CE II, III) or thick viscous discharge (CE IV), as well as difficulties in performing a pericystectomy for adequate elimination of the RC when the hydatid is located 3/4 or more in the liver parenchyma.

Immune recognition of latent neuronal Toxoplasma gondiiinfection

Abstract Toxoplasma gondii is a neurotropic parasite with high mortality rates in immunocompromised individuals. Successful therapies have been developed against the acute tachyzoite stage, but no treatment options exist to target the latent form of the parasite – bradyzoites that form cysts within neurons. It is thought that residence of cysts in neurons shelters T. gondii from immune recognition and clearance. However, a decline in cyst numbers over time suggests the presence of anti-cyst immunity. Additionally, neuronal deletion of STAT1 results in increased cyst size and number, but no change in tachyzoite replication, providing evidence for IFN-γ-mediated cyst control. T cells are a major source of IFN-γ and are crucial for parasite control in the CNS, but it remains unclear if T cells directly target cyst-infected neurons. The use of transgenic parasites with bradyzoite-restricted OVA expression (BagOVA) reveals that cyst-derived antigen can induce OT-I CD8+ T cell responses in the brains of chronically infected mice. These cyst-specific OT-Is have distinct effector phenotypes and cytokine production when compared to T cells responding to antigen expressed by both tachyzoites and bradyzoites (ptubOVA). To determine whether neurons directly present cyst antigen to induce CD8+ T cell responses in BagOVA infection, mice with neuronal-specific loss of MHCI were generated. Infection of these mice showed no significant change in the magnitude of T cell responses or parasite burden in the CNS. Together these findings reveal that T cell responses can be mounted against cyst antigens, but another cell type likely mediates cross presentation of cyst derived antigens. Supported by grants from NIH (R01 580-5803-4-580697-XXXX-2000-3000)

Endoscopic versus Microsurgical Resection of Third Ventricle Colloid Cysts: A Single-Center Case Series of 140 Consecutive Patients

Both endoscopic and microsurgery transcortical resection methods are used for colloid cysts of the third ventricle but they have not been compared regarding benefits and pitfalls. Data of patients who underwent surgical resection of third ventricle colloid cyst via either endoscopic or microsurgery approach by a single surgeon from 2005 to 2020 were retrospectively collected. After administration of criteria, 140 records were retrieved (60 patients through endoscopic resection and 80 patients by a transcranial microsurgery approach). Clinical and surgical measures were compared between the 2 types of surgery after adjustment for confounders. Length of hospital stay, postoperative meningitis, operation time, cyst size, and baseline comorbidities were similar between two groups. Gross total resection (GTR) was achieved for all patients in the microsurgery group, whereas in the endoscopic group, resection was lower (90% vs. 100%; P= 0.005). Intraoperative hemorrhage occurred in 14 endoscopic patients (23.3%), whereas for the microscopic group, it was zero (P < 0.001). Postoperative shunt was required for 2 patients (one in the endoscopic group and the other in the microscopic group). Two patients had tumor recurrence, both of whom were in the endoscopic group. No mortality was detected in either group. Multivariate analyses were insignificant for confounding effects of clinical and demographic factors in occurrence of worse surgical outcomes (non-GTR and hemorrhage). In our series, the rate of intraoperative hemorrhage was higher with the endoscopic method and GTR was lower, even after adjustment for other factors. This situation could be caused by technological shortcomings and limited space for resection maneuvers and management of complications.

Antiparasitic Properties of Allium sativum: Can it be Used as a Complementary Treatment for Echinococcosis?

Echinococcus granulosus (E. granulosus) is a parasitic tapeworm that can infect humans and various animal species, causing echinococcosis or hydatid disease. The larval stage of E. granulosus causes this infection and can have serious consequences if left untreated. The larvae hatch in the intermediate host's small intestine and then migrate to the liver or lungs, forming cysts that can grow to several centimeters. Garlic, a plant species scientifically known as Allium Sativum, is used for medicinal purposes due to its various sulfur compounds. This review article aims to critically evaluate the potential of garlic as a natural treatment for echinococcosis, a parasitic disease caused by E. granulosus, based on the available scientific evidence. Garlic have been demonstrated to have antiparasitic effects and can enhance the immune response against E. granulosus. Garlic may inhibit the growth and development of cysts in infected animals and have immunomodulatory effects. Garlic treatment could significantly reduce the number and size of cysts in infected mice. The present review aimed to highlight the potential of garlic as a natural treatment for echinococcosis but emphasized the importance of seeking medical treatment under the guidance of a healthcare professional.

Ultrasonographic features associated with previous torsion and the impact of surgery in managing neonatal ovarian cysts: a 20-year single-centre retrospective study

PurposeTo identify markers of previous ovarian torsion and outline the outcomes according to US appearance and operative management.MethodsA retrospective single-centre review of neonatal ovarian cysts from January 2000 to January 2020. Data on postnatal cyst size and sonographic features and operative treatment were co-related with outcomes of ovarian loss and histology.Results77 females were included with 22 simple and 56 complex cysts, one patient had bilateral cysts. 9/22 (41%) simple cysts regressed spontaneously in a median of 13 weeks (8–17). Complex cysts regressed spontaneously less frequently, 7/56(12%, P = 0.01), in 13 weeks (7–39). 38/56 (68%) complex and 12/22 (55%) simple cysts were treated operatively. 21/22 (95%) ovaries with initially simple cyst were salvaged compared to 20/56(36%) with initially complex cyst (P < 0.001). A fluid-debris level in 23/26 complex cysts was most associated with ovarian loss (P = 0.0006). Presence of viable ovarian stromal tissue was seen in 8/20 (40%) excised specimens during ovarian sparing procedures and in 5/30 (17%) oophorectomies for necrotic appearing ovaries.ConclusionsFluid-debris level on US is significantly associated with ovarian loss likely due to previous torsion. Simple cysts are viable and often regress spontaneously. The finding of viable ovarian stromal tissue in resected specimens supports attempting ovarian preservation wherever possible.