Cysts In Children Research Articles

Treatment of recurrent pilonidal cysts in children: minimally invasive Gips technique

Introduction. Currently, long-term outcomes after surgical treatment of pilonidal disease are not always satisfactory. In particular, relapses can reach 40% by different authors and pose a big problem for operating surgeons. Repeated surgical interventions are technically more complicated, often require extensive excision and often lead to rough scars, which worsen cosmetic results. The minimally invasive Gips method has no abovementioned disadvantages and can be used in pilonidal cyst relapses. Purpose. To assess the Gips surgery effectiveness in relapses of pilonidal cysts in children.Material and methods. 7 children with relapses of pilonidal cysts have been treated with Gips technique in the surgical department of Ivano-Matreninskaya Children's Clinical Hospital (Irkutsk) since January 2020. All surgeries were performed by the generally accepted Gips technique: local infiltration anesthesia with 1% lidocaine solution; fistula excision with a trepan-circular knife and curettage of the pathological cavity. Then, wounds were processed openly with gauze tampons until complete healing.Results. Gender – 71.4% boys and 28.6% girls. The average age is 16.5 years (12–17 years). Previously performed surgical interventions: excision of the pilonidal cyst – 4 and Gips procedure – 3. Restoration of motor activity – on the first day after surgery. Duration of NSAIDs therapy – 2 days after the procedure. No early postoperative complications were registered. The average length of hospital stay – 4.75 days. Complete healing of postoperative wounds – 4.1 weeks, in average. Catamnesis – 9.5 months , in average; early relapses - in one patient (14.3%).Conclusion. Minimally invasive intervention for treating pilonidal cysts by the Gips technique can be used both in primary and recurrent forms of the disease. The discussed technique provides good cosmetic results and has a minimal number of postoperative complications.

The impact of pre-operative cholecystostomy on laparoscopic excision of choledochal cyst in paediatric patients.

This aim of this study was to identify the pre-operative risk factors for conversion during laparoscopic excision of choledochal cyst in paediatric patients. A retrospective single-centre study was carried out. All paediatric patients (< 18years) who had undergone laparoscopic excision of choledochal cyst between 2004 and 2021 were reviewed. The outcome was conversion to open surgery and pre-operative factors that affected the conversion rate were analyzed. Sixty-one patients were included. Conversion was required in 24 cases (39.3%). There was no difference in the conversion rate between the first (before 2012, n = 30) and second (after 2012, n = 31) half of the series (36.7% vs. 42.0%, p = 0.674). Majority was type 1 cyst (86.8%) and the median cyst size was 4.6cm (IQR: 2.2-6.4cm). Antenatal diagnosis was available in 18 patients (29.5%). The median age at operation was 23.0months (IQR: 8.0-72.0months). Pre-operatively, 19 patients (31.1%) suffered from cholangitis and 5 (8.2%) of them required cholecystostomy. Comparing patients with successful laparoscopic surgery (L) and converted cases (C), there were no differences in the age at operation (p = 0.74), cyst size (p = 0.35), availability of antenatal diagnosis (p = 0.23) and cholangitic episodes (p = 0.40). However, a higher percentage of patients required cholecystostomy in the converted group (L vs. C = 2.7% vs. 16.7%, p = 0.05). Using logistic regression analysis, it was also a risk factor for conversion (OR = 3.5 [1.37-5.21], p = 0.05). Pre-operative cholecystostomy is a potential risk factor for conversion during laparoscopic excision of choledochal cyst in children.

Gastric duplication Cyst in a Child - An insight

Gastric duplication cyst is uncommon congenital anomaly in paediatric population with an incidence rate of 17 per million populations. Its diagnosis and treatment is challenging in infants and children for both the clinicians and the pathologists. Most of the cases, diagnosis is rendered on laparotomy followed by histopathology as could not be possible on clinical and imaging studies alone due to its varied presentation. The aim of this editorial is to highlight the morphology and rarity of gastric duplication cyst in children as less than 50 reported cases were available in literature.

Prevalence of thyroid gland tissue in midline neck dermoid cysts in children and a proposed new 'thyroglossal entrainment' hypothesis for their formation.

Thyroglossal duct cysts and dermoid cysts both commonly present as midline neck lumps in children. They are treated as separate entities with different embryological origins. There are isolated reports of thyroid gland tissue in a dermoid cyst, concurrent thyroglossal and dermoid cysts, and cysts with mixed histology. It is not known if these are rare or common. All children undergoing excision of a congenital midline neck cyst between January 2017 and December 2022 were identified. Histopathology slides were reviewed in detail. In 53 children, there were 26 thyroglossal duct cysts, 24 dermoids, 1 lymph node and 2 with no diagnostic material identified. Five dermoids (28 per cent) had associated thyroid gland tissue, and 1 (4 per cent) had hybrid histology with keratinising and respiratory epithelium. Infection occurred in 17 per cent of dermoids prior to excision and 8 per cent of dermoids recurred after excision. Hybrid histology, infection and recurrence are all common in midline neck dermoids. A new theory for their embryological origin is proposed, with the suggestion that some may need more extensive surgery.

Thoracoscopic Excision of Technically Challenging Mediastinal Bronchogenic Cysts in Children

Thoracoscopic Excision of Technically Challenging Mediastinal Bronchogenic Cysts in Children

A Multi-Centric Comparative Study Between Endoscopy-Assisted Laparoscopic Surgery (EALS) vs Laparoscopic Surgery for the Treatment of Gastric Duplication Cysts in Children.

To compare and analyze the therapeutic effects of endoscopy-assisted laparoscopic surgery (EALS) and laparoscopic surgery (LS) in the treatment of gastric duplication cysts (GDCs). We reviewed the clinical data of children with GDCs who underwent surgical treatment at Hubei Maternal and Child Health Hospital, Yijishan Hospital of Wannan Medical College, and Qingdao Women and Children's Medical Center from September 2014 to November 2022. The study comprised 29 children with GDCs, including 14 in the EALS group and 15 in the LS group. There was no significant difference between the two groups in terms of age, sex, weight, and cyst size characteristics. There was a significant difference between the two groups in terms of average surgical time (P>0.05), which was 1.100 ± 0.833 hours in the EALS group and 1.933 ± 0.159 hours in the LS group. There was a significant difference between the two groups (P<0.05) in average intraoperative blood loss, which was 7.93 ± 3.81 milliliters in the EALS group and 11.80 ± 2.72 milliliters in the LS group. There was a significant difference between the two groups (P<0.05) in average postoperative fasting time, which was 73.79 ± 8.36 hours in the EALS group and 114.1 ± 9.24 hours in the LS group. There was a significant difference between the two groups (P<0.05) in average postoperative hospital stay, which was 10.21 ± 4.25 days in the EALS group and 14.47 ± 4.36 days in the LS group. EALS technology can not only shorten surgical time, accurately locate GDCs, reduce injuries, and decrease the probability of complications but also achieve treatment goals safely and reliably.

Isolated Renal Hydatid Cysts in Children: A Systematic Review of Case Reports

Background: Echinococcosis is a zoonotic tapeworm infection caused by Echinococcus granulosus, occasionally affecting humans. The larval infection most commonly affects the liver and lungs and very rarely the kidneys. Objective: The present systematic review compiles data regarding clinical presentations, diagnostic modalities, management strategies and recurrences in children with isolated renal hydatid cysts. Methods: A comprehensive search was done in major databases PubMed and Google Scholar using defined search terms encompassing case reports or case series on isolated renal hydatid cysts in children. The identified reports underwent screening by three different authors for inclusion and exclusion criteria. Results: The median (range) age at presentation of isolated renal hydatid disease was 10 (6) years with female preponderance (52.7%). Most common presenting symptom and sign were abdominal pain (64.8%) and palpable abdominal mass (56.7%), respectively. Ultrasonography (94.5%) was most common diagnostic method. Patients were primarily managed with surgical interventions (95.5%) and only 2/37 were managed solely by medical management for a median duration of 3.5 weeks. Laparoscopic cystectomy was the most commonly used surgical procedure (45.9%). Recurrence was observed to be rare, seen in only 3 cases. Conclusion: Hydatid cysts need to be considered in the differential diagnosis of renal cysts. Radiological evaluation with pathological confirmation enables diagnosis. Surgery combined with adjuvant anti-parasitic chemotherapy is used to treat the condition.

Subpleural pulmonary cysts in children: Associations beyond Trisomy 21.

Small air-filled peripheral subpleural cysts are a well-described feature of pulmonary anatomy at computerized tomographic (CT) scan in children with Trisomy 21, yet only anecdotally described in association with other pathologies. The significance of these cysts is unknown. To investigate and explore the pathogenesis of these subpleural cysts in children. A retrospective review of 16 cases with subpleural cysts diagnosed on CT chest was performed. The distribution, location, and ancillary CT findings were recorded. Hospital charts were reviewed for clinical details, especially cardiac abnormalities, pulmonary artery hypertension (PAH) and genetic associations. Histopathological and clinical correlative data were recorded. Eleven of the 16 children (69%) were found to have an underlying chromosomal or genetic abnormality, six of whom had Trisomy 21. The remaining 5 of the 16 cases (21%) had miscellaneous disorders without an identifiable genetic basis. The most common co-morbidities were cardiac abnormalities (81%) and PAH (62.5%). Regardless of their underlying etiologies, the cysts were present bilaterally in most cases (14/16, 88%). We observed both the postnatal development and the progression of cysts in our cohort. On long-term follow-up, there were five deaths (31%) and six cases (38%) requiring maintenance oxygen therapy due to chronic hypoxia. Two cases (12.5%) became completely asymptomatic after correction of their underlying abnormalities. Subpleural cysts are not exclusive to Trisomy 21 and may be seen in other inherited or acquired causes, likely due to altered alveolar growth. We suspect these cysts are a sign of an underlying developmental disorder with variable clinical effect, especially in children with congenital cardiac disease.

Our experience in the treatment of complicated dermoid nasal cysts in children

Our experience in the treatment of complicated dermoid nasal cysts in children

In Reply to the Letter to the Editor Regarding “Factors that Influence Subdural Hemorrhage Secondary to Intracranial Arachnoid Cysts in Children”

In Reply to the Letter to the Editor Regarding “Factors that Influence Subdural Hemorrhage Secondary to Intracranial Arachnoid Cysts in Children”

Letter to the Editor Regarding: Factors That Influence Subdural Hemorrhage Secondary to Intracranial Arachnoid Cysts in Children

Letter to the Editor Regarding: Factors That Influence Subdural Hemorrhage Secondary to Intracranial Arachnoid Cysts in Children

Skene Duct Cyst in Childhood: A Case Report

Introduction. Vaginal cysts are uncommon and may be either congenital or acquired. the most common vaginal cysts is a urothelial cyst or a paraurethral cyst. With an incidence of 1 in every 2000–7000 live births, paraurethral cysts are an uncommon cause of interlabial mass in newborns and account for less than 0.5 per cent of all congenital urinary system anomalies. Study Purpose. This report describes a rare Vaginal cyst in a child at the posterior vaginal wall.. Results.this is a case report study about a girl 1-year-8-months old with vaginal cyst since the age of 2 months. Physical examination and ultrasound finding revealed a cystic mass size 3x3x1 cm in posterolateral of the right vaginal wall extended to right periurethral. Management of this case was extirpation of the vaginal cyst.Conclusion. A vaginal cyst is an uncommon case in a child. Vaginal cysts have several possible etiologies, such as possibly embryological origin, ectopic inclusion tissue or possibly due to urological abnormalities. Diagnosis requires a thorough understanding of diagnostic possibilities and a systematic evaluation. This patient has been treated with surgical excision due to a high success rate.

Pancreatic cysts in children: diagnostical and surgical tactics

BACKGROUND: Surgical treatment of pancreatic cysts is one of the most difficult procedures in pediatric surgery. In children with pancreatic cysts, the issues of differential diagnosis and determining the connection of the cyst cavity with the main pancreatic duct remain problematic. Recent publications have focused on the use of endoscopic ultrasonography in pediatric practice to visualize the parenchyma and the ductal system of the pancreas with high accuracy.&#x0D; AIM: This work aimed to study the results of treatment of children with cystic formations of the pancreas using modern radiation diagnostic methods and minimally invasive surgical technologies.&#x0D; MATERIALS AND METHODS: Analysis was conducted on the results of treatment of 66 patients consisting of 30 boys (45.5%) and 36 girls (54.5%) aged 6 months to 18 years (average age of 10.9 5.2 years) with extraparenchymatous and intraparenchymatous pancreatic cysts.&#x0D; RESULTS: Multispiral computed tomography (Se 90%, Sp 91%, and Ac 91%; p 0.05) and magnetic resonance imaging (Se 96%, Sp 94%, Ac 95%; p 0.05) are the most informative for the differential diagnosis of intra- and extraparenchymatous pancreatic cysts. For thin-walled extraparenchymatous cysts up to 6 cm in size, conservative therapy is effective in the early period of the disease. External (42.4%) and internal (51.3%) drainage of cysts can be performed when the existence of pancreatic pseudocysts is prolonged (more than 2 months). Indications for simultaneous longitudinal pancreaticoejunostomy may occur in 9.5% of patients. Excision of the pseudocyst with pancreatic resection may be required in 4.7% of cases. For intraparenchymatous cysts, 33.3% of cases require the enucleation of cystic formation, 25% require the distal splenoserving resection of the pancreas, 25% require the central resection of the pancreas with the imposition of distal pancreatoejunoanastomosis, and 12.5% require pylori-preserving pancreatoduodenal resection. Approximately 70.8% of surgical interventions on the pancreas in children can be performed by laparoscopic access with a conversion rate in 12.5% of cases.&#x0D; CONCLUSIONS: The choice of surgical intervention in children with pancreatic cysts is determined by the etiology, cyst size, localization, connection with the main pancreatic duct, and degree of involvement of the parenchyma in the tumor process. Most operations on the pancreas may be performed using minimally invasive approaches.

Intradural Spinal Arachnoid Cysts in Children: A Collective Experience of 2 Centers

Pediatric intradural spinal arachnoid cysts are rare and can cause spinal cord or nerve root compression. Spinal arachnoid cysts can cause pain, motor/sensory neurological impairments, gait disturbances, spasticity, and bladder problems depending on their location. This study discusses the clinical aspects, management, surgical nuances, and postoperative clinical outcomes of symptomatic congenital intradural spinal arachnoid cysts, which are rarely seen in the pediatric population. Our study involves a retrospective evaluation of 8 pediatric patients who underwent surgery for spinal intradural arachnoid cysts at the Department of Neurosurgery, Kocaeli University School of Medicine, and the Department of Neurosurgery, Selros University School of Medicine. The demographic data of all patients, preoperative/postoperative clinical findings, surgical procedures, surgical complications, and radiological imaging were evaluated. The average age of the patients was 8.7 uated. surgicrange:1-17).The female to male ratio was 4:4. The most common complaint was weakness in the lower extremities (87.5%). Urinary problems (50%) and sensory disturbances (50%) were less frequently observed. All patients had dorsal localization of the cysts. Cyst excision was performed in 7 out of 8 patients, and cyst fenestration was performed in 1 patient. Postoperatively, 7 patients showed complete symptom resolution, while one patient had partial improvement. The success of surgical treatment depends on cyst location, neural tissue compression, and duration of symptoms. Complete removal or fenestration is determined by cyst location and accessibility. Intracystic shunts may be used in certain cases. Timely diagnosis and surgical intervention are crucial for improving neurological function in these rare cases.

Методи лікування кіст щелеп у дітей. Ретроспективний аналіз

Odontogenic cysts of the jaws are one of the most common tumour-like neoplasms of the maxillofacial region in children. Today, there are various methods of treating cysts, but in childhood, the problem of choosing a treatment method is relevant and at the same time difficult, as some authors prefer cystectomy, while others prefer cystotomy. Purpose - to analyze the methods of treatment and management of jaw cysts in children depending on the type of cyst. Materials and methods. A retrospective analysis of 286 case histories of patients with jaw cysts aged 4 to 17 years was performed. The case histories were analysed according to the developed examination chart. Results. A retrospective analysis of 286 case histories of children with jaw cysts was performed. The age of the children ranged from 4 to 18 years. Radicular dentoalveolar cysts were diagnosed in 35% (n=100) of cases, radicular cysts - in 36% (n=104), follicular cysts - in 15% (n=43), suppurative cysts - in 5% (n=14), residual cysts - in 5% (n=14), primary bone cysts - in 3% (n=7), polycystic cysts - in 2% (n=4). Cystotomy was performed in the vast majority of cases - 58% (n=166), cystectomy - in 42% (n=120). Tamponade was performed in 63% (n=181) of cases, and in 37% (n=105) it was not performed. Conclusions. Radicular cysts are the most common odontogenic cysts of the jaws. Cystotomy and cystectomy are variable methods of cyst treatment. The most common method of treating cysts in children is cystotomy. The research was carried out in accordance with the principles of the Helsinki Declaration. The study protocol was approved by the Local Ethics Committee of the participating institution. The informed consent of the patient was obtained for conducting the studies. No conflict of interests was declared by the authors.

Robot-assisted resection of choledochal cyst in children.

The emergence of the robotic surgery system has assisted the further development of minimally invasive surgery by facilitating more delicate and precise complex procedures. The purpose of this study was to present a study of robot-assisted resection of the choledochal cyst and to discuss the technical points. In total, 133 patients who were diagnosed with a choledochal cyst and underwent surgery from April 2020 to February 2022 in the Children's Hospital, Zhejiang University School of Medicine, were retrospectively analyzed. The data were collected including the clinical information of the patients, operative details, and postoperative outcomes. Among these 133 patients, 99 underwent robot-assisted surgery and 34 underwent laparoscopic assisted surgery. The median operation time was 180 min, with an interquartile range (IQR) of 170-210 min for the robot-assisted group and 180 min with an IQR of 157.5-220 min in the laparoscopic assisted group (P = 0.290). The detection rate of 82.5% for the distal opening of the cystic type of choledochal cyst was higher in the robot-assisted group than that in the laparoscopic assisted group at 34.8% (P = 0.000). The postoperative hospital stay was shorter (P = 0.009) and the hospitalization expense was higher (P = 0.000) in the robot-assisted group than that of the laparoscopic assisted group. There was no significant difference between the two groups in terms of complications, postoperative indwelling days of the abdominal drainage tube, intraoperative blood loss, and postoperative fasting time (P > 0.05). Robot-assisted resection of choledochal cyst is safe and feasible, it is ideal for the patient requiring a meticulous operation, and its postoperative recovery was shorter than for traditional laparoscopy.

Nonparasitic Splenic Cysts in Children: Outcomes after Sclerotherapy or Surgical Resection as Initial Management

Management of splenic cysts in children remains undefined. Sclerotherapy is an innovative, less invasive treatment. This study examined the safety and preliminary effectiveness of sclerotherapy for splenic cysts in children compared with those of surgical treatment. A retrospective review of pediatric patients treated for nonparasitic splenic cysts from 2007 to 2021 was performed at a single institution. Posttreatment outcomes for patients who underwent either expectant management, sclerotherapy, or surgery were reviewed. Thirty patients aged between 0 and 18 years met the inclusion criteria. Cysts in 3 of 8 patients who underwent sclerotherapy were either unresolved or recurred. Patients who underwent sclerotherapy and required surgery for residual symptomatic cyst had an initial cyst diameter of >8 cm. Symptoms resolved in 5 of 8 patients who underwent sclerotherapy, with a significantly reduced cyst size compared with that in patients with continued symptoms who underwent sclerotherapy (61.4% vs 7.0%, P = .01). Sclerotherapy is an effective treatment for splenic cysts, particularly those measuring <8 cm. However, surgical excision may be preferable for large cysts.

A Cervical Thymic Cyst in an Adult Female; A Case Report and Comprehensive Literature Review.

Introduction: Cervical thymic cyst accounts for (0.3-1) % of cervical cysts in children and are usually present during the first decade of life with few reported cases in adults. Herein, we present a 34-year-old female with a cervical thymic cyst. We conducted a review of all the previously reported cases as well. Case presentation: The patient complained of an anterolateral neck swelling that was noticed one year ago. It was a soft, fluctuant, mobile, non-tender swelling in the midline and the right side of the lower neck. Neck ultrasonography revealed a large thin-walled cyst, with no internal septa, echoes, or solid parts. Post-contrast MRI of the neck showed a well-defined, oblong-shaped, lobulated cystic lesion just beneath the strap muscle. The cyst extended caudally to the superior border of the anterior mediastinum at the level of the upper border of the manubrium sterni. The patient underwent excision of the swelling under general anesthesia via Kocher's collar neck incision. Connection with the thymus gland was detected behind the manubrium sterni which was separated. Pathological examination showed prominent thymic tissue confirming the diagnosis of a cervical thymic cyst. Conclusion: Adult cervical thymic cyst is very rare with a few cases reported in the literature. Surgical excision in symptomatic patients is the treatment of choice. Paper's main novel aspects: • A rare presentation of a cervical thymic cyst in an adult. • A comprehensive literature review including all the previously reported cases in one table.

Management of complicated choledochal cyst in children: ultrasound-guided percutaneous external drainage and subsequent definitive operation

ObjectiveThe purpose of this study was to analyze the outcomes of the combination of ultrasound (US)-guided percutaneous external drainage and subsequent definitive operation to manage complicated choledochal cyst in children.MethodsThis retrospective study included 6 children with choledochal cyst who underwent initial US-guided percutaneous external drainage and subsequent cyst excision with Roux-en-Y hepaticojejunostomy between January 2021 and September 2022. Patient characteristics, laboratory findings, imaging data, treatment details, and postoperative outcomes were evaluated.ResultsMean age at presentation was 2.7 ± 2.2 (0.5–6.2) years, and 2 patients (2/6) were boys. Four patients (4/6) had a giant choledochal cyst with the widest diameter of ≥ 10 cm and underwent US-guided percutaneous biliary drainage on admission or after conservative treatments. The other 2 patients (2/6) underwent US-guided percutaneous transhepatic cholangio-drainage and percutaneous transhepatic gallbladder drainage due to coagulopathy, respectively. Five patients (5/6) recovered well after US-guided percutaneous external drainage and underwent the definitive operation, whereas 1 patient (1/6) had liver fibrosis confirmed by Fibroscan and ultimately underwent liver transplantation 2 months after external drainage. The mean time from US-guided percutaneous external drainage to the definitive operation was 12 ± 9 (3–21) days. The average length of hospital stay was 24 ± 9 (16–31) days. No related complications of US-guided percutaneous external drainage occurred during hospitalization. At 10.2 ± 6.8 (1.0–18.0) months follow-up, all patients had a normal liver function and US examination.ConclusionsOur detailed analysis of this small cohort suggests that US-guided percutaneous external drainage is technically feasible for choledochal cyst with giant cysts or coagulopathy in children, which may provide suitable conditions for subsequent definitive operation with a good prognosis.Trial registrationRetrospectively registered.

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.