Initial Cyst Size Research Articles

The natural history of pineal cysts in children and young adults

The authors reviewed their experience with pediatric pineal cysts to define the natural history and clinical relevance of this common intracranial finding. The authors identified all patients with pineal cysts who had been clinically evaluated at their institution over an 11.5-year interval and were < 25 years of age at the time of diagnosis. All inclusion criteria were met in 106 patients, and included repeated MR imaging as well as repeated clinical evaluation over at least a 6-month interval. The mean age at diagnosis was 11.7 +/- 7.2 years. Forty-two patients were male and 64 were female. On follow-up MR imaging evaluation at a mean interval of 3.0 years from the initial study, 98 pineal cysts had no increase in size and no change in imaging appearance. Six pineal cysts increased in size and 2 others had a change in imaging characteristics without associated growth. Younger age was associated with cyst change or growth on follow-up imaging (p = 0.02). The mean age of patients with cysts that changed or grew was 5.5 years, and the mean age of patients with stable pineal cysts was 12.2 years. Initial cyst size and appearance on MR imaging were not significant predictors of growth or change in imaging appearance at follow-up. Similarly, the patient's sex was not a significant predictor of growth or change in imaging characteristics. Follow-up imaging and neurosurgical evaluation may be considered optional in older children with pineal cysts.

The Natural History of Osteoarthritic Bone Cysts After Uncemented Total Hip Arthroplasty

This study quantified the radiographic changes of osteoarthritic acetabular bone cysts after uncemented total hip arthroplasty (THA). Ten-year follow-up radiographs from 130 primary THAs were reviewed. Forty-one cysts were identified on immediate postoperative radiographs. Two-dimensional cyst size was measured postoperatively and on long-term radiographs. Mean initial cyst size was 1.0 ± 0.9 cm 2. Four (10%) of the 41 cysts expanded over time. The average increase in cyst size was 5.1 ± 8.6 cm 2 which equated to a mean size increase of 713%. Twenty-seven cysts (66%) shrank, and the remaining 10 cysts (24%) did not change with time. Because cysts located in zone II, near the dome hole of the cup, were statistically more likely to progress, we hypothesize that these cysts communicated with the joint space via these holes. We propose that placing the acetabular component to seal an osteoarthritic cyst from the joint space during THA can help prevent its subsequent progression and the risk of associated osteolysis.

The Natural History of Simple Renal Cysts in Adults

Purpose: Simple renal cysts are common in older patients and they are usually left untreated, yet only a few studies have been done on the natural history of simple renal cysts. We investigated the sequential changes in their size and number in 103 patients. Materials and Methods: From January 1993 to August 2003, we followed 103 patients who were suffering with simple renal cysts. Their mean age was 55.8±18.72 years old (M:F=58:51). Using Abdominal USG and CT, the annual changes in renal cysts were analyzed through the follow-up period, and the mean follow-up period was 52.3±17.58 months. The values of the parameters were compared with using a 2-tailed Student's t-test, multivariate logistic regression analysis and the chi-square test. Results: At the time of diagnosis, the mean number and size of simple renal cyst were 1.5±1.31 cysts per each kidney and 25.3±12.42mm, respectively. On the consecutive imaging study, the size of the renal cysts was increased 4.4±1.54mm per year. The average size increase was significantly greater in the individuals younger than 50 versus the patients 50 years or older (5.7±2.14mm/year vs 3.7±1.45mm/year, respectively). The multiple cysts showed a significantly larger size increase than did the single cysts (8.1±3.27mm/year vs 3.6±1.64mm/year, respectively). The size increase of the bilateral renal cysts was significantly larger than that of the unilateral renal cysts (5.6±1.48mm/year vs 4.1±1.02mm/year, respectively). No significant difference was observed for the average size increase with regard to gender or the initial cyst size. Only the number of cysts was a significant predictor of aggressiveness on the multivariate logistic regression analysis. Conclusions: The simple renal cysts progress in size and they appear to grow with aging. They seem to grow more rapidly in patients with a younger age, and for multiple and bilateral renal cysts. (Korean J Urol 2006;47:80-84) ꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏ

Sclerotherapy with OK-432 for recurrent cystic thyroid nodule.

We have adopted OK-432 as a sclerosing agent in the treatment of cystic predominant thyroid nodules and have analyzed our findings to assess the efficacy of intralesional instillation of OK-432. From 1992 through 1993, 48 patients with recurrent or progressive cystic thyroid nodules after 2 or 3 aspirations alone, and whom were cytologically negative for malignancy, were used for this study. The OK-432 solution was prepared by dissolving 0.1 mg of OK-432 in 2 ml of physiologic saline and it was instilled in the amount of 1/10-to-1/5 of the aspirated cystic fluid. A repeated course of therapy was given up to 3 times when sufficient resolution was not obtained 4-to-6 weeks after treatment. The mean number of treatment sessions per patient was 1.5. Throughout the follow-up period from 30-to-45 months (mean, 38 months), 32 (66.7%) patients experienced an almost complete disappearance (< 0.05 cm in diameter) of the cystic lesion, and 12 (25%) patients responded partially by having it decrease by more than half (> 0.5 cm in diameter) of the initial cyst size, and none of these patients required further treatment. The remaining 4 (8.3%) patients showed insufficient resolution despite 3 courses of therapy and 2 of these patients underwent thyroidectomy, in which the lesion proved benign in both cases. All of the patients tolerated the sclerotherapy well. No significant local complications attributed to this treatment were observed. However, a low-grade fever was observed in 26 (54.2%) patients for 2 to 5 days after instillation, which subsided with symptomatic treatment. On the basis of our experience, OK-432 sclerotherapy appears to be safe, simple and effective, and can be a useful alternative treatment for cystic thyroid nodules.

The nature and course of cystic pancreatic lesions diagnosed by ultrasound.

To determine the nature and course of cystic pancreatic lesions, we reviewed the records of 93 patients who were followed up with serial ultrasound until resolution occurred or definitive therapy was given. Initially, 105 cystic lesions were seen. Single cysts occurred in 83 patients and multiple cysts in ten. Eight patients had two cysts and two patients had three. Twenty-one patients had a single ultrasound examination and 72 had two or more examinations. Spontaneous resolution occurred in 29 of (28%) 105 cysts in 24 patients. In 46 patients, 53 pseudocysts were found at operation or autopsy. Five patients had pancreatic abscesses. Two patients became unavailable for follow-up and three refused surgery. The results of one examination were false negative. Twelve patients had false-positive ultrasound results. Factors influencing the likelihood of spontaneous resolution included initial cyst size, subsequent increase in size, multiple cysts, and the presence of calcifications. This study confirms the usefulness of serial ultrasound scans in determining the nature and necessity for treatment of cystic lesions of the pancreas.