Epithelial Cysts Research Articles

Variant Pseudocystic Desmoplastic Small Round Cell Tumor With Heterologous Mullerian Cysts.

A desmoplastic small round cell tumor (DSRCT) presented in a 13-year-old female with an acute abdomen due to torsion of a fallopian tube cyst. She was found to have an incidental 2 cm pedunculated, solid, and multicystic mass attached to the pelvic floor on laparoscopy. The neoplasm had a variably myxoid and spindle cell pattern with nests and cords of small cells, forming pseudocysts, and true cysts lined by ciliated epithelium which were PAX-8+ and ER+/PR+. The tumor had the EWSR1::WT1 fusion. Numerous peritoneal nodules less than 1 cm were noted on repeat laparoscopy 3 months later. These had similar features including the ciliated epithelial cysts. Our case illustrates yet another potential variant pattern of DSRCT with Mullerian-like ciliated epithelial cysts.

3D Imaging Resolves Human Pancreatic Duct-β-Cell Clusters During Cystic Change.

Pancreatic cystic changes in adults are increasingly identified through advanced cross-sectional imaging. However, the impact of initial/intra-lobular epithelial remodeling on the local β-cell population remains unclear. In this study, we examined 10 human cadaveric donor pancreases (tail and body regions) via integration of stereomicroscopy, clinical H&E histology, and 3D immunohistochemistry, identifying 36 microcysts (size: 1.22±0.56 mm) alongside 54 low-grade pancreatic intraepithelial neoplasias (positive control of epithelial remodeling; size: 2.42±1.05 mm). Both conditions exhibited significant increases in CK7 and insulin immunoreactive signals compared with normal lobules. Importantly, despite luminal contents of microcysts causing false positives (autofluorescence) in fluorescence imaging, the defined cystic epithelium showed distinct duct-β-cell associations-including β-cells in the epithelium and duct-β-cell clusters-visualized via antifade 3D/Airyscan super-resolution imaging in the high-refractive-index polymer. The peri-luminal β-cells displayed insulin+ vesicles residing near the basal domain, while the CK7+ cytokeratins in duct cells accumulated in the apical domain, underlining polarized tissue and cellular organizations. Overall, in microcyst formation, we demonstrate local and associated pancreatic exocrine and endocrine tissue remodeling. Because artifacts are a concern in β-cell investigation in a novel environment, our work using 3D-labeled human pancreas with cytokeratin and vesicle resolving powers provides a robust approach for characterizing the duct-β-cell association in a clinically relevant setting.

When a Road Traffic Accident Reveals an Intravitreal Cyst: A Case Report

Vitreous cysts, whether congenital or acquired, are rare ocular malformations. We report the case of a 70- year-old patient who sustained multiple traumas following a severe road traffic accident. Brain magnetic resonance imaging revealed an intravitreal cyst associated with intravitreal hemorrhage and a subluxated left lens. The remaining findings were unremarkable. Two months later, a combined procedure involving phacoemulsification, vitrectomy, and implantation of a posterior iris-claw intraocular lens was performed. Histopathological analysis of the cyst identified a ciliary epithelial cyst with no evidence of malignancy. Postoperatively, the patient’s visual acuity improved significantly, from hand motion to 10/10. Pigmented or non-pigmented vitreous cysts are exceptionally rare and originate from the pars ciliaris or the hyaloid system. They are often asymptomatic and incidentally discovered, requiring no specific treatment. Management of vitreous cysts should be undertaken with caution and tailored to the clinical indications.

Inflammation of adenohypophysis is commonly associated with headache in surgically managed Rathke's cleft cysts.

Rathke's cleft cysts (RCC) are present in up to 20% of autopsy studies but only a minority necessitate surgical treatment. Inflammation of RCC is thought to be significant in three processes: the development of classical symptoms, a predisposition to rupture or apoplexy, and increasing the rate of RCC recurrence. We aim to characterize clinical presentation, histological and radiological findings in patients with surgically managed RCC. We conducted a retrospective case series of 31 RCC, which had undergone surgical management between April 2016 and April 2024. Histopathology and radiology were independently reviewed by neuropathologist and neuroradiologist, and case notes were reviewed for clinical and biochemical data. Median age was 43 years (IQR 32-63); 77% were female. 23/31 demonstrated inflammation of RCC cyst epithelium (n = 13), cyst wall (n = 20) or anterior pituitary (adenohypophysitis) (n = 12). 8 cases were not inflamed. Preoperative features included pituitary dysfunction (70%), headache (65%), visual disturbance (26%) and polyuria/polydipsia (7%). Six patients presented with features of apoplexy. Headache was more prevalent (92%) in patients with adenohypophysitis vs. those without (47%), p = 0.020, and present in all 11 cases where inflammation in the adenohypophysis was chronic. Pituitary dysfunction was not associated with inflammation overall (76% vs. 70% p = ns), nor specifically within the adenohypophysis (75 vs. 63% p = 0.69). Histological inflammation was associated with radiological loss of posterior bright spot (70% vs. 14% p = 0.024). Headache but not pituitary dysfunction was associated with adenohypophyseal inflammation. A trend of increasing headache prevalence was seen with increasing degree of inflammatory infiltrate within RCC.

The Expression of HIF-1α and VEGF in Radicular Cysts and Periapical Granulomas.

This study aimed to evaluate the expression levels of hypoxia-inducible factor 1-α (HIF-1α) and vascular endothelial growth factor (VEGF) in radicular cysts and periapical granulomas, thereby contributing to the understanding of their potential significance in the differential diagnosis and treatment of these lesions. In the present cross-sectional study, 51 samples of periapical lesions were included. Of them, 24 samples were radicular cysts, and 27 samples were periapical granulomas. Samples were immunohistochemically analyzed for HIF-1α and VEGF proteins expression. Chi-square tests and Spearman's rank correlation coefficient tests were used to detect differences and correlations among the parameters, respectively. In radicular cysts, HIF-1α expression was absent in 1 (4.2%), weak in 5 (20.8%), mild in 7 (29.2%), and strong in 11 (45.8%) cases, while VEGF expression was absent in 1 (4.2%), weak in 6 (25.0%), mild in 9 (37.5%), and strong in 8 (33.3%) of the cases; nevertheless, in periapical granulomas, HIF-1α expression was absent in 8 (29.6%), weak in 6 (22.2%), mild in 9 (33.3%), and strong in 4 (14.8%) of the cases, whereas VEGF expression was absent in 4 (14.8%), weak in 16 (59.3%), mild in 4 (14.8%), and strong in 3 (11.1%) of the cases. Chi-square test revealed a significant difference in the expression of HIF-1α and VEGF between radicular cysts and periapical granuloma (chi-square test = 8.906, p = 0.031; chi-square test = 10.401, p = 0.015, respectively). Spearman's correlation test showed a significant correlation between HIF-1α and VEGF in the total samples of both radicular cysts and periapical granulomas (rho = 0.385, p = 0.005). There is high expression of both HIF-1α and VEGF throughout the odontogenic epithelium and connective tissue of the radicular cyst and periapical granuloma. Both HIF-1α and VEGF are more highly expressed in radicular cysts than in periapical granulomas. These findings may aid in the diagnosis and management of suspected periapical lesions, suggesting that radicular cysts exhibit more advanced hypoxic conditions and associated pathways compared with periapical granulomas.

Synthesis and evaluation of anti-Giardia activity of oseltamivir analogs

We reported earlier that oseltamivir (Osm, Tamiflu®), an anti-viral agent, inhibits the attachment of trophozoites to intestinal epithelial cells and cyst production in culture. Osm also disassembles lipid rafts (LRs) and the biogenesis of extracellular vesicles (EVs) by Giardia. In the current study, we synthesized forty-one Osm analogs with the derivatization of oseltamivir phosphate. These compounds were tested on giardial growth, and cyst production. Of these, four analogs, i.e., compounds 3b, 2c, 11i, and 11d, were found to have superior activities against trophozoites and cysts compared to the parent oseltamivir. Investigation of the mechanism(s) of action of these agents are in progress and will be reported in due course.

Clinical features of midzonal iris pigment epithelial cysts: surprising findings revealed by ultrasound biomicroscopy.

Midzonal iris pigment epithelial (IPE) cysts are typically asymptomatic but can pose a differential diagnostic challenge by mimicking ciliary body melanoma. We conducted a case series study of the clinical characteristics of these iris cysts, particularly their shapes and sizes and associated lesions revealed by ultrasound biomicroscopy (UBM). Charts of patients with midzonal IPE cysts encountered by one or more of the authors were reviewed retrospectively. Pertinent demographic information and clinical data about these patients and their cysts were abstracted. 69 patients were identified. At initial diagnosis, patients ranged in age from 14.8 to 89.5years (median: 66.0years). Only one patient was < 30years old at diagnosis. 38 patients (55.1%) were female. 74 eyes (39 right, 35 left) contained one or more clinically identified midzonal IPE cysts. The cysts involved the right eye alone in 34 (49.3%), the left eye alone in 30 (43.5%), and both eyes in 5 (7.2%) patients. The midzonal IPE cysts were located most often inferotemporally (51.4%) and second most often temporally (23.0%). UBM imaging had been performed on 44 of the 74 affected eyes. The median largest basal diameter of the midzonal IPE cysts evaluated by UBM was 4.5mm (extremes: 1.5 to 13mm), and the median height of these cysts was 1.5mm (extremes: 0.6 to 6mm). The largest lesion was a complete ring cyst. All 3 UBM-evaluated eyes that appeared by slit lamp biomicroscopy to have two or more distinct midzonal IPE cysts were shown by UBM to have a single sausage or kidney-bean shaped partial ring cyst with radial folds between the lobules and not separate multiple cysts. UBM imaging also identified peripheral IPE cysts in 32 of 44 evaluated eyes (72.7%). Our case series confirmed previously reported findings regarding age at diagnosis and most common locations of midzonal IPE cysts. However, our UBM images revealed that at least some IPE cysts identified by slit lamp biomicroscopy as multifocal are partial ring cysts with radial folds in the cyst wall between lobules and not true independent multiple cysts. What is known Midzonal IPE cysts occur most often unilaterally and inferotemporally. Midzonal IPE cysts are frequently associated with peripheral IPE cysts. What is new UBM imaging of eyes with two-clinically detected IPE cysts showed that they were confluent as opposed to separate cysts. The median largest basal diameter of midzonal IPE cysts evaluated by UBM was 4.5 mm (extremes: 1.5 and 13 mm). The median height of midzonal IPE cysts evaluated by UBM was 1.5 mm (extremes: 0.6 and 6 mm).

Modern methods of treatment of complicated forms of pilonidal cyst

There are several theories of the origin of diseases of the epithelial coccygeal tract: empirical, neurogenic, ectodermal and acquired. Most Russian scientists consider this pathology to be congenital, while foreign colleagues believe that it is a consequence of sacrococcygeal area injuries. This pathology is quite common, affecting more than 5 % of the adult population, it also occurs in children and adolescents. This disease decreases the quality of patients` life significantly, affecting all aspects of their life. Conservative methods of treatment do not provide a complete cure, since they do not eliminate the causes of the disease. These include sclerotherapy and obliteration of the cavity with silver nitrate or hydrochloric acid. These methods are not used nowadays. Surgical treatment is the most effective one for this pathology. Surgical intervention, despite its apparent simplicity, turns out to be quite complex, which makes it inaccessible to any general surgeon. Treatment results are often disappointing due to the high incidence of complications after surgery, as well as the long period of activity limitation. Therefore, the resulting rough scar is a cosmetic defect, and the risk of recurrence remains quite high. Studying the literature data, one can see that the authors` opinions concerning surgical tactics for this disease differ. At the moment, there is no single approach and surgical tactic for the treatment of epithelial pilonidal cyst. The problem of creating and introducing new methods of treatment of pilonidal disease remains relevant nowadays.

A large long standing keratinous cyst on the cheek: a case report

Epidermal inclusion cysts or keratinous cysts can be congenital or acquired. These slow-growing, chronic cysts can sometimes be neglected, unless they affect cosmesis or present the fear of turning malignant. We present a case of a keratinous cyst on a patient’s cheek, overlooked for many years, which slowly and steadily kept on growing and finally presenting as a disfiguring ovoid swelling over the patient’s cheek. Epithelial inclusion cysts have a tendency of slow but steady growth, with a rare of real risk of malignant change. Secondary infection, abscess formation, pressure effect and cosmetic effect are a few complications seen in such cases. Improper excision of these cysts leads to recurrence due to left over residual cyst tissue. This unearths the importance of timely investigation and treatment of swellings that we might at first assume to be insignificant.

Resection of a Ruptured Epidermoid Cyst with Limberg Flap: Case Report

Epidermoid cysts, also known as epidermal cysts, keratin cysts, epithelial cysts, or sebaceous cysts (although this term is no longer widely used), are benign lesions frequently seen in clinical practice. These cysts arise from epidermal cells trapped beneath the skin's surface. The most common complication is cyst rupture, which can lead to significant inflammation and even a granulomatous response. This article presents the clinical case of a male patient with a ruptured epidermoid cyst that triggered a granulomatous reaction, treated with surgical excision and reconstruction using a Limberg flap. Proper surgical management is crucial in such cases to prevent long-term complications and ensure optimal healing.

Multiomics profiling of mouse polycystic kidney disease progression at a single-cell resolution

Autosomal dominant polycystic kidney disease (ADPKD) is the most common hereditary kidney disease and causes significant morbidity, ultimately leading to kidney failure. PKD pathogenesis is characterized by complex and dynamic alterations in multiple cell types during disease progression, hampering a deeper understanding of disease mechanism and the development of therapeutic approaches. Here, we generate a single-nucleus multimodal atlas of an orthologous mouse PKD model at early, mid, and late timepoints, consisting of 125,434 single-nucleus transcriptomic and epigenetic multiomes. We catalog differentially expressed genes and activated epigenetic regions in each cell type during PKD progression, characterizing cell-type-specific responses to Pkd1 deletion. We describe heterogeneous, atypical collecting duct cells as well as proximal tubular cells that constitute cyst epithelia in PKD. The transcriptional regulation of the cyst lining cell marker GPRC5A is conserved between mouse and human PKD cystic epithelia, suggesting shared gene regulatory pathways. Our single-nucleus multiomic analysis of mouse PKD provides a foundation to understand the earliest changes molecular deregulation in a mouse model of PKD at a single-cell resolution.

Pseudo-plateau iris secondary to multiple peripheral pigment epithelial cysts: A case report

Iris epithelial cysts are rare, spontaneous, epithelium-lined spaces that arise from the iris-pigmented epithelial layer and ciliary body and can cause a narrowing of the anterior chamber angle leading to a pseudo-plateau iris configuration (PPI). We present the case of an 80-year-old female patient with a history of decreased visual acuity, diagnosed with bilateral cataracts and pseudo-plateau iris secondary to multiple peripheral pigment cysts. This report describes the detection process, management strategy and course of treatment of a patient with bilateral cataracts who underwent cataract surgery by manual incision, and clinically presented with Pseudo-plateau iris secondary to Iris epithelial cyst. It highlights the importance of early detection and correct differentiation from malignant conditions, and anterior segment pathologies to prevent associated permanent complications.

P2X4 receptor mediates macrophage infiltration leading to endometriotic cyst epithelium proliferation and hyperalgesia in mouse model

To evaluate the effects of a P2X4 receptor (P2X4R)-specific antagonist on murine endometriotic-like lesions and human endometriotic stromal cells. Experimental study using an invivo mouse endometriosis model and invitro primary culture of human endometriotic stromal cells. NC-2600, an antagonist of the P2X4 ionotropic ATP receptor (P2X4R), was orally administered to the mice and cells. Gene expression analyses for cytokines were conducted in the endometriotic-like cysts and vaginal portion of mice, and immunohistochemistry was performed to evaluate the proliferative activity and localization of macrophages in addition to cytokine expression. The sensation of murine vaginal pain was evaluated using visceromotor responses. The study was performed in academic and hospital research laboratories. NC-2600 reduced the proliferation of the cyst epithelium and vaginal pain sensation. In both cysts and vaginas, P2X4R is mainly expressed in macrophages, and NC-2600 reduces the number of tissue macrophages and reverses the elevated expression of InterleukinL-33 and cyclooxygenase-2 in animals with endometriosis. These results indicate unknown pathophysiological roles of P2X4R expressed in local macrophages at the injury site of endometriosis and in the vagina, suggesting the potential therapeutic effects of orally administered P2X4R inhibitors for alleviating the symptoms of endometriosis.

Minimal Invasive Approach to The Branchial Neck Cyst.

Branchial cleft cysts are congenital epithelial cysts, which arise on the lateral part of the neck. They may not present clinically until later in life. Surgical excision is a definitive treatment for branchial cleft cysts. This article presents the clinical report where the big inflamed cysts were excised under local anesthesia. It also presents guidelines for minimally invasive surgery under local anesthesia, which can be used in adequately selected cases.

The Influence of Non-Pharmacological and Pharmacological Interventions on the Course of Autosomal Dominant Polycystic Kidney Disease.

Polycystic kidney disease (PKD) includes autosomal dominant (ADPKD) and autosomal recessive (ARPKD) forms, both of which are primary genetic causes of kidney disease in adults and children. ADPKD is the most common hereditary kidney disease, with a prevalence of 329 cases per million in Europe. This condition accounts for 5-15% of end-stage chronic kidney disease (ESKD) cases, and in developed countries such as Poland, 8-10% of all dialysis patients have ESKD due to ADPKD. The disease is caused by mutations in the PKD1 and PKD2 genes, with PKD1 mutations responsible for 85% of cases, leading to a more aggressive disease course. Recent research suggests that ADPKD involves a metabolic defect contributing to cystic epithelial proliferation and cyst growth. Aim: This review explores the interplay between metabolism, obesity, and ADPKD, discussing dietary and pharmacological strategies that target these metabolic abnormalities to slow disease progression. Conclusion: Metabolic reprogramming therapies, including GLP-1 analogs and dual agonists of GIP/GLP-1 or glucagon/GLP-1 receptors, show promise, though further research is needed to understand their potential in ADPKD treatment fully.

INTRAOSSEOUS EPIDERMOID CYST OF JAW – A case report

Abstract Epidermoid cysts are benign, rare which can occur all throughout the body of an individual. Their occurrence in the oral cavity is rare and is difficult to distinguish from other intraoral cysts. Method A 27-year-old female patient presented with a swelling to the oral and maxillofacial surgery department for the removal of the cystic lesion. Results Based on the clinical and radiographic features the provisional diagnosis was given as odontogenic keratocyst. But the histopathological examination revealed a stratified squamous cystic epithelium with abundant keratin suggestive of an epidermoid cyst. Conclusion This case report presents an uncommon finding in the oral cavity with a history of teeth extraction. Based on these findings even though epidermoid cyst is rare it should be included in the differential diagnosis of radiolucent lesions of the jaws.

Renal Solitary Fibrous Tumor With Müllerian Cysts: A Novel Differential Diagnosis for Biphasic Renal Neoplasms.

Solitary fibrous tumor is an uncommon mesenchymal neoplasm, initially described in the pleura and infrequently found in the kidney. It is characterized by haphazardly arranged spindle cells, staghorn vasculature, coexpression of CD34 and signal transducer and activator of transcription 6 (STAT6), and a NAB2::STAT6 gene fusion. We report a 64-year-old woman who presented with a 2.5 cm multilocular cystic renal mass. On microscopic examination, the tumor consisted of a spindle cell component closely intermingled with ciliated and hemorrhagic epithelial cysts. The spindle cell component was positive for CD34, B-cell lymphoma 2 (BCL2), and STAT6, confirming the diagnosis of a solitary fibrous tumor. The epithelial cysts expressed keratin 7, PAX8, BCL2, estrogen receptor 1, and progesterone receptor, indicative of Müllerian cysts. The occurrence of solitary fibrous tumor in the kidney is extremely rare, and its association with Müllerian cysts has not been previously reported in the kidney. This morphologic variant has a striking similarity with biphasic renal neoplasms, especially with mixed epithelial and stromal tumors and angiomyolipoma with epithelial cysts. This report describes a novel renal solitary fibrous tumor subtype within this differential and underscores clinical and pathological distinctions of biphasic renal neoplasms.

Do we more often opt for conservative management of ovarian tumors after changing the Dutch national guideline on enlarged ovaries? A nationwide cohort study.

Increasing evidence shows that conservative management of ovarian tumors classified as benign, based on ultrasound assessment, is safe. Therefore, conservative management has been adopted as the preferred strategy for certain ovarian tumors assessed as benign in the Dutch national guideline on enlarged ovaries in 2013. The aim of this study was to examine whether implementation of this guideline has led to changes in the number of women/100 000 women undergoing surgery for an ovarian tumor in the Netherlands. Histopathology reports were requested for all examinations of ovarian and fallopian tube specimens (including cyst enucleations) registered in Palga, the Dutch nationwide pathology databank, from 2011 (before guideline adaptation) and 2019 (after guideline adaptation). Reports on prophylactically removed adnexa, removal for other primary tumors (eg endometrial carcinoma), and for patients under 18 years of age, were excluded from the analysis. Interobserver agreement for the inclusion and classification of reports was assessed using Cohen's Kappa analysis. A total of 34 932 reports were retrieved, 13 917 of which were included in the analysis. In 2011 and 2019, respectively, 96.3/100 000 vs 68.8/100 000 women aged ≥18 underwent surgery for benign ovarian tumors, and 19.6/100 000 vs 18.3/100 000 for borderline and malignant tumors combined. The number of women/100 000 who had surgery for a benign ovarian tumor per 100 000 women declined by 28.5% (p < 0.001) between 2011 and 2019. The largest difference between 2011 and 2019 was observed in the number of women per 100 000 women who underwent surgery for a serous cystadenoma (-40.7%; 20.8/100 000 vs. 12.3/100 000), followed by endometrioma (-33.2%; 14.7/100 000 vs. 9.8/100 000), simple epithelial cyst (-57.3%; 8.4/100 000 vs. 3.6/100 000), and corpus luteum cyst (-57.0%; 4.0/100 000 vs. 1.7/100 000). Cohen's Kappa for the interobserver agreement was 0.96. The number of women/100 000 undergoing surgery for a benign ovarian tumor has substantially decreased in the Netherlands when comparing data before and after implementation of the national guideline in 2013, while the number of women/100 000 undergoing surgery for a malignant or borderline tumor remained the same. These findings suggest successful implementation of the updated guideline, and a measurable effect on increased adoption of conservative management for benign-looking ovarian tumors.

Using Microfluidics to Align Matrix Architecture and Generate Chemokine Gradients Promotes Directional Branching in a Model of Epithelial Morphogenesis.

The mechanical cue of fiber alignment plays a key role in the development of various tissues in the body. The ability to study the effect of these stimuli in vitro has been limited previously. Here, we present a microfluidic device capable of intrinsically generating aligned fibers using the microchannel geometry. The device also features tunable interstitial fluid flow and the ability to form a morphogen gradient. These aspects allow for the modeling of complex tissues and to differentiate cell response to different stimuli. To demonstrate the abilities of our device, we incorporated luminal epithelial cysts into our device and induced growth factor stimulation. We found the mechanical cue of fiber alignment to play a dominant role in cell elongation and the ability to form protrusions was dependent on cadherin-3. Together, this work serves as a springboard for future potential with these devices to answer questions in developmental biology and complex diseases such as cancers.

Endoscopic ultrasound-guided needle-based confocal laser endomicroscopy for pancreatic cystic lesions: current status and future prospects.

Pancreatic cystic lesions (PCLs) have increased in prevalence due to the increased usage and advancements in cross-sectional abdominal imaging. Current diagnostic techniques cannot distinguish between PCLs requiring surgery, close surveillance, or expectant management. This has increased the morbidity and healthcare costs from inappropriately aggressive and conservative management strategies. Endoscopic ultrasound (EUS) needle-based confocal laser endomicroscopy (nCLE) allows for microscopic examination and delineation of the surface epithelium of PCLs. Landmark studies have identified characteristics distinguishing various types of PCLs, confirmed the high diagnostic yield of EUS-nCLE (especially for PCLs with an equivocal diagnosis), and shown that EUS-nCLE helps to change management and reduce healthcare costs. Refining procedure technique and reducing procedure length have improved the safety of EUS-nCLE. The utilization of artificial intelligence and its combination with other EUS-based advanced diagnostic techniques would further improve the results of EUS-based PCL diagnosis. A structured training program and device improvements to allow more complete mapping of the pancreas cyst epithelium will be crucial for the widespread adoption of this promising technology.