Cystic Tumor Research Articles

A CASE REPORT OF 3.31 KG MUCINOUS CYSTADENOMA OF THE OVARY IN A POSTMENOPAUSAL WOMEN

Almost 60% of total ovarian tumors are of epithelial origin.. Serous tumors are commonest cystic ovarian tumors and mucinous being the second most common. Majority are unilateral but rarely they can be bilateral. Epithelial ovarian cancer is the commonest gynecological malignancy that can cause mortality.

Bimaxillary odonto-ameloblastic fibroma: A case report

Introduction:
 Ameloblastic fibroma is a rare mixed odontogenic tumor, affects the young population, its management is mainly surgical. We report in this work the first observation of a concomitant bimaxillary localization.
 Clinical observation:
 This is a 31-year-old female patient with no pathological history who presented to our department for management of a maxillomandibular tumor. The clinical examination revealed a poor oral condition and a swelling of the alveolar ridges. The CT scan of the facial mass revealed a multilocular cystic lesion encompassing teeth in the maxillary and mandibular bone. The biopsy came back in favor of an odontoameloblastic fibroma. Management consisted of radical resection with reconstruction using local flaps.
 FOA is a tumor distinct from ameloblastoma, it affects the young patients without any predilection to gender. The radiological image is a mono or multilocular cystic image which poses a problem of differential diagnosis with other cystic tumors. The management is surgical, clinical and radiological postoperative surveillance is primordial given the risk of recurrence or sarcomatous transformation.
 Conclusion:
 The FOA was for a long time considered as a form of ameloblastoma, is a rare tumor in the mandibular localization is the most frequent, the bimaxillary localization has never been described and the case we presented is the first in literature.

Expression of p16 Tumor Suppressor Protein in Malignant Ovarian Germ Cell Tumors; Immunohistochemical Study.

Malignant ovarian germ cell tumors represent small percentage of malignant ovarian neoplasms but they affect significantly young age group. To investigate the immunohistochemical expression of p16 tumor suppressor protein in malignant ovarian germ cell tumors. Twenty-two malignant ovarian germ cell tumors (five dysgerminoma, eight immature teratoma, and nine yolk sac tumors), twenty mature cystic teratoma tumors and twenty normal ovarian tissue were immunohistochemically stained with p16 monoclonal antibody. Ki67 immunohistochemical staining was done for malignant ovarian germ cell tumors to assess proliferation. We found that p16 tumor suppressor protein is overexpressed in all malignant ovarian germ cell tumors in both nuclear and cytoplasmic locations compared to control and to mature cystic teratoma (p-value <0.001). Cytoplasmic p16 expression was significantly correlated to Ki67 proliferation index in malignant ovarian germ cell tumors (p-value = 0.033, r = 0.445). Overexpression of p16 in malignant ovarian germ cell tumors denotes that dysfunction of the cyclin dependent kinase pathway is involved in tumorigenesis of malignant ovarian germ cell tumors.

Successful management of 30 kg Gigantic para-testicular liposarcoma

We report the successful management of a paratesticular liposarcoma, which, to the best of our knowledge, is the largest known of its type. A 62-year-old male presented with a painless, gradually progressive left testicular “giant” mass measuring 60 × 40 cm, weighing 30 kg and growing over a period of three 3 years. Additionally, a 5 × 5 cm trophic ulcer could be seen at the bottom of the scrotum. The ultrasound of the left testis revealed the testis having been completely replaced with a cystic and solid tumour. Preoperative serum testicular tumour markers (STM) were within normal limits. The markers included Alpha Feto Protein, Beta Human Chorionic Gonadotropin and Lactose Dehydrogenase. A left sided high inguino-scrotal approach with a huge skin resection including the trophic ulcer with complete removal of the tumour and a primary complex closure of the wound was performed. The post-operative period was uneventful, and histopathology revealed a dedifferentiated liposarcoma. We believe social taboo and fear of disfigurement impart a sense of shame in patients which led to the delayed presentation in a hospital in the index patient. The absence of metastases even with a protracted course is surprising.

O144 The role of cytology in the investigation and management of cystic lesions of the pancreas with special reference to mucinous cystic neoplasms

Abstract Introduction Pancreatic cystic lesions encompass benign and malignant disease within the pancreas. Cytology has been increasingly used in the physician's toolbox to provide an accurate, non-invasive and cost-effective modality for the diagnosis of pancreatic lesions. The cytological appearance alone may be insufficient to establish the diagnosis and it's crucial for effective clinicopathological correlation in a multidisciplinary setting, highlighting the vital role of the pathologist to ensure effective and quality care. Methods We identified 178 cases of cystic lesions of the pancreas between 2017 and 2021. We used the C grading system and the Papanicolaou grading systems (Pap) to assess the potential risk of malignancy. Results We identified 20 cases with moderate and high grade intraductal papillary mucinous neoplasms (IPMN) and 12 cases of mucinous cystic neoplasms (MCN) by using the Pap grading system, 18% that may require surgical intervention. 39 cases (22%) are low grade IPMN. 72 cases are classified as high risk and potentially malignant (Pap grade 4b) in comparison with 25 cases, using the C grading (C4 and C5). The remaining cases 77 (43%) are benign to very low risk malignant potential that don't require surgical intervention. Conclusion The use of Pap grading allowed for a less invasive approach to tissue sampling which, when combined with routine staining and specialised immunohistochemistry can help establish the diagnosis and parameters associated with progressive malignancy. The study provides a powerful non-invasive diagnostic tool that helps in surgical decision making for patients with cystic lesions of the pancreas.

Endoscopic Ultrasound-Guided Local Ablative Therapies for the Treatment of Pancreatic Neuroendocrine Tumors and Cystic Lesions: A Review of the Current Literature.

Since its emergence as a diagnostic modality in the 1980s, endoscopic ultrasound (EUS) has provided the clinician profound access to gastrointestinal organs to aid in the direct visualization, sampling, and subsequent identification of pancreatic pathology. In recent years, advancements in EUS as an interventional technique have promoted the use of local ablative therapies as a minimally invasive alternative to the surgical management of pancreatic neuroendocrine tumors (pNETs) and pancreatic cystic neoplasms (PCNs), especially for those deemed to be poor operative candidates. EUS-guided local therapies have demonstrated promising efficacy in addressing a spectrum of pancreatic neoplasms, while also balancing local adverse effects on healthy parenchyma. This article serves as a review of the current literature detailing the mechanisms, outcomes, complications, and limitations of EUS-guided local ablative therapies such as chemical ablation and radiofrequency ablation (RFA) for the treatment of pNETs and PCNs, as well as a discussion of future applications of EUS-guided techniques to address a broader scope of pancreatic pathology.

Endoscopic Placement of Intracystic Catheters: A Technical Note.

Intraventricular neuroendoscopic surgery for tumor resection, biopsy, or cyst fenestration frequently requires precise placement of an intraventricular or intracystic catheter. Placement under direct visualization is not feasible because of small bore of working channel of the standard small ventriculoscope. Various techniques have been reported using a separate transcortical trajectory, endoluminal endoscope, or endovascular guide wire. To describe a technique allowing precise placement of intraventricular/intracystic catheter using a small bore working ventriculoscope, without need for additional equipment. Description of the technique including intraoperative photographs, video, and illustrative cases are provided. The peel-away sheath is peeled off approximately 1 to 2 cm to allow for the shaft of the endoscope to pass past its tip. Ventricular access is gained using the peel-away sheath. After the stylet is removed, the peel-away sheath is not peeled further or stapled to the skin. The endoscope is introduced into the ventricle through the peel-away sheath. After the required intraventricular work is performed, the endoscope is maneuvered into the location of the desired catheter position. The peel-away sheath is slowly advanced over the stationary endoscope past its tip. While the peel-away sheath is being held in place, the endoscope is removed. After the catheter has been introduced into the peel-away sheath to a premeasured depth, the peel-away sheath is peeled and removed. The catheter is then connected to collection system, reservoir or shunt system. The current technique allows for the precise placement of intraventricular/intracystic catheters without the need for additional equipment or a separate transcortical trajectory.

Glycemic Abnormalities in Pancreatic Cystic Lesions—A Single-Center Retrospective Analysis

Background and Objectives: Glucose metabolism alterations are very common in solid pancreatic lesions, particularly in pancreatic cancer. Similarly, diabetes and especially new-onset diabetes (NOD) have been associated with the malignant transformation of pancreatic cysts. We aimed to assess the prevalence and relevant associations of glycemic abnormalities in pancreatic cystic lesions (PCLs) in a retrospective analysis. Materials and Methods: We retrospectively recruited all patients who underwent endoscopic ultrasound for a PCL over a period of 36 months (January 2018 to December 2021). Final diagnosis was set by means of tissue acquisition, surgery, follow-up, or board decision. Demographic and clinical data, laboratory workup, and imaging features were extracted from the patients’ charts according to a predefined protocol. We considered fasting blood glucose (FBG) and HbA1c values and stratified the patients as nondiabetic (FBG ≤ 99 mg/dL, HbA1c ≤ 5.6%, no history of glycemic abnormalities), prediabetic (FBG 100–125 mg/dL, HbA1c 5.7–6.4%), or diabetic (long-lasting diabetes or NOD). Results: Altogether, 81 patients were included, with a median age of 66 years, and 54.3% of them were male. The overall prevalence of fasting hyperglycemia was 54.3%, comprising 34.6% prediabetes and 22.2% diabetes, of which 16.7% had NOD. The mean FBG and HbA1c levels were higher in malignant and premalignant PCLs (intraductal papillary mucinous neoplasm (IPMN), mucinous cystic neoplasm (MCN), cystadenocarcinoma, and cystic neuroendocrine tumor) compared to the benign lesions (pseudocysts, walled-off necrosis, and serous cystadenoma): 117.0 mg/dL vs. 108.3 mg/dL and 6.1% vs. 5.5%, respectively. Conclusions: Hyperglycemia and diabetes are common in PCLs, with a high prevalence in premalignant and malignant cysts. Screening and follow-up for glycemic abnormalities should be routinely conducted for PCLs, as they can contribute to a tailored risk assessment of cysts.

Operative treatment of cystic prolactinomas: a retrospective study

BackgroundThe optimal therapeutic approach for cystic prolactinomas remains unclear. This study aimed to evaluate the remission rates of prolactinoma patients after surgical treatment and the risk factors affecting postoperative remission in cystic prolactinoma patients.MethodsThe clinical data were retrospectively compiled from 141 patients with prolactinomas (including 41 cases of cystic prolactinomas, 21 cases of solid microprolactinomas and 79 cases of solid macroprolactinomas) who underwent transsphenoidal surgery (TSS) between April 2013 and October 2021 at the First Affiliated Hospital of Sun Yat-sen University.ResultsEarly postoperative remission was achieved in 65.83% (n = 27/41) of cystic prolactinomas, 80.95% (n = 17/21) of solid microprolactinomas and 40.51% (n = 32/79) of solid macroprolactinomas. The mean length of follow up in all patients was 43.95 ± 2.33 months (range: 6-105 months). The follow-up remission rates were 58.54%, 71.43% and 44.30% in cystic, solid micro- and solid macroprolactinomas, respectively. For cystic prolactinomas, the early postoperative remission rates in the patients with preoperative dopamine agonists (DA) treatment were significantly higher than those without preoperative DA treatment (p = 0.033), but the difference in the follow-up remission rates between these two groups was not significant (p = 0.209). Multivariate stepwise logistic regression analysis indicated that tumor size and preoperative prolactin (PRL) levels < 200 ng/ml were independent predictors for early postoperative remission in cystic prolactinomas.ConclusionFor cystic prolactinomas, tumor size and preoperative PRL levels were independent predictors of early postoperative remission. Preoperative DA therapy combined with TSS may be more beneficial to cystic prolactinoma patients.

Middle segment pancreatectomy: Does it deserve a second chance? Report of three cases and review of the literature

Introduction and importanceMeddle segment pancreatectomy (MP) is a parenchyma-sparing surgical procedure that has recently been proposed for treatment of benign or attenuated malignant tumors. However, this procedure is not fully recognized. Case presentationWe herein report 3 patients undergoing MP for tumors of pancreas body and tail. The first patient was a 38-year-old woman with a neuroendocrine tumor, the second was a 42-year-old woman with a serous cystic neoplasm and the 3rd patient was 57 years old, with mucinous cystadenoma.A MP with spleen preservation was performed in the 3 patients, with ligatures of splenic vessels in the first patient. Only one patient developed a pancreatic fistula, which was managed medically. In our 3 patients, no endocrine or exocrine insufficiency was observed, but the first patient showed a disease recurrence with liver metastasis 3 years after surgery. Clinical discussionMiddle pancreatectomy can not only avoid the pancreatic effects of extensive resections, but it is also a technique that has a very low operative or postoperative mortality rate. ConclusionMP is a feasible, safe procedure with several advantages, but which unfortunately remains rarely practiced.

Laparoscopic resection of a retrorectal cystic tumor.

Laparoscopic resection of a retrorectal cystic tumor.

Vallecular Cholesterol Granuloma: Case Report

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

Pancreatic Mucinous Cystic Neoplasm with Associated Invasive Carcinoma: A Case Report and Literature Review

Background. Pancreatic mucinous cystic neoplasm (PMCN) with associated invasive carcinoma is a rare entity. According to the World Health Organisation (WHO) 2010, PMCN with associated invasive carcinoma is referred to the malignant lesions of the pancreatic epithelial tumour. Case report. A 52-year-old female patient presented with pain in the umbilical and epigastric regions for 5 months and noticed a solid visible tumour on the left side of the abdomen 3 months ago when she lied down. The level of the CA125 was 47.64 U/ml (normal value &lt;35 U/ml). Abdominal and pelvic magnetic resonance imaging (MRI) showed a cystic multiseptal mass in the left iliac region, defined as a left ovary tumour, while Computed tomography scan revealed a cystic tumour of the pancreatic tail. The patient underwent a resection of the pancreatic tail with a 20 cm cystic solid tumour, splenectomy and left hemicolectomy. Histopathology report confirmed mucinous cystic neoplasm of the pancreatic tail with associated invasive carcinoma (combined badly differentiated (G3) ductal (40%) and undifferentiated (G4) anaplastic (60%) carcinoma) pT1bN0. Postoperative course complicated with wound infection. The patient was discharged on postoperative day 10. The patient is still alive 2 years on follow-up. Conclusions. PMCN with associated invasive carcinomas are rare lesions of pancreas with relatively benign course. This malignant pancreatic tumour displays morphologies as pleomorphic epithelial cells and relatively mononuclear spindle cells, and not always tends to have underlying ovarian type stroma. The comprehensive histopathological examination of the tumour is necessary in order to cure most MCN patients with minimally invasive types.

ТУБУЛОКИСТОЗНАЯ ПОЧЕЧНО-КЛЕТОЧНАЯ КАРЦИНОМА: КЛИНИЧЕСКОЕ НАБЛЮДЕНИЕ И ОБЗОР ЛИТЕРАТУРЫ

Tubulocystic renal cell carcinoma is a rare malignant epithelial tumor with unique morphological features. It usually demonstrates indolent behavior with low recurrence rate and low metastatic potential. Here we present literature review and a case report of 65 y.o. woman with tubulocystic renal cell carcinoma. Pitfalls of differential diagnostic with other cystic renal neoplasms are shown.

Laparoscopic Distal Pancreatico-Splenectomy for Mucinous Cystic Neoplasm of Pancreas

Introduction: Mucinous cystic neoplasms are rare premalignant tumors of the pancreas and account for 1–2% of all pancreatic tumors. Surgical removal before invasive malignancy offers the best long-term outcome.1 Distal pancreatectomy with or without spleen preservation remains the standard procedure. Although an open technique is still the most commonly used approach, laparoscopy is associated with less pain, less blood loss, less morbidity, similar clinical outcomes, and an early return to activities.2,3 This video presents a laparoscopic distal pancreaticosplenectomy (LDPS) performed for a mucinous cystic neoplasm in the body of pancreas. Materials and Methods: A 30-year-old lady presented with a 2-year history of recurrent epigastric pain that had increased in severity over the past 2 months and required admission. Her physical examination was normal. A contrast-enhanced computed tomogram revealed a 3 × 3 cm well-defined cystic lesion in the tail of the pancreas adherent to the splenic vein. An endoscopic ultrasonography with fine needle aspirate revealed a complex cystic mucinous cystic neoplasm measuring 2.8 × 2.5 cm in the body of the pancreas. Owing to its premalignant potential and recurrent symptoms, an LDPS was performed for the mucinous cystic neoplasm of the body of pancreas. Vaccinations covering Streptococcus pneumoniae, Neisseria meningitidis, and Haemophilus influenzae were administered 2 weeks before surgery. The patient was placed in a French position with ports as shown in the video. Spleen preservation was not attempted because of the splenic vein involvement. The pancreas was divided using a stapler and the vessels were divided using sequential clips. The pancreas was separated from the spleen as it was a nonmalignant lesion and enabled easy removal from the port site without enlarging the incision or morcellation. Results: The operative time was 90 minutes with <10 mL of blood loss. The perioperative course was uneventful, and her diet was resumed on postoperative day 1. The drain was removed on postoperative day 3 after an insignificant drain amylase. The patient was discharged on postoperative day 4. Final histopathology report revealed a low-grade mucinous cystic neoplasm of the pancreas. The patient is asymptomatic at 3 months follow-up. Conclusion: LDPS is a safe and feasible approach for mucinous cystic neoplasms of pancreas. It provides less pain, lower blood loss, and early return to work to the patient while providing similar outcomes. The authors have no commercial associations resulting in conflict of interest with respect to the submitted video. Author(s) have received and archived patient consent for video recording/publication in advance of video recording of procedure. Runtime of video: 9 mins 57 secs This video was presented and awarded third best video presentation at SURGICON 2022 (Annual conference of Association of Surgeons of India—Delhi Chapter) on November 13, 2022.

A retroperitoneal cystic lymphangioma involving the spleen and pancreas: a case report.

In the present case, the girl complained of abdominal pain and dysuria. Clinical examinations showed a palpitated mass in her left pelvis; a radiology exam revealed a cystic mass infiltrating the spleen and pancreatic tail, reaching the pelvis. The mass, including the spleen and pancreatic tail, among the cystic compound was removed. The final diagnosis of benign CL was done based on a histopathology exam. A one-year follow-up showed no signs of recurrence. CL is usually asymptomatic. The retroperitoneal location of the mass delayed the diagnosis and allowed the mass to grow to a large size and compress nearby structures. The typical presentation of CL is usually a substantial, multichambers cystic mass. However, it could be easily misdiagnosed with other cystic tumors of the pancreas. Age-based differential diagnosis should be taken into consideration in children as abdominal mass can originate from gastrointestinal or genitourinary systems. The imaging features of CL are insufficient, and the final diagnosis depends on the histopathology exam. Furthermore, CL can mimic pancreatic cysts in its presentation and cite; therefore, it must be included in the diagnosing strategy whenever a retroperitoneal cyst is being investigated, as imaging features can be misleading. Surgical treatment of CL should be associated with long-term ultrasound follow-up to identify and manage recurrence early.

Pathologic View of Intraductal Papillary Mucinous Neoplasm

Among pancreatic cystic lesions, mucinous cystic neoplasm (MCN) and intraductal papillary mucinous neoplasm (IPMN) of the pancreas are precursor lesions of pancreatic adenocarcinoma. IPMN is characterized by intraductal papillary proliferation of mucin-producing epithelial cells that exhibit various degrees of dysplasia. IPMN is classified as the main duct type (MD-IPMN), mixed type and the branch duct type (BD-IPMN) according to the location of involvement, and into four histological subtypes (gastric, intestinal, pancreatobiliary, and oncocytic) according to the histomorphological and immunohistochemical characteristics. Most patients with MD-IPMN undergo tumor resection due to moderate to high risk of malignancy. Patients with BD-IPMN who do not undergo resection may develop malignant change, and concomitant separate pancreatic cancer occurs in 2-10% of patients with IPMN. Patients with BD-IPMN who do not undergo resection should do careful surveillance including endoscopic ultrasound sonography for the early detection of malignant change and separate pancreatic cancer.

Mature ovarian teratoma in a newborn: A case report

Mature cystic ovarian teratomas, also called dermoid cysts, are one of the most frequent ovarian tumors and are suggested when a fat-containing cystic tumor is identified on imaging. Knowledge of the imaging features of these tumors allows for a confident diagnosis to be made in most cases. Treatment is usually based on surgical resection, which is preferably carried out by laparoscopic way.

Progressive ovarian sertoli – leydig cell tumor: case report

Introduction: Ovarian Sertoli – Leydig Cell Tumor (SLCT) are one of sex cord tumor that has incidence rate less than 0,2% of all ovarian tumors. It occurs predominantly in second and third decades of lifetime. It has characteristics mostly low–grade malignant although poorly differentiated type may behave more aggressively. Clinical characterstic of ovarian SLCT usually hormonal changes, nevertheless in patients without hormonal changes, the manifestation of the disease consists of abdominal pain and abdominal enlargement, and palpable adnexal mass on physical diagnostic. Case: a 52 years woman that has been undergo right salpingooforectomy 5 months prior with PA result shows poorly differentiated sertoli – leydig cell tumor, and refusing to chemotherapy. She came with chief complaint of abdominal enlargement since 3 months accompanied with lower abdominal pain 2 weeks prior. Ultrasound examination shows cystic ovarian neoplasm with solid part size 9 x 9 x 9 cm from left adnexa. Tumor markers that arise are Alpha–Fetoprotein (AFP) 52 ng/mL and Lactate Dehydrogenase (LDH) = 432 U/mL which correspond to sex cord tumor. She has undergone Laparotomy Total Abdominal Hysterectomy Left Salpingooforectomy and chemotherapy afterward. Conclusion: Ovarian Sertoli – Leydig Cell Tumors (SLCT) are a rare sex cord ovarian tumor that may behave more aggressively as it poorly differentiated. It has manifestations of hormonal changes and also abdominal enlargement.

Serous cystic neoplasm with portal annular pancreas

門脈輪状膵（portal annular pancreas：PAP）は，膵鉤状突起が門脈あるいは上腸間膜静脈を全周性に取り囲んで膵体部の背側に癒合する膵の形態異常である．通常は無症状で臨床的意義に乏しいため見逃されることが多いが，膵切除の際には術後の膵液瘻のリスクとなるため注意が必要である．PAPを伴う膵SCNに対し腹腔鏡下膵体尾部切除術を施行した一例を経験したので報告する．