Differential Diagnosis Of Cystic Lesions Research Articles

Deep learning in the diagnosis for cystic lesions of the jaws: a review of recent progress.

Cystic lesions of the gnathic bones present challenges in differential diagnosis. In recent years, artificial intelligence (AI) represented by deep learning (DL) has rapidly developed and emerged in the field of dental and maxillofacial radiology (DMFR) Dental radiography provides a rich resource for the study of diagnostic analysis methods for cystic lesions of the jaws and has attracted many researchers. The aim of the current study was to investigate the diagnostic performance of DL for cystic lesions of the jaws. Online searches on Google Scholar, PubMed, and IEEE Xplore databases, up to September 2023, with subsequent manual screening for confirmation. The initial search yielded 1862 titles, and 44 studies were ultimately included. All studies used DL methods or tools for the identification of a variable number of maxillofacial cysts. The performance of algorithms with different models varies. Although most of the reviewed stu dies demonstrated that DL methods have better discriminative performance than clinicians, further development is still needed before routine clinical implementation due to several challenges and limitations such as lack of model interpretability, multicenter data validation, etc Considering the current limitations and challenges, future studies for the differential diagnosis of cystic lesions of the jaws should follow actual clinical diagnostic scenarios to coordinate study design and enhance the impact of artificial intelligence in the diagnosis of oral and maxillofacial diseases.

Extrahepatic and extrapulmonary hydatid cysts as primary lesions

Background: Hydatid cyst disease, caused by the larval stage of the parasite Echinococcus granulosus, commonly affects the liver and lungs but can also manifest in various extrahepatic and extrapulmonary locations. Splenic hydatid disease, despite being rare, is the third most common location. This paper presents a case series highlighting the clinical presentation, diagnostic challenges, and management strategies for patients with extrahepatic and extrapulmonary hydatid cysts. Several studies already postulated on sites of hydatid cysts which have statistically significant results. Methods: Patients who were operated on for hydatid disease or cystic lesions, which were later diagnosed as hydatid disease, between September 2022-August 2023 were retrieved retrospectively. Patients with lesions localized outside the liver and the lung as well as in liver and lung were enrolled in the study. Fifty-Two patients with extra-hepatic primary hydatid disease were treated surgically at our clinic. The cysts were located in different part of body. Results has undergone statistical methods like Z-test and Mann-Whitney U test. Any patient of any gender admitted with diagnosis of hydatid cyst in any part of body with age >18 but less than 70 years irrespective of any comorbidities. Results: Surgical techniques like partial or total cystectomy with or without tube drainage are good option for management of extrahepatic and extrapulmonary primary hydatid cysts. There were no complications or mortality in the postoperative period. Hydatid cyst is considered in the differential diagnosis of cystic lesions, especially in endemic areas. Surgical technique planned according to the location of the cyst. Conclusions: Cystectomy is a surgical option in extrahepatic and extrapulmonary hydatid cyst which is evaluate better in this study.

Apocrine Hidrocystoma- A Histological Diagnosis

An Asian female in her 20s, presented with a painless swelling in the left upper eyelid for 2 years. A cystic, non-tender, well defined swelling of 3 by 4 mm with a punctum was seen in the medial aspect of left upper eyelid. Best corrected visual acuity was 20/20 in both eyes, with anterior and posterior segment examination within normal limits in both eyes. Provisional diagnosis of Sebaceous cyst was made, excision of cyst was planned for cosmetic indication. Cyst removal in toto was done and sent for histopathological examination. HPE report was awaited and came the surprise report - APOCRINE HIDROCYSTOMA, a rare, benign, cystic tumor of the apocrine sweat glands. Since surgical excision is the treatment option for apocrine hidrocystoma, patient was informed of the same and reassured. The diagnosis is histological and hence apocrine hidrocystoma must be kept in mind while considering differential diagnosis of cystic lesions in ocular adnexa.

Gastric ectopic pancreas with a pseudocyst.

Ectopic pancreas (EP) is defined as pancreatic tissue that lacks anatomical or vascular connections to the normal pancreas. EP is generally asymptomatic and is detected incidentally during endoscopy. However, due to pseudocyst formation, inflammation, or malignant transformation, it may cause non-specific gastrointestinal symptoms, such as abdominal pain, abdominal discomfort, nausea, vomiting, and bleeding. Pseudocyst formation in EP may result from the retention of exocrine secretions in the absence of connections between the glandular epithelium and gastric lumen. We herein report a case of EP with a pseudocyst associated with epigastric pain. EP with a pseudocyst, although rare, needs to be considered in a differential diagnosis of cystic lesions of the stomach.

A documentation of echinococcosis cases in Batman between 2010-2022

Objective: Echinococcosis is characterized by cystic structures formed by Echinococcus parasites in various organs, particularly liver, lung, and spleen. Our aim is documenting echinococcosis cases detected in Batman province in Turkey. 
 Methods: Clinicopathological data of all echinococcosis cases with histopathological diagnosis in Batman province between 2010-2022 were retrospectively recorded. Descriptive analyses of the data were made using the IBM SPSS 22.0 package program. 
 Results: A total of 55 echinococcosis cases, 23 male (41.8%) and 32 female (58.2%) were identified. The average age is 30 (3-77). Of 33 cases with known clinical complaints, 22 (66.7%) had abdominal pain, two (6.1%) had chest pain, two (6.1%) had cough, and seven (21.2%) had other complaints. One case was diagnosed incidentally in the post-traumatic examination. The mean diameter was 8.5 cm (2.8-25 cm) in 43 lesions of known diameter. The localization was liver in 36 (65.5%) cases, lung in 10 (18.2%) cases, and spleen in three (5.5%) cases. In three cases (5.5%), there was more than one organ involvement. In addition, echinococcosis was detected in the brain, kidney, and arm in three cases (5.5%). Of 45 cases with known data, 32 (71.1%) were unifocal and 13 (28.9%) were multifocal. Excision was performed in 34 (61.8%) cases, resection in 20 (36.4%), and aspiration in one (1.8%) case. 
 Conclusion: Echinococcosis can be seen in all age groups and present with a variety of findings depending on the organ involvement. It should be kept in mind in the differential diagnosis of cystic lesions in Turkey, which is among the endemic countries.

Primary hydatid cyst of the thyroid glands: two case reports and a review of the literature

IntroductionAlthough hydatid cyst remains one of the prevalent parasitic infections in humans, hydatid cyst of the thyroid is extremely rare, even in endemic areas. Here we present two cases of thyroid hydatid cysts.Case presentationA 35 and a 50 year-old Iranian female with a positive history of animal contact were presented with a neck lump without any compressive symptoms. A physical exam revealed neck masses that elevated with swallowing. Thyroid gland ultrasonography showed cystic thyroid lesions, and fine needle aspiration (FNA) suggested a thyroid hydatic cyst. Thyroid lobectomy and isthmectomy were done for the first patient, and near-total thyroidectomy was done for the other. The pathology report confirmed the diagnosis of a hydatid cyst. None of the patients had hydatid cysts in other sites. Patients were discharged without an antiparasitic drug, and no recurrence was detected at the six-month follow-up.ConclusionIt is necessary to consider hydatid cysts in the differential diagnosis of cystic lesions of the thyroid gland in endemic areas, especially in people with a positive history of animal contact.

Eight-Kilogramme Giant Mesenteric Cyst of Mullerian Origin: Case Report and Review of Literature

Mesenteric cysts are a rare occurrence in clinical practice, and even fewer are found to be of Mullerian origin. Diagnosis of mesenteric cysts is typically based on clinical assessment and radiological imaging. Surgical excision remains the primary treatment option. We report a case of a middle-aged lady presenting with a giant mesenteric cyst weighing 8-kilogrammes that was managed with laparotomy. Current literature of this rare clinical entity was also reviewed, including differential diagnoses of cystic lesions within the abdomen and role of imaging in guiding pre-operative diagnosis and management strategies. The giant mesenteric cyst was successfully excised en bloc without spillage via a laparotomy. Analgesia optimisation was achieved with a continuous local anaesthetic infusion. Pre-operative radiology can assist in diagnosis of the mesenteric cyst and guide management. Should an open surgical approach be selected, analgesia can be optimised with a continuous local anaesthetic infusion which decreases need for opioid medications.

THE ROLE OF ENDOSCOPIC ULTRASONOGRAPHY IN THE DIAGNOSIS OF CYSTIC FORMULATIONS OF THE PANTACRATIC GLAND

Summary. Differential diagnosis of cystic lesions of the pancreas remains one of the most problematic sections of abdominal surgery. Endoscopic ultrasonography is gaining more and more importance in the diagnosis and determination of treatment tactics of cystic lesions.
 The goal is to determine the place of endoscopic ultrasonography in the diagnosis of patients with cystic lesions of the pancreas.
 Materials and methods. Analyzed literary sources that were devoted to the use of endoscopic ultrasonography for the diagnosis of cystic lesions of the pancreas.
 Results and their discussion. Endoscopic ultrasonography, thanks to its high resolution and the absence of interposition of air-containing organs, allows you to visualize both the characteristic features of the structure of the cystic tumor itself and the ductal system of the pancreas, as well as to evaluate the thickness of the cyst wall, the presence of intracystic membranes and a solid component, the nature of the contents, the number of cystic cavities in the lesions.
 Conclusions. Endoscopic ultrasonography is a clarifying method of diagnosis, which should be used in all patients at the stages of examination, planning treatment tactics and choosing a surgical intervention method.

Narrowing the Differential Diagnosis of Cystic Lesions in Smokers with Expiratory CT Acquisition Using the Cyst-Airway Communication Hypothesis.

The aim of this study was to assess percentage respiratory changes (δ) in the size of pulmonary cysts of different smoking-related etiologies. Retrospectively, we measured the cystic lesions due to histopathological-confirmed honeycombing from interstitial pulmonary fibrosis, pulmonary Langerhans cell histiocytosis (PLCH), and paraseptal emphysema, using paired inspiratory and expiratory CT scans. In a sample of 72 patients and 216 lesions, the mean diameter of PLCH and honeycombing decreased during expiration (PLCH, δ = 60.9%; p = 0.001; honeycombing, δ = 47.5%; p = 0.014). Conversely, paraseptal emphysema did not show any changes (δ = 5.2%; p = 0.34). In summary, our results demonstrated that cysts in smokers with PLCH and honeycombing fibrosis get smaller during expiratory CT scans, whereas the size of cystic-like lesions due to paraseptal emphysema and bullae tend to remain constant during respiratory cycles. These results support the hypothesis of cyst-airway communication in some cystic diseases, which could assist in the differential diagnosis in smoking-related lung diseases.

Differential Diagnosis of Cystic Lesions of the Spleen: A Review of Clinical, Imaging and Pathological Findings.

Cystic lesions of the spleen are being noticed with increased frequency as "incidentalomas" during imaging work-up for unrelated causes. As a group, these lesions encompass pure cystic and mixed cystic and solid, benign and malignant processes that in general require a tissue sample for definitive diagnosis. In this review, we will describe the differential diagnosis of cystic lesions of the spleen, highlighting key imaging, clinical and pathologic findings.

Mesenteric cyst manifested as obesity, gastroesophageal reflux, urinary incontinence, and abdominal mass during pregnancy-Case report and literature review.

Introduction and importanceThe mesenteric cyst (MC) is a rare entity, a benign lesion that causes the growth of an abdominal mass and other clinical presentations. The presentation of MC during pregnancy is even less frequent.Case presentationA 34-year-old Mexican woman presented with a mesenteric cyst treated with laparotomy aspiration during the 16th week of pregnancy; the pregnancy was resolved by cesarean section without problems. Nevertheless, 17 months later, the lesion recurred. New assessment and surgical treatment with complete excision are performed without evidence of further recurrence.Clinical discussionThis case is essential due to the low frequency of association between pregnancy and mesenteric cyst. Incomplete resection, aspiration, and marsupialization of the lesion carry a high risk of recurrence. Therefore, the opportune moment to perform a complete resection of the lesion and avoid complications should be evaluated during pregnancy.ConclusionMC should be considered a differential diagnosis in cystic lesions during pregnancy. Imaging studies, complete surgical resection, histological evaluation, and follow-up are necessary for adequate treatment.

Intra-cerebellar schwannoma with various degenerative changes: a case report and a systematic review

BackgroundIntra-cranial schwannomas account for less than 8% of brain tumors, among which more than 80% arise from the vestibular nerve. Intra-cerebellar schwannomas are extremely rare. Several cases have been previously reported but without remarkable degenerative changes on histology.Case presentationA 61-year-old man presented with worsening disorientation, and an imaging study revealed a cystic lesion (6.5 cm in the largest diameter) in the left hemisphere of the cerebellum accompanied by a mural nodule (2.5 cm) located just inside the skull with enhancement and focal calcification, in addition to hydrocephalus. The lesion was more than 5 mm from the left acoustic nerve. The patient underwent gross total resection. Pathological examination revealed remarkable degenerative changes with various morphological features. Tumor cells were pleomorphic with rich cytoplasm containing numerous eosinophilic granules. Blood vessels and extracellular matrix showed remarkable hyalinization. Immunohistochemical staining revealed that the tumor cells were positive for S-100 protein and negative for Olig2. The tumor was diagnosed as a schwannoma with marked degenerative changes.ConclusionsThe present case is discussed with reference to a systematic review of previous reports of intra-cerebellar schwannoma. Intra-cerebellar schwannoma should be included in the differential diagnosis of cystic lesions with heterogeneous histopathological morphology in the cerebellum.

Bone and Intramuscular Hydatid Cysts: A Rare Association

<i>Background:</i> Hydatidosis is a parasitic disease linked to the development of Echinococcus Granulosus larval form in humans. This anthropozoonosis is characterized by many topographical and evolutionary aspects. Musculoskeletal hydatidosis is rare, it represents only 0.9 to 2.5% of all locations. <i>Objective:</i> the aim of this manuscript is to report a rare case of bone and muscle location of hydatid cyst and show the imaging contribution in its positive diagnosis and pre-therapeutic assessment. <i>Method:</i> We report the observation of a 61-year-old man admitted to our training for a right thigh mass, revealing a muscular hydatid cyst with a concomitant iliac bone location. <i>Result:</i> Ultrasound examination shows an intra muscular cystic lesion, of the Sartorius and rectus femoris muscles, with hydatid membranes inside. A simultaneous bone location, at the ipsilateral iliac bone, was fortuitously discovered on CT scan and MRI exploration, which show a multicystic lytic lesion with cystic signal and round daughter cysts on MRI examination. A complementary X-ray of the pelvis shows the classic "honeycomb" appearance of the right iliac bone. A positive hydatid serology confirmed the diagnosis. No concomitant hepatic or pulmonary localization was demonstrated on abdominal ultrasound and chest CT scan. An anthelminthic therapy (Albendazole) was started, and the patient was a candidate for further surgical treatment. <i>Conclusion:</i> Musculoskeletal hydatid cyst location is rare. The Hydatid osteopathy is usually infiltrative, slow and progressive, which makes diagnosis late and compromises the quality of treatment. So, despite its rarity; musculoskeletal hydatid cyst should always be considered in the differential diagnosis of cystic lesions in endemic areas.

Pancreatic neuroendocrine tumor trapped in a cyst

Pancreatic neuroendocrine tumor (Pan NET) accounts for only 1–2% of pancreatic neoplasms and &lt;1% of tumors present as cystic lesions. A diagnosis of cystic tumor in the pancreas can be very challenging and confusing. Endoscopic ultrasound (USG) and fine needle aspiration (FNA) of these cystic lesions can help the clinician to narrow down the differential diagnosis. A multidisciplinary approach is warranted for a definitive diagnosis and optimal treatment. Here, we present to you a very rare case of Pan NET presenting as a cystic mass. A 65-year-old man was admitted with a history of abdominal pain. Laboratory tests showed increased levels of serum amylase, and other biochemical tests were normal. The patient underwent transabdominal USG and computed tomography (CT). CT showed well-defined cystic lesion in the proximal body of the pancreas. Endoscopic guided FNA (EUS-FNA) using 22 gauges was done. Cytological examination demonstrated clusters and sheets of plasmacytoid cells. EUS core needle biopsy was done which showed loose clusters of cells with fine uniformly distributed chromatin that stained positively for insulinoma associated protein-1 which was suggestive of a Pan NET. The differential diagnosis of cystic lesions in the pancreas is very difficult with conventional radiology such as CT and magnetic resonance imaging. Cytology is helpful for a pre-operative diagnosis of cystic Pan NET. A diagnosis of Pan NET in a pancreatic biopsy or FNA with limited and suboptimal material is often challenging. This unusual case highlights the importance of pre-operative workup of EUS followed by FNAC in cystic pancreatic lesions.

Hydatid cyst in the neck, an unusual localization of the disease: A case report.

Introduction and importanceHydatid cyst disease or hydatidosis is an old parasitic disease. Humans represent an accidental intermediate host. Neck is considered a rare location of hydatid cysts. It is usually overlooked as a deferential diagnosis in any cystic lesion in the neck, even in the regions where the disease is considered endemic.Case presentationA 26 year old female was admitted to Al-Mouwasat Hospital with the complaint of an anterior cervical mass causing compressive symptoms. Examinations determined a big cystic lesion at expense of the thyroid gland and extended to the level of aortic arch, in addition to smaller lesions in the two thyroid lobes. Multinodular goiter was diagnosed. However, Hydatid cyst disease was suspected during surgery. Cystectomy and total thyroidectomy were performed. Histopathology confirmed the diagnosis of hydatid cyst disease.Clinical discussionHydatid cyst disease in the neck is usually asymptomatic unless it compresses near structures. Histopathological study makes the definitive diagnoses. The best treatment of thyroid hydatid cysts is total surgical excision of all cysts with intensive care not to spread the disease.ConclusionHydatid cyst disease in the neck is extremely rare. Hydatid cyst should be included in differential diagnosis of cystic lesions in the neck especially in patients from endemic countries. Post-operative surveillance is important to diagnose the complete healing or recurrence of hydatid disease in operated or other locations but also for follow up of replacement therapy after total thyroidectomy as the patient require lifelong thyroid hormone replacement.

Cytology-Histology Correlation of Hydatid Cyst: A Case Study and Literature Review

Abstract Casestudy: Hydatid cyst results when humans get infected by ingesting the eggs of Echinococcus Granulosus. Upon release, the six-hooked oncospheres penetrate the intestinal wall and migrate via circulation to various organs, mostly liver and lung. Here, they develop into hydatid cyst. The cyst enlarges gradually and is filled with daughter cysts and protoscolices. We report the case of a 69-year old female, native of Uzbekistan, who presented with right upper quadrant pain. Imaging showed a 20 cm liver cyst and multiple pelvic cysts with a stage of CE2 implying that they were most likely functional. Serum Echinococcal antibody was positive. After 2 months of Albendazole treatment, there was no radiological change. The patient underwent laparoscopic puncture aspiration and injection with 20% saline (PAIR) and pericystectomy of the pelvic cysts. The aspirate revealed scattered scolices, inflammatory cells and abundant amorphous debris consistent with hydatid cyst. Bilateral 5-cm pelvic cysts had pale yellow, soft to firm walled, multiple cavities. Microscopy revealed a fibrofatty outermost layer with chronic inflammation and a two-layered cyst wall including a thin germinal epithelium covered by a thick acellular outer membrane. Multiple parasites, some degenerate (dense eosinophilic) were present, confirming the cytologic diagnosis of cystic echinococcosis. Following further treatment with Albendazole, she underwent a robotic assisted PAIR and partial peri-cystectomy of the liver cyst with repair of the duct to cyst communication. The liver cyst contained daughter cysts of Echinococcus and brood capsule with protoscolices. After 2 months more of Albendazole her Elisa was intermediate. A prior study reported cytopathologic diagnosis of hydatid cyst in 17 patients evaluated for various masses. Our case highlights the role of cytology sampling in confirming the diagnosis of hydatid disease. Potentially fatal in untreated patients, this entity has to be considered in the differential diagnosis of cystic lesions.

Lumbar Facet Joint Cyst Caused by Calcium Pyrophosphate Arthropathy of the Spine: Case Report and Review of Literature

Background Data: Calcium pyrophosphate dihydrate (CPPD) deposition disease is a metabolic disorder caused by the deposition of CPPD crystals in the articular or periarticular structures that leads to inflammation of the joints. Spine affection is rare. Purpose: To present a rare case of lumbar facet joint cyst caused by calcium pyrophosphate arthropathy. Study Design: A case report with a brief review of the literature. Patient and Methods: Seventy-three-year-old man, who underwent PLIF L5/S1 ten years ago, presented with right L4 nerve root compression symptoms that have started two months ago. Clinical examination revealed no motor function disturbance but hypoesthesia in the L4 dermatome. He has no history of crystal deposition disorder. The patient underwent decompression and fusion at this level. Results: The symptoms were completely resolved postoperatively and after one-year follow-up. Histopathological examination of the cyst revealed fibrous granulation tissue. Examination of the tissue under polarized light showed positively birefringent, short blunt crystals of calcium pyrophosphate dihydrate. Conclusion: Calcium pyrophosphate arthropathy, although rare, should be incorporated into the differential diagnosis of cystic lesions of the facet joints. (2020ESJ221)

Primary retroperitoneal hydatid cyst in pancreatic head region

A hydatid cyst in retroperitoneal space is uncommon and one in the pancreatic head region is rare. We hereby report a case of a 20-year-old male presenting with a retroperitoneal hydatid cyst of the pancreatic head region. Investigations revealed no hydatid cysts in other organs of the body. The diagnosis was confirmed at laparotomy and partial pericystectomy was performed. Hydatid cyst should be considered in the differential diagnosis of cystic lesions of retroperitoneal area.------------------

A Rare Presentation of Primary Hydatid Cyst in an Adolescent – A Case Report

The aim of this case study was to report a very uncommon and rarely seen, but serious condition, involving spine. Hydatid cyst is caused by Echinococcus granulosus mainly. It is rarely found in spine, lumbar spine is least commonly involved in spine. A 14 years old boy with lower back pain radiating to both lower limbs observed in the hospital. Associated with progressive weakness and sensory deficit in both lower limbs investigations showed a space occupying lytic lesion extending from L3-S1 with cystic nature, showing nerve root compression at L3, L4 and L5. Managed with excision of cyst through posterior approach to lumbar spine and stabilized with posterior spinal instrumentation L2-L5 and S2AI screw. Hydatid cyst in lumbar spine should be considered as differential diagnosis of cystic lesions of spine. Treatment of hydatid cyst in spine is primarily removal of lesion. Postoperatively the patient improved, mobilized on first post-operative day and has been complication free in one-week follow up.

Sphenoid sinus cholesterol granuloma with orbital complications: a case report

Cholesterol granulomas are benign lesions that affect many parts of the body. Although they are benign, their expansile properties might affect important neighborhood structures which is an associated risk. Paranasal sinuses are rare locations to be affected. A case of sphenoid sinus cholesterol granuloma with orbital complications is presented. The study places emphasis on preoperative examination, radiological evaluation, and endoscopic management, and we recommend including cholesterol granulomas in the differential diagnosis of cystic lesions in paranasal sinuses.