Daughter Cysts Research Articles

Evaluation of radiologic diagnostic criteria and treatment options in skeletal muscle hydatid cysts.

To investigate the diagnosis and treatment methods of soft tissue involvement of hydatid cysts (HCs). Eleven patients who were diagnosed as having HC with muscular tissue (soft tissue) involvement between 2010 and 2016 were evaluated retrospectively. Seven patients had typical HC magnetic resonance imaging (MRI) and four patients had cysts with an unusual appearance. We evaluated how to diagnose the cysts using imaging methods, their characteristic radiologic images, and treatment alternatives against the disease. The patients were treated with antihelminthic chemotherapy preoperatively and postoperatively. Of the 11 patients who underwent treatment, 7 were diagnosed using MRI and 4 were diagnosed with histopathologic examinations. The mean follow-up period was 16 (range, 6-24) months, and the mean age was 39.4 (range, 24-56) years. In seven patients, multivesicular appearance with specific MRI findings, T2-hypointense rim appearance, double-rim sign, membrane dissociation, and appearance of daughter cysts were identified as diagnostic criteria. Two patients underwent ultrasound assisted percutaneous aspiration-injection-reaspiration (PAIR) treatment. Seven patients underwent total pericystectomy, and two patients underwent subtotal pericystectomy with serum saline injection into the cyst. Two patients showed signs of mild anaphylaxis, one during the diagnosis and one during treatment. There may be difficulties in the diagnosis and treatment of HCs of the musculoskeletal system. It should be known that there are alternative methods in the treatment (cyst excision and PAIR treatment). Clinical, serologic, and radiologic findings should be used in the diagnosis. To avoid complications during the histopathologic diagnosis, MRI should be examined in detail. It is thought that atypical cysts can be diagnosed (double-layer appearance and peripheral rim sign) in addition to typical cysts (detached membrane and multivesicular appearance), and diagnosis and treatment can be planned without anaphylactic complications.

Daughter cyst sign in liver hydatid cyst.

Daughter cyst sign is one of the most characteristic imaging findings of liver hydatid cysts. It is schematically divided into two types according to the daughter cyst localization in regard to the hydatid cyst wall: endogenous daughter cysts and exogenous daughter cysts. The endogenous daughter cyst is presented by a small cyst that protrudes into the lumen of the cystic mass. The exogenous daughter cysts are enclosed in the laminated layer then gradually pushed outwards giving the hydatid a bumpy appearance that distorts the classic circular radiological image. Imaging findings could detect these daughter cysts and dictate some additional precautions during surgical procedures. This surgery is associated with a high recurrence rate essentially in case of exogenous daughter cysts. However, if we detect many exogenous daughter cysts, a radical treatment should be favored otherwise the post-operative recurrence will be certain.

Hydatid cyst of the thyroid gland with tracheal fistula: A case report and review of the literature

Hydatid disease, also known as echinococcal disease, is a zoonotic disease caused by Echinococcus infection. Hydatid cysts of the thyroid are rare. The present case study reports on a patient with hydatid cyst in the thyroid with tracheal fistula. A 54-year-old male patient without any history of exposure to farm animals was hospitalized due to fever and productive cough with occasional hydatid daughter cyst. The patient was diagnosed with a hydatid cyst of the thyroid gland with tracheal fistula by relevant examination. An operation was performed to remove the hydatid cyst and to repair the fistula. The patient took oral albendazole after surgery to prevent hydatid recurrence. Operative recovery was uneventful and the patient resumed his normal activities. Prompt diagnosis and an appropriate surgical treatment prevented a potentially fatal outcome. Furthermore, the characteristics of thyroid cystic echinococcosis, and its diagnosis and treatment in the present case and other cases reported in the literature were summarized and reviewed. Although the thyroid gland is rarely affected, hydatid cyst disease should be considered as a differential diagnosis of cystic lesions of the thyroid gland in patients living in regions where hydatid cyst disease is endemic.

SAT-292 Superimposed Peripheral Precocious Puberty Caused by Autonomous Ovarian Follicular Cyst in Being Treated Central Precocious Puberty Patient: Underlying Condition of Herlyn-Werner-Wunderlich Syndrome

Autonomous ovarian follicular cysts are known as the most common cause of peripheral precocious puberty(PPP) in prepubertal girls, and relapses of autonomous ovarian cysts resulting in prolonged estrogen exposure can precipitate early maturation of the hypothalamic-pituitary-gonadal axis, resulting in progression from PPP to central precocious puberty(CPP), which is called “combined precocious puberty”, an evolution which may require GnRH therapy. In present case, PPP caused by autonomous ovarian follicular cyst was developed concomitantly during the treatment course of CPP, with suppressed status of hypothalamic-hypophyseal-axis. In addition, a rare congenital Müllerian anomaly known as Herlyn-Werner-Wunderlich syndrome(HWWS), consisting of uterus didelphys, obstructed hemivagina and unilateral renal agenesis was incidentally diagnosed as an underlying condition. A 7-year-old girl was presented to our clinic with the development of breast buds which was examined as Tanner stage 2-3. Right renal agenesis was diagnosed in infancy. Her bone age was advanced as 10 years of age, and Luteinizing hormone(LH) showed pubertal response in LHRH stimulation test. The pelvic US revealed absence of right kidney and uterine enlargement. Brain MRI showed no specific abnormalities. Based on these results, We diagnosed idiopathic central precocious puberty. Thereafter, we commenced the treatment with Leuprolide acetate 3.75mg every 4 weeks. After the 11th injection of Leuprolide acetate, however, the patient complained of sudden breast engorgement and vagnal bleeding. Being considered as unsuccessful suppression of HPG axis, Leuprolide acetate was boosted. Hormonal analysis results revealed an extremely elevated level of estradiol and suppressed baseline gonadotropin levels. The pelvic US revealed double uterus, which had not been detected to that point. Abdominopelvic MRI demonstrated right renal agenesis and uterus didelphys with clearly separated uterine body, cervix and vagina. About 3cm sized cystic lesion with several internal daughter cysts is also discovered in left adnexa area. Based on all examinations, we concluded that PPP caused by autonomous ovarian cyst was superimposed on treatment course of CPP and HWWS was incidentally found as underlying disease. Maintaining GnRH agonist treatment, the progression of secondary sexual characteristics was halted and left ovarian cyst disappeared. In couclusion, clinician should be aware of possibility of autonomous ovarian follicular cyst when sudden progression of secondary sexual characteristics is shown in being treated CPP patients, and discriminate PPP from unsuccessfully treated CPP. Additionally, careful suspicion for HWWS that is tied to indications of renal agenesis in children may be the key for successful early diagnosis and immediate treatment intervention, which could prevent long-term complications.

Retroperitoneal Hydatid Cyst Masquerading as a Retroperitoneal Cystic Tumor

Hydatid disease is an endemic disease, with canines the primary host and humans the intermediate host. Liver, spleen and lungs are most common involved organs, but it can involve any organ. Retroperitoneal hydatid cyst are categorised into two types, primary and secondary. Primary retroperitoneal hydatid cyst is rare disease, with most of the cases diagnosed intra-operatively, hence pre-operative high index of suspicion for any retroperitoneal cystic lesion to prevent inadvertent complication intra-operatively is of utmost important. 25-year male patient presented with right flank pain for 3 months, high grade fever for 10 days. On cross sectional imaging a retroperitoneal cystic lesion of size 7.1×7.6 cm was noted. Leucocytosis was present and rest of the blood parameters were with in normal limits. Patient was planned for surgery with a diagnosis of the retroperitoneal cystic tumour with possible tumour degeneration. On exploration 8×8 cm pelvic retroperitoneal hydatid with daughter cysts and purulent material noted. Diagnosis of infected retroperitoneal hydatid cyst was made and cyst de-roofing and drainage was done. Final diagnosis of hydatid cyst was confirmed by histopathology report. The retroperitoneal hydatid cyst is a rare entity even in endemic areas. First reported in 1958 by Lockhart and Sapinza, an isolated retroperitoneal hydatid cyst could be caused by haematogenous dissemination of protoscoleces after bypassing the liver (veno-venous shunts within the liver and in the space of Retzius) and the lungs or by the gastrointestinal tract into the lymphatic system. Dew and Waddle had favoured airborne transmission and direct implantation of the embryo in the bronchial mucosa as another possible mode of entry. This raises the possibility of an embryo of the parasite entering a venule after penetrating the bronchial mucosa and reaching the left side of the heart to involve other sites and thus bypassing the lung. Spontaneous, traumatic, or surgical rupture of a hepatic cyst may also give rise to cysts in retroperitoneum. The definitive diagnosis of a retroperitoneal hydatid cyst requires a combined assessment of clinical, radiological and serological analysis. Definitive treatment is total cystopericystectomy. Though retoperitoneal hydatid cyst are rare, diagnosis should be considered if any retroperitoneal cyst lesion is noted to prevent the complications of the cyst rupture. The gold standard treatment is total cystopericystectomy. If complete resection is not possible, cyst de-roofing, drainage and adjuvant anti-helminthic should be considered.

ISOLATED PRIMARY HYDATID DISEASE OF THYROID PRESENTING AS A SOLITARY NODULE: A RARE CASE REPORT

Echinococcosis is a significant health problem in endemic areas with a prevalence rate of 2–6%. Hydatidosis is reported in the liverin 70% of cases and lungs 15%, and rarely <1% are reported in breast, bones, gallbladder, pancreas, thyroid, and ovaries. Primaryhydatid cyst of the thyroid is a rare clinical entity. Review of literature reveals <60 cases of isolated hydatid cyst of the thyroid.Here, we present the case of primary hydatid cyst in thyroid presenting as a solitary nodule. Uncommon presentation of thyroidin endemic areas during initial radiological workup should raise suspicion and warrant careful further evaluation. Immunologictests have low sensitivity and specificity and, hence, have a limited role. Neck ultrasonography demonstrating daughter cysts ischaracteristic of hydatid cyst. Although enucleation and intracystic injection of albendazole are suggested, excision of cyst avoidingspillage of contents is currently the approved treatment strategy. Surgical excision with perioperative albendazole gives excellentresults with low recurrence.

Should Pediatricians Be Aware of Cystic Echinococcosis? A Literature Review.

Among parasitic hepatic cystic lesions, the most common disease is represented by cystic echinococcosis (CE), especially in high endemic countries. European epidemiology of CE in children is difficult to assess because of under-reporting but is increasing, because of high immigration flows from endemic countries and an increased awareness. Hydatidosis can be localized in every part of the body. The liver and lungs are the most common localizations in both children and adults. Multiorgan involvement is rarely reported in children. Different tests are available. Usually the sensitivity of serological screening tests is variable, ranging between 60% and 90%. The immunoblot assay is used as a confirmatory test because of its higher sensitivity and specificity. Radiological tests are the criterion standard for diagnosis of CE, with an ultrasound accuracy of approximately 90%. In case of inactive and uncomplicated cysts the watch-and-wait approach is recommended. Albendazole, currently used for 3 to 6 months consecutively represents the most commonly used drug in children even if there is limited experience in treating children younger than 6 years of age. Percutaneous treatment with the puncture, aspiration, injection, and reaspiration technique is a minimally invasive procedure. Surgery is indicated based on cyst characteristics in case of big cysts with multiple daughter cysts, single superficial cysts at risk of spontaneous or traumatic rupture, cysts related with the biliary tract in which the percutaneous treatment is contraindicated, and cysts compressing related structures.

Recurrence of odontogenic keratocysts and possible prognostic factors: Review of 455 patients.

BackgroundTo describe epidemiological features of 565 Chinese patients with odontogenic keratocysts (OKC), to investigate possible prognostic factors related to recurrence, and to analyse features of recurrent OKC (rOKC).Material and MethodsA retrospective chart review of 565 cases of OKC treated between 2003 and 2015 was undertaken. The probability of recurrence related to prognostic factors including large size, cortical perforation combined with involved teeth in the lumen of the cyst, inflammation, sites of the involved lesion, sex, and daughter cyst variables were analysed. The subsequent relapse of each OKC was compared.ResultsPatients ranged in age from 7 to 81 years (mean age, 28.4 years) and, of those affected, 66.9% were male and 33.1% were female. Mandibular OKC occurred in 63.01% and 36.99% occurred in the maxilla, 80.53% of patients had non-rOKC, 10.44% rOKC, and 9.03% had multiple OKC lesions. Enucleation with preservation of the involved teeth in the cystic lesion combined with cortical perforation was statistically associated with high recurrence rate, as were daughter cysts, and multilocular lesions. The number of recurrences and the average time (in years) to relapse decreased from the first relapse of OKC to the third relapse, and the difference was significant (P<.05).ConclusionsPreservation of the involved teeth combined with cortical perforation appeared to be a potential prognostic factor associated with high recurrence. The follow-up evaluation period for rOKC with ≥ 2 previous treatments should be shorter than for first-time rOKC. The decreasing average duration (years postoperatively) to relapse was related to the number of rOKCs, timing of relapse, and rOKC type. Key words:Keratocystic odontogenic tumor, risk of recurrence, involved teeth and cortical perforation, relapse, epidemiological features.

Histopathological Examination and Literature Review of Orthokeratinized Odontogenic Cyst

Background: With transitions in the disease concept of orthokeratinized odontogenic cyst (OOC), the pathogenesis and etiology have not been sufficiently elucidated. Objectives: OOC cases were reclassified and observed to understand the clinico-histopathological characteristics. In addition, literature review of OOC was performed to better organize the pathology. Materials and methods: Subjects with jawbone cysts lined by keratinized stratified squamous epithelium from 2005 to 2018 were reclassified, and clinico-histopathological findings were analyzed. Previous reports of OOC/orthokeratinized-type odontogenic keratocyst (OKC) from 1980 to 2019 were organized. Results: Five cases of OOC were diagnosed, representing 2.1% of odontogenic developmental cysts (total, 239 cases). Mean age was 37.6 years, with a female predominance. The mandibular molar area was the frequent site, and all cysts were solitary. Sixty percent involved an impacted tooth. Mean maximum diameter of the cyst was 2.2 cm. Histopathologically, 4 cases were unilocular, and partial palisading of the basal layer and scattered epithelial islands were observed in 2 cases each and formation of daughter cysts was noted in 3 cases. Previous papers described that most were unilocular and related to impacted teeth. Mean age ranged between 20 and 40 years, and the mandibular molar region was dominant. Recurrence rates were low. Conclusion: OOC shows a different biological attitude to OKC and is closer to dentigerous cyst. Meanwhile, OOC shows a similar histology of epidermoid cysts accompanying the granular layer. We thus surmised that OCC represents an independent concept as an odontogenic developmental cyst.

Comparative Evaluation of Laminin 1 Expression in Odontogenic Keratocyst, Dentigerous Cyst, and Ameloblastoma: An Immunohistochemical Study

Introduction: Odontogenic keratocysts, dentigerous cysts, and ameloblastoma are the most common forms of cystic pathology that affect the jaw bones. The purpose of this study was to assess the immunohistochemical expression of laminin 1 in these lesions and to study the probable role of laminin 1 in their biologic behavior. Materials and Methods: Serial sections of 4 µm were obtained from the archival blocks using standard microtome. One set of sections was used for immunohistochemical study. Presence of brown colored end product at the site of target antigen was considered as positive immunoreactivity. Results: Of the 10 ameloblastomas, 9 were positive. Among the 10 odontogenic keratocysts, 9 showed a positive immunoreactivity for laminin 1 and 1 case was negative. Among the 10 dentigerous cysts, all of them showed a positive immunoreactivity for laminin 1. A statistical analysis was carried out using chi-square test and the statistical significance was evaluated. Discussion: All the lesions that showed positive immunoreactions for laminin 1 had basement membrane immunolocalization. The laminin 1 in odontogenic keratocysts showed that it is not involved in the formation of daughter cysts and the separation of epithelium and surrounding connective tissue. Conclusion: Expression of laminin 1 in the stellate reticulum can be a sign of the aggressiveness of ameloblastoma. Laminin 1 expression in the lining epithelium of dentigerous cyst can be used to explain its potential to transform to ameloblastoma. It can be concluded that the nature and aggressiveness of odontogenic cysts and tumors can be explained using laminin 1.

Glandular odontogenic cyst of the mandible: A case report and literature review

Glandular odontogenic cyst (GOC) is a rare developmental odontogenic cyst that has gained special attention primarily due to its aggressive potential and the microscopic features, it shares with central mucoepidermoid carcinoma of the jaws. This relatively new entity has a prevalence rate of 0.17% and lacks pathognomonic clinicoradiographic features, making the correct diagnosis a major challenge. This report describes a case of GOC presenting as a solitary osteodestructive lesion in the anterior mandible of a 54-year-old male. Cone-beam computed tomography (CBCT) images revealed a multilocular radiolucent lesion with bicortical expansion, cortical thinning, and perforation, indicating an aggressive potential. Histopathology revealed pseudoglandular epithelium with daughter cysts within the stroma, suggesting an invasive nature. The patient was diagnosed and treated in our institution. In view of the high probability of recurrence of GOC, CBCT evaluation and histopathological examination are essential. An aggressive treatment approach is recommended followed by long-term follow-up.

A Primary Intramuscular Hydatid Cyst of the Proximal Thigh : A Rare Case Report

Primary intramuscular hydatid cyst of thigh is a very rare parasitic disease caused by Echinococcus granulosus. We present an unusual case of primary hydatid cyst in a 21-year old male who presented with slowly growing painless lump in the anteromedial aspect of proximal right thigh. Ultrasonography of the mass revealed a multiloculated cyst in the medial compartment of right proximal thigh without detectable primary any other location. MRI clearly displayed the lesion showing cystic mass with multiple well defined daughter cysts and diagnosis of hydatid cyst was made. The patient was treated surgically and cyst was excised. Macroscopic and microscopic histopathological examination confirmed the diagnosis of muscular hydatid cyst. Primary muscular hydatidosis is kept in mind in the differential diagnosis of a cystic mass of a skeletal muscle especially in endemic areas.TAJ 2011; 24(2): 142-144

A Rare Cause of Biliary Obstruction: Intrabiliary Rupture of a Hepatic Hydatid Cyst

Introduction: Hydatid disease is a parasitic infection most commonly caused by the larva of Echinococcus Granulosus. The disease is endemic to some cattle and sheep farming areas of the world and is common in the Mediterranean countries. The most frequently involved organ is the liver. Patient's with hydatid cysts may remain symptom free for many years. However, approximately 1/3 of patients with hydatid disease will develop a complication. This case describes one of the most common and severe complications of hepatic hydatidosis, intrabiliary rupture. Case presentation: A 56 year old Greek man presented with one week of right upper quadrant (RUQ) abdominal pain and nausea as well as a 20 pound weight loss over the past 2 months. He emigrated from Greece 47 years ago. Family history was significant for a cousin who grew up with him on a farm in Greece where they raised livestock who had a brain mass that required resection approximately 20 years ago. Physical exam was notable for jaundice, icteric sclera and RUQ tenderness. Laboratory tests were significant for a leukocytosis of 9.6 K/uL, AST 395 IU/L, ALT 684 IU/L, alkaline phosphatase 851 IU/L, total bilirubin 3.1 mg/dL, and direct bilirubin 2.1 mg/dL. CT scan of the abdomen and pelvis revealed a calcified cystic mass measuring 8.5 x 8.1cm in the left lobe of the liver. There were multiple ill-defined central cystic lesions suggestive of multiple daughter cysts.The common bile duct measured 3cm. He subsequently underwent endoscopic retrograde cholangiopancreatography (ERCP). A sphincterotomy was performed and parasitic byproducts were extracted from the common bile duct. PCR assay of the tissue obtained from the ERCP was positive for Echinococcus granulosis. He was taken to the operating room for definitive treatment with a left hepatectomy fifteen days after the start of albendazole. Discussion: Communication between the hydatid cyst and the biliary tree occurs in 2—42% of patients with liver hydatidosis. ERCP with sphincterotomy is an important technique in the preoperative management of intrabiliary rupture as it leads to relief of biliary obstruction, prevents the need for bile duct exploration during surgery and appears to decrease the rate of postoperative biliary fistula. Preoperative ERCP for patients with hepatic hydatidosis should be considered if the pretest probability for intrabiliary rupture is high based on the patient's clinical presentation or radiographic findings.1407_A.tif Figure 1: CT image of a peripherally calcified hepatic cyst with central daughter cysts suggestive of Echinococcus infection1407_B.tif Figure 2: Parasitic byproducts extruding from common bile duct following biliary sphincterotomy1407_C.tif Figure 3: Hydatid cyst containing numerous parasites, morphologically compatible with Echinococcus Granulosus infection

The “extracapsular cystic” sign in pancreatic serous cystic neoplasms: A clinicopathologic study of 177 patients with cystic pancreatic lesions

ObjectiveTo assess a new imaging feature that we have named the extracapsular cystic sign which can make a constructive contribution towards differentiating serous cystic neoplasms (SCNs) from other pancreatic cystic lesions. Material and methodsWe retrospectively reviewed 177 CTs/MRIs of patients who underwent pancreatic resection of cystic lesions at two institutions from January 2011/2013, to September 2017. For each patient, demographic information, clinical presentation, especially imaging features were carefully investigated by two experienced abdominal radiologists, retrospectively. All statistical analyses were performed using SPSS V.23.0. ResultsTwenty-one lesions had extracapsular cystic signs which were newly discovered, 17 (28.3%) of 60 SCNs and 4 (3.4%) (mucinous cystic neoplasm = 1, walled-off necrosis = 2, retention cyst = 1) of 117 Non-SCNs were included, from which indicating that the extracapsular cystic sign was more often detected on SCNs. As for 21 lesions, 86% (n = 18) were females, and mean age at diagnosis was 51.2 years. 71% (n = 15) located in the pancreatic body and tail. Average size was 27.2 mm (23.7–53.4), mean (SD) ratio of biggest daughter cyst to mother cyst was 0.51[0.14] (p = 0.99), average (SD) angle between two of them was 105.5° [14.9] (p = 0.84). The average time interval between last imaging examination and surgery was 8.4 days. ConclusionsThe new sign named the extracapsular cystic sign in SCNs may help differentiate SCNs from other pancreatic cystic lesions. Furthermore, this study supports an original diagnosis for SCNs when the sign of extracapsular cyst appears.

A case of intra-operative anaphylactic shock in hepatic hydatidosis with inadequate chemotherapy and proximity to hepatic vessels

Incidence of intraoperative Hydatid anaphylaxis is 0.2-3.3% Reporting of such rare cases is crucial for future reference and study. 52 years old lady presented with hepatic hydatidosis. Computed Tomography showed 2 cystic lesions; one in segment 6, 7 in proximity to right hepatic vein; multiseptated cyst with multiple daughter cysts in segment 4 adjoining the middle hepatic vein with intracystic vessel. No rupture seen. Preoperatively she was prescribed Albendazole 400mg twice-daily for 3months. She was given Hydrocortisone before surgery. 10% povidone iodine mops to prevent intraperitoneal spillage and hypertonic saline used to flush the cyst. One hour after anesthesia when the Segment IV cyst close to middle hepatic vein was punctured she had anaphylactic shock, resuscitated. Marsupialization of both the cysts with omentoplasty and intracystic drains done. She recovered well and discharged with Albendazole for 1 month. Growing cyst produces complex echinococcal antigens, increased cellular immune response, Th2 balanced with Th1; elevated immunoglobulin levels. In dead cysts Th2 responses drop rapidly. Albendazole 10mg/kg for 3 months causes good cyst wall degeneration, less viability of protoscoleces and cyst, less echinococcal antigen production. After the surgery we found that she had stopped albendazole in the preoperative period, which she did not reveal pre-operatively fearing delay in surgery. Inadequate albendazole, close proximity of cysts to vascular structures with high intracystic pressure would have predisposed to develop anaphylactic shock during cyst handling. Preoperative Albendazole can reduce anaphylaxis, morbidity and mortality due to hydatid, making hydatid surgery safer.

Daughter cyst sign in ovarian cysts.

Daughter cyst sign in ovarian cysts.

Comparison of seldinger and trocar techniques in the percutaneous treatment of hydatid cysts.

AIMTo comparatively evaluate Seldinger and Trocar techniques in the percutaneous treatment of hydatid disease.METHODSTrocar and Seldinger techniques were used for 49 and 56 cysts, respectively, among 106 hydatid cysts in 88 patients. The number of males and females were 22 and 66, respectively with a mean age of 44.9 years (range, 15-87). Follow-up studies included cyst diameter, cyst contents, and morphological changes in the cyst wall, local recurrence, and secondary invasion, using ultrasound, computerized tomography and chest X-rays.RESULTSThe positive criteria of healing were a decrease in cyst diameter, progressive solidification of the cyst contents, and disappearance of the cyst. Local recurrence was defined as an increase in the cyst diameter and contents, and appearance of daughter cysts in the primary cavity, while secondary dissemination was defined as the appearance of new cysts outside the treated cyst. Mean duration of follow-up was 19.23 mo (range, 18-26 mo). Follow-up results demonstrated that no significant differences were present between the Trocar and Seldinger techniques in the percentage of decrease in the cyst volume, rate of early complications, local recurrence and secondary dissemination (P = 0.384, 0.069, 0.215 and 0.533, respectively).CONCLUSIONThere are no differences between the Seldinger and Trocar techniques that gain entry to the cyst cavity in terms of the efficacy of the treatment and the rates of early and late complications.

A Case of Echinococcosis: Surgical Management of Hepatic Hydatid Cyst

Echinococcosis is a parasitic infection, also known as hydatidosis, caused by of the tapeworm Echinococcus. In regions endemic to cystic echinococcosis the World Health Organization reports incidence rates over 50 per 100,000 person-years. It is globally distributed and commonly seen in regions with pastoral and rangeland areas. Humans are accidental intermediate hosts through ingesting food and water contaminated with the parasites eggs. The species Echinococcus granulosus causes cystic echinococcosis predominately affecting the liver. A 34 year old female Yemeni immigrant, presented with the chief complaint of right upper quadrant abdominal pain, and slightly elevated transaminases. An abdominal CT with contrast noted a 10.1 X 9.3 cm cyst in the superior right hepatic lobe. Using ultrasound guidance cyst 500 ml of colorless fluid was aspirated from the cyst. Cytology demonstrated parasitic structures with hooklets consistent with Echinococcus. She was treated with a 10 day course of Albendazole, however she continued to have persistent abdominal pain. Repeat CT and US revealed recurrence of the cyst with findings concerning for daughter cyst formation. Based on World Health Organization staging criteria treatment options included; repeat cyst aspiration or surgical resection with concomitant Albendazole. In light of the cystic septations noted on MRI surgery was favored and she underwent hepatic segment VII resection with the encapsulated cyst. She had an uneventful recovery with normal hepatic function and was discharged home with 4 weeks of albendazole therapy. Repeat ultrasound 2 months post op revealed no evidence of recurrent cyst formation. The diagnosis of hepatic hydatid cysts requires a high degree of clinical suspicion and knowledge of the subtle signs and symptoms of the disease. Early diagnosis and appropriate treatment prevents complications of the disease including pressure symptoms, cyst leakage, cholangitis and anaphylaxis. Treatment options are dependent on the stage of the hydatid cysts, and surgery should be considered for patients who have not responded to medical management and have evidence of cyst criteria not amenable to percutaneous drainage. Rates of recurrent infection are significantly lower after radical surgical procedures however follow up is still recommended for up to 5 years post treatment with periodic imaging.Figure: Cut sections of the single hepatic cyst with multiple concentric membranes and yellow scoleces.Figure: Admission CT abdomen and pelvis with contrast shows right hepatic lobe cyst measuring 10.1 x 9.3 cm.Figure: MRI w contrast demonstrating the floating membranes.

Histopathological and immunohistochemical study in keratocystic odontogenic tumors: Predictive factors of recurrence.

The aim of the present study was to identify the most useful markers for predicting recurrence of keratocystic odontogenic tumors (KCOTs). A total of 65 tumor samples from 63 patients diagnosed with typical parakeratinized cysts and KCOTs between 1992 and 2014 were retrospectively studied. Clinical and histopathological data and treatment modality were reviewed. In addition, the expression profiles of Ki-67, cluster of differentiation (CD)34 and podoplanin were assessed using immunohistochemistry. The association between these factors and the rate of KCOT recurrence was evaluated. The presence of daughter cysts, epithelial islands and high Ki-67, CD34 and podoplanin expression levels were revealed to be associated with tumor recurrence. In particular, univariate analysis revealed that high CD34 expression levels were significantly associated with tumor recurrence (P=0.034), as was conservative surgical treatment (P=0.003). Multivariate analysis revealed that conservative treatment was the greatest independent risk factor for tumor recurrence (odds ratio=13.337; P=0.018). These results suggest that overexpression of CD34 may be a potent predictor of tumor recurrence and radical treatment of the teeth that are in contact with the tumors is recommended in order to prevent tumor recurrence.

Collapsed membranes within pelvic cyst: What is the diagnosis?

Key Clinical MessageCollapsed membranes and daughter cysts are pathognomonic for hydatid cysts on imaging. The comma‐shaped lesions, visible within the hydatid cyst in sagittal view of MRI, are collapsed membranes. Although primary hydatid cyst of pelvic cavity is rare, clinicians should remember to include hydatid cysts in differential diagnosis of pelvic cysts.