Fibrous Cysts Research Articles

Effect of the presence of cysts in the hip joint on hip arthroscopy.

The aim of this study was to investigate whether the presence and size of fibrous cysts affected postoperative results in patients undergoing hip arthroscopy. Between January 2010 and December 2019, a total of 261 patients (138 males, 123 females; mean age: 39.5±11.9 years; range, 18 to 66 years) who underwent hip arthroscopy with the diagnosis of cam-pincer-mixed-type femoroacetabular impingement (FAI) and labral pathologies were retrospectively analyzed. The study groups (impingements and labral pathologies) and the presence of cyst (or cyst size: <5 mm, 5-8 mm, >8 mm) were used as the fixed effects, and the analysis was adjusted for baseline age, sex, and preoperative scores. Pre- and postoperative modified Harris Hip Score (mHHS) and Visual Analog Scale (VAS) scores that were applied to all patients were used as an indication of clinical results. The mean preoperative mHHS score of the patients with a cyst was significantly lower compared to the patients without a cyst (56.8±12.3 vs. 60.3±12.7, p=0.026). The mean change in the mHHS score and the mean percentage change in VAS score were significantly higher in the patients with a cyst compared to the patients without a cyst (mHHS score: 28.1±14.0 vs. 22.5±14.1, p=0.002; VAS score: 61.9±30.2 vs. 52.6±47.4, p=0.038). The increase in mHHS score over time for patients with a cyst was significantly higher than the patients without cysts in the pincer group (38.1±11.1 vs. 19.3±13.5, p<0.001). The patients with a cyst size of >8 mm had a significantly higher increase in the mHHS scores compared to the patients with a cyst size of <5 mm (29.5±12.9 vs. 23.5±13.8, p=0.043). Subchondral cysts in the femoral head and neck junction accompanied cam-type and mixed-type FAI, while subchondral cysts in the acetabulum accompanied pincer-type impingement. In all groups, the mean increase in mHHS scores and the mean decrease in VAS scores were higher in patients with subchondral cysts than in patients without cysts. In patients with subchondral cysts, if the lesion causing FAI is treated arthroscopically, it can positively affect the functional results.

The Epidemiology of Benign Proliferative Processes of the Skeletal System in Children.

A suspicion of a proliferative bone lesion in a child seems to be a major diagnostic problem for clinicians. There are no diagnostic and treatment algorithms described in the literature and no reliable cohort epidemiological data. Our study was conducted among 289 paediatric patients (0–18 years old) with an initial diagnosis of a bone tumour or tumour-like lesion. The study comprised a retrospective epidemiological analysis, an assessment of the concordance of the initial diagnoses with the histopathological diagnoses and an analysis of the specific locations of the various bone lesions. The results obtained have made it possible to formulate the following conclusions. (1) The most common proliferative bone lesion in children is osteochondroma; also common are fibrous dysplasia, non-ossifying fibromas and bone cysts. (2) Verifying the initial diagnosis by means of biopsy is essential. (3) Osteochondromas are typically located in the metaphyses of long bones, fibrous dysplasia in the femur and skull, cyst-like lesions in the proximal humerus and non-osteochondral fibromas exclusively in the lower limbs. What could improve the quality of treatment for children with primary proliferative bone diseases is the establishment of centres of paediatric orthopaedic oncology skilled in early diagnosis and prompt management.

Brown Tumors Secondary to Parathyroid Carcinoma Masquerading as Skeletal Metastases on 18F-FDG PET/CT: A Case Report

Brown tumors develop as skeletal manifestations of hyperparathyroidism. Increased osteoclast activity leads to accumulation of highly active giant cells and to excess cortical bone resorption, producing fibrous cysts. Though most often reported in patients with parathyroid adenomas, brown tumors secondary to parathyroid carcinoma create a clinical dilemma. Increased signal uptake on 2-deoxy-2-(fluorine-18)fluoro-D-glucose positron emission tomography (18F-FDG PET)/computed tomography (CT) seen within brown tumors may be indistinguishable from bone metastases. We report a case of parathyroid carcinoma in a 38-year-old man presenting with osteolytic bone lesions on 18F-FDG PET/CT that were diagnosed as brown tumors by biopsy. We describe the patient history, presentation, diagnostic studies, and treatment. We report a case of a 38-year-old man diagnosed with parathyroid carcinoma with associated hypercalcemia and elevated parathyroid hormone levels who had undergone 3 surgical resections for local recurrences and had persistent hypercalcemia. He was found to have multiple osteolytic lesions throughout his skeleton on 18F-FDG PET/CT imaging 2 months after diagnosis. Biopsy of a right scapula lesion confirmed a brown tumor. The role of 18F-FDG PET/CT in management of parathyroid carcinoma has not been systematically evaluated. Skeletal manifestations of parathyroid carcinoma may be present in this imaging modality. Clinicians should consider the possibility of brown tumors in patients with parathyroid carcinoma who undergo 18F-FDG PET/CT imaging.

Brown Tumors Due to Primary Hyperparathyroidism in a Patient with Parathyroid Carcinoma Mimicking Skeletal Metastases on (18)F-FDG PET/CT.

Parathyroid carcinoma only represents <1% of all cases of primary hyperparathyroidism (PHPT). Even rare, chronic PHPT may lead to excessive osteoclast activity, and the increased resorption leads to destruction of cortical bone and formation of fibrous cysts with deposits of hemosiderin—so-called brown tumors. These benign, osteolytic lesions may demonstrate FDG-avidity on 18F-FDG PET/CT, and as such are misinterpreted as skeletal metastases. Regression of the lesions may occur following successful treatment. We present a case demonstrating the diagnostic work-up and follow-up of a patient with PHPT due to parathyroid carcinoma and with presence of brown tumors on 18F-FDG PET/CT, visualizing the possible role of this imaging modality in the evaluation of treatment response in these patients.

Ortleppascaris sp. and your host Rhinella marina: A proteomic view into a nematode-amphibian relationship.

The success of the helminth-host relationship depends on a biochemical molecular arsenal. Perhaps the proteome is the largest and most important set of this weaponry, in which the proteins have a crucial role in vital processes to the parasite/host relationship, from basic metabolism and energy production to complex immune responses. Nowadays, the bioproducts expressed by the parasites are under the "spotlight" of immunoassays and biochemical analysis in helminthology, especially in proteomic analysis, which has provided valuable information about the physiology of the infecting agent. Looking into this point of view, why not turn to the infected agent as well? This study characterised the proteomic profile of fluid-filled fibrous cysts of encapsulated Ortleppascaris sp. larvae in the hepatic parenchyma of their intermediate host, the amphibian Rhinella marina. The proteins were separated by two-dimensional electrophoresis and identified by MS with the aid of Peptide Mass Fingerprint. A total of 54 molecules were analysed in this system, revealing a complex protein profile with molecules related to basic metabolic processes of the parasite, energy production, oxi-reduction and oxidative stress processes as well as molecules related to the host response. This study contributes to proteomic studies of protein markers of the development, infectivity, virulence and co-existence of helminths and their hosts.

Effect of high porosity on biodegradation of poly (4-hydroxybutyrate)in vivo

Poly-4-hydroxybutyrate, P(4HB), is a biosynthetic thermoplastic polymer that has been studied as a bio-absorbable medical material. In order to explore the in vivo biodegradation behaviour of porous P(4HB) membranes with specified apertures (89-150 µm), membranes with different porosities were implanted subcutaneously into the backs of 27 eight-week-old Sprague Dawley® rats. The implanted specimens were examined with Masson and hematoxylin and eosin staining. Masson staining indicated that the P(4HB) membranes were encased in fibrous cysts and that more collagen fibers were present within the sections of the hyper-porosity group. Hematoxylin and eosin staining showed that the residual area of the P(4HB) membranes in the hyper-porosity group decreased sharply compared to the hypo-porosity group, which implied that the P(4HB) membranes with higher porosity degraded faster than those with lower porosity. A slow degradation phase persisted for approximately 14 weeks during the degradation process. After the 16th week, the P(4HB) scaffolds fell into a fast degradation phase. The residual areas of the hyper-porosity P(4HB) membranes at the 32nd week were reduced by 39.76% compared with the second week after implantation. We concluded that P(4HB) membranes manifest a special biodegradation behavior in vivo and that the increased porosity of these membranes is an important factor favoring their biodegradation rates.

Multiple skeletal lesions on FDG PET in severe primary hyperparathyroidism

A 55-year-old man presented with weight loss and diffuse bone pain. Strongly elevated concentrations of calcium (3.49 mmol/L, with normoalbuminuria) and parathyroid hormone (260 pmol/L) indicated primary hyperparathyroidism.F-FDG PET/CT scanning demonstrated uptake in the right upper and right lower pole of the thyroid region but also multiple F-FDG-avid osteolytic lesions, including the 7th cervical and 3rd lumbar vertebrae (a). Histopathological examination of a vertebral bone biopsy revealed a brown tumour. An enlarged left upper and right upper parathyroid gland were resected using a sestamibi gamma probe. In addition, a left-sided hemithyroidectomy with ipsilateral paratracheal nodal dissectionwas performed because of a suspected mass in the left thyroid lobe and enlarged lymph nodes [1]. Pathological examination demonstrated a parathyroid adenoma but no carcinoma. Postoperative recovery was complicated by a severe hungry bone syndrome. Repeat FFDG PET/CT scanning 4 months after surgery showed a marked reduction in the number of F-FDG-avid lesions in the skeleton (b). Also the intensity of F-FDG uptake in the remaining lesions was significantly lower. Severe parathyroid bone disease is nowadays rarely encountered [2]. Brown tumours are osteolytic lesions which may mimic skeletal metastasis [3–5]. Microscopically, excessive osteoclast resorption is seen with destruction of cortical bone and formation of fibrous cysts. The marrow may be replaced by vascularized fibrous tissue and osteoclast-like giant cells. Haemosiderin deposits give these tumours their characteristic brown colour. Reduction in abnormal F-FDG uptake paralleled resolution of the hungry bone syndrome in our patient. Indeed, brown tumours may disappear after successful parathyroidectomy [5].

Morphological and Molecular Characterization ofOrtleppascarisSp. Larvae, Parasites of the Cane ToadRhinella marinafrom Eastern Amazonia

This study presents a new record for the occurrence of larval Ortleppascaris sp.(Sprent, 1978). The nematodes were collected from inside fibrous cysts found in the livers of cane toads, Rhinella marina (Linnaeus, 1758), captured in eastern Brazilian Amazonia. This is the first record of Ortleppascaris sp. larvae in both Brazil and this amphibian host, increasing its distribution in South America as well as expanding the number of helminths known to infect this toad. The detailed description of Ortleppascaris sp. provides new taxonomic data for these larvae, as well as sequences of the internal transcribed spacers and small subunit DNA segments, and the cytochrome oxidase I gene, which will, in time, contribute to a better understanding of the phylogeny of this group of parasites.

A 32-Year-Old Man With Recurrent Kidney Stones and an Abnormal Chest Radiograph

A 32-Year-Old Man With Recurrent Kidney Stones and an Abnormal Chest Radiograph

Two cases of cystic seroma following mesh incisional hernia repair

Cystic seromas, or mature fibrous cysts, are rare complications after ventral and incisional hernioplasties employing polypropylene mesh. We analyzed the medical records of patients, whose abdominal-wall hernias were surgically repaired with polypropylene mesh from November 1996 to February 2004 (N=685). Of the 162 patients, who had incisional hernias repaired with the Rives technique (preperitoneal mesh), we detected two patients who developed giant cystic seromas. Both patients underwent surgical resection of the cyst wall. As follow-up care improves for patients undergoing hernioplasties with polypropylene meshes, more cystic seromas are detected, thereby improving our knowledge of the clinical, radiological, and histopathological characteristics of this complication. However, the etiologic factors related to the appearance of this chronic cyst remain uncertain.

Giant mature cyst formation following mesh repair of hernias: An underreported complication?

Numerous complications have been described following the implantation of synthetic meshes during hernia repair; one of the rarest, with only three reported cases, is giant mature fibrous cyst formation. Our clinical experience with this complication has led us to believe that it may be more common than previously thought. Surgical operation notes and pathology archives were reviewed for the period January 1998-January 2002 to determine the prevalence of mature cyst formation following mesh repair of hernias. Out of 1100 hernia repair operations involving the use of synthetic meshes in our institution during the period of study, five developed histologically confirmed mature fibrous cysts giving a prevalence of 0.45% for this complication. The formation of a giant mature cyst following mesh repair of hernias is an underreported complication.

A Radiological Approach to the Systemic and Neurologic Features of Hyperparathyroidism

Parathyroid hormone (PTH) affects the nervous system directly and indirectly. The induced pathology may present typical imaging findings in neuroradiology. The hormone controls the physiological level of blood calcium. Increased serum PTH causes pathological features in the kidneys and especially in the skeleton where most calcium is situated. Primary hyperparathyroidism is due to hyperplasia or to adenomatous or carcinomatous degeneration of glandular tissue. It causes relapsing nephrolithiasis and, more seldon, nephrocalcinosis. Bone shows increased osteoclastic activity with various aspects of diffuse demineralization. In severe cases pathological fractures and sub-periosteal, sub-chondral reabsorptions appear, especially at the tendon and capsuloligamentous insertions. In even more severe disease fibrous osseous cysts and brown tumours may be found in bone. In the central nervous system, clinical symptoms, such as mental confusion, lethargy and exceptionally coma may appear. Radiologically, bone resorption can be observed in the skull as microlacunar confluent osteolysis (salt and pepper skull). Body fractures may develop in the spine. Secondary hyperparathyroidism is due principally to renal failure. Both hypocalcaemia and hyperphosphoraemia cause the hormone secretion increase. In this case, other pathologic features are associated with the typical manifestations of primary hyperparathyroidism. The uraemic kidney is inable to synthetize active vitamin D, leading to rickets in the young and osteomalacia in adults. Hyperphosphoraemia causes ectopic periarticular calcifications. Furthermore, the lack of degradation of an endogenous protein (beta 2 microglobulin) by the kidney and its poor elimination by dialytic treatment, cause chronic retention and consequent systemic amyloidosis which induces intraosseous cystic lesions and severe destructive arthropathy. All these aspects, together, are known as renal osteodystrophy. The radiological features of secondary hyperparathyroidism are the same as those observed in the primary form. In addition, all the lesions of renal osteodystrophy may be associated, further worsening the disease. In the secondary form, mild hypocalcaemia, if present, rarely leads to the neurological manifestations of the primary disease. Frequently carpal tunnel syndrome arises due to local amyloid infarction. Chronic aluminium retention may produce neurological aspects of dementia. Finally, the decrease of PTH hormone blood levels, as in hypoparathyroidism and the consequent hypocalcaemia may determine neurologic symptoms such as paresthaesias, and in severe disease, tetanic contractions. Radiologically, typical micronodular calcifications can be observed in the brain basal ganglia.

Angiostrongylus michiganensis sp. n. (Nematoda: Metastrongyloidea), a Lungworm Occurring in the Shrew, Sorex cinereus cinereus, in Michigan

Angiostrongylus michiganensis sp. n. from the bronchioles of Sorex cinereus cinereus in Michigan is described. It can be distinguished from a closely related European species, A. soricis, by its greater body length, longer spicules, and the more anterior position of the vulva. It differs from A. blarini, an American species also found in shrews, in being larger, having longer spicules, and by not occurring in fibrous cysts in the lung. The species of Angiostrongylus and related genera are discussed. Two species of Angiostrongylus have been reported from the continental United States. Dougherty (1946) described A. gubernaculatus from the badger (Taxidea taxus neglecta) and skunk (Mephitis mephitis holzneri) in California, and Ogren (1954) described A. blarini from the short-tailed shrew (Blarina brevicauda) in Illinois. During the summer of 1956 investigations were carried out at the University of Michigan Biological Station, Cheboygan, Michigan, on an undescribed species of Angiostrongylus occurring in small mammals. The worm was found in the lungs of 14 of 41 Sorex cinereus cinereus Kerr, a common small shrew, from a locality known as Reese's Bog. In the previous summer, other workers at the Biological Station observed the same parasite in Sorex, and the same or a different lungworm was observed in Microtus pennsylvanicus pennsylvanicus (Ord) and Zapus hudsonius hudsonius (Zimmerman). Specimens from the latter two animals were not available for study. The description of the new species is based on material collected from Sorex only. The average for each range of measurements is given in parentheses. Measurements are in microns unless otherwise indicated. The drawings were made with the aid of a camera lucida. Received for publication 4 January 1967. * This study was supported in part by grants AI04919 and E-936 from the NIH, Public Health Service. t Present address: c/o South Pacific Commission, P. 0. Box 9, Noumea, New Caledonia. Address reprint requests to Department of Tropical Medicine and Public Health, Tulane University School of Medicine, New Orleans, Louisiana. Angiostrongylus michiganensis sp. n.