Intact Cysts Research Articles

Intrabiliary and abdominal rupture of hepatic hydatid cyst leading to biliary obstruction, cholangitis, pancreatitis, peritonitis and septicemia: a case report

BackgroundHydatid cysts are fluid-filled sacs containing immature forms of parastic tapeworms of the genus Echinococcus. The most prevalent and serious complication of hydatid disease is intrabiliary rupture, also known as cystobiliary fistulae. In this study, a sporadic case of biliary obstruction, cholangitis, and septicemia is described secondary to hydatid cyst rupture into the common bile duct and intraperitoneal cavity.Case presentationA 21-year-old Iranian man was admitted to the emergency ward with 5 days of serious sickness and a history of right upper quadrant abdominal pain, fatigue, fever, icterus, vomiting, and no appetite. In the physical examination, abdominal tenderness was detected in all four quadrants and in the scleral icterus. Abdominal ultrasound revealed intrahepatic and extrahepatic biliary duct dilation. Gallbladder wall thickening was normal but was very dilated, and large unilocular intact hepatic cysts were detected in segment IV and another one segment II which had detached laminated membranes and was a ruptured or complicated liver cyst.ConclusionIntrabiliary perforation of the liver hydatid cyst is an infrequent event but has severe consequences. Therefore, when patients complain of abdominal pain, fever, peritonitis, decreased appetite, and jaundice, a differential diagnosis of hydatid disease needs to be taken into consideration. Early diagnosis of complications and aggressive treatments, such as endoscopic retrograde cholangiopancreatography and surgery, are vital.

Lateral Odontogenic Keratocyst Clinically Diagnosed as a Dentigerous Cyst (A case report and literature review)

Odontogenic keratocyst (OKC) has been an area of considerable research over the last decades owing to its unique behavior, debated origin, distinctive tendency to recur, and argued nature. In 2005, WHO has adopted the designation of keratocystic odontogenic tumor (KCOT) because of its aggressive nature and tendency to recur, so, it has been long been considered as a benign jaw neoplasm rather than a cyst, though the last classification has returned the OKC back to cyst category. It is not uncommon for OKC to be clinically and radiographically identical to dentigerous cyst which makes the initial diagnosis rather confusing; however, in our reported case another interesting and an unusual feature was the arrival of an intact cyst attached to the neck of an impacted tooth which has further drawn the attention toward the dentigerous cyst, particularly the lateral type. The final diagnosis was made following the microscopic examination of the surgical specimen which was almost convincing and consistent with OKC. The clinical, radiological and histological features of this pathological entity along with brief relevant studies have been discussed.

Rupture of pulmonary hydatid cyst in pediatrics: A cross-sectional study

IntroductionPulmonary hydatid cyst is a parasitic disease causing an endemic and a health burden in many regions. Lung cysts are more common than liver cysts in children and patients may remain asymptomatic. Cyst rupturing is not uncommon, and it is considered the most feared complication. In this cohort study, we aimed to identify the risk factors related to cyst rupture in a Jordanian pediatric population. MethodsWe retrospectively evaluated all pediatric patients who underwent cystostomy and capitonnage for pulmonary hydatid cyst between 2003 and 2020 at King Abdullah University Hospital. ResultsWe found 43 patients with a mean age of 13 ± 4 years who suffered from 61 pulmonary cysts. 55.6% of them were males. The most prevalent symptom was shortness of breath. The rupture rate for patients was 39.5%, and 29.5% for cysts. None of the patients with cyst rupture had an anaphylactic reaction. The left lower lobe was the most common location for both intact and ruptured cysts. 25.6% of the patients had giant cysts (>10 cm) with a mean of 7.4 cm for all cysts. Patients with intact cysts had higher-rates of cough (42.3% vs. 29.4%) and lower-rates of shortness of breath (34.6% vs. 52.9%) than patients with ruptured cysts, which were not statistically significant. Although statistically insignificant, patients with ruptured cysts tended to have multiple cysts in one lung (29.4% vs. 7.7%, p = 0.180), and more complication rates (29.4% vs 7.7%, p = 0.09). Both groups had almost identical IgG-ELISA positive results. We found no significant association between cyst rupture and age, gender, presenting symptoms, cyst size, cyst location, and rate of postoperative complications. ConclusionThe rupture of pulmonary hydatid cyst has clinical consequences in pediatric patients, further studies on larger populations are needed to identify factors that make patients more prone to rupture and prioritize them for clinical monitoring and management.

Cerebral Cystic Echinococcosis: A Child with a Giant Hydatid Cyst

Aim: Raising awareness of healthcare providers about headache and early morning vomiting in children. Background: Intracranial cystic hydatid disease (Echinococcosis) is a rare worldwide disease caused by encysted larvae of the dog tapeworm Echinococcus granulosa. Human is the intermediate host of this parasite and CNS involvement occurs in only 3%. Clinically, the cyst causes a seizure, increased intracranial pressure and/or focal neurological deficit. Surgical removal of the intact cyst by the Dowling technique is the treatment. A 4-year-old girl was referred to a neurosurgery clinic with a history of headache and early morning vomiting over the previous 2 months. Neurological examination revealed right hemiparesis and bilateral papilloedema. Emergency brain CT-scan revealed a huge intracranial cystic lesion with midline shift. Emergency craniotomy was done and the cyst was removed intact without complication and sent for histopathological examination. The patient was discharged from the hospital with full recovery.

Intracystic Hemorrhage of an Arachnoid Cyst: a Case with Prediagnostic Imaging of an Intact Cyst

Intracystic Hemorrhage of an Arachnoid Cyst: a Case with Prediagnostic Imaging of an Intact Cyst

Management of a Giant Hepatic Cyst by Total Cyst Enucleation in Uganda. A Case Report and Review of Literature

Introduction: Giant hepatic cysts are uncommon and cause symptoms due to compression effects. Symptoms include early satiety, abdominal discomfort, abdominal mass and rarely pain in case of haemorrhage, rupture or cyst infection. Aetiology is unknown but liver cysts are thought to be congenital. Management if liver cysts is debatable but options include sclerotherapy, fenestration or deroofing, open or laparoscopic partial or total cyst excision, cyst enucleation and rarely liver resection. There is paucity of data on management of Giant liver cysts in Uganda and the East African region and to the best of our knowledge, this is the first reported case in our country and region. Method: We present a sixty one year old female Ugandan who was admitted due to an increasing abdominal mass with associated discomfort and early satiety. Contrasted abdominal computed tomography (CT) scan revealed a 28 x 26 cm simple liver cyst. Results: She underwent open total cyst enucleation after initial cyst decompresion. Postoperative recovery was uneventful and she was discharged on the 8th postoperative day. Conclusion: It is easier to perform a total cyst excision or enucleation for Giant liver cyst with a thick wall or cyst capsule. Figure 1: Abdominal CT scan of the giant liver cyst (top left), intraoperative intact cyst (top middle), cyst dissection (top right), detaching cyst from inferior vena cava (bottom left), atrophied right lobe and hypertrophied left lobe (bottom middle), after total cyst excision/enucleation (bottom right)

Intracranial hydatid cysts: a report on 16 cases

AimTo describe the epidemiological and clinical criteria of those patients with rare intracranial cysts.BackgroundCentral nervous system (CNS) hydatid cysts are a rare presentation of hydatid cyst, although may be the cause of intracranial space-occupying lesions in 4% in endemic countries. It affects mostly children. The diagnosis of CNS hydatid is still problematic despite the advancements in imaging techniques (computed tomography or MRI). Extirpation of the intact cyst is the treatment of choice, resulting in most cases to a complete recovery.Patients and methodsA retrospective descriptive study was conducted on the CNS hydatid cases operated in our departments between 2011 and 2016. A total of 16 cases were included. For each case, we reviewed the presenting clinical manifestations and the imaging findings. The Glasgow Outcome Scale was followed for all cases throughout the follow-up period.ResultsOf 16 cases, 12 were children (<12 years). The most presenting findings were increased intracranial pressure. A single cyst was detected for 14 cases, whereas multiple cysts were identified in two cases. Extirpation of the cyst without rupture was achieved in 12 patients. Only two cases developed recurrent hydatid after 3 years. No intraoperative mortality was detected, whereas postoperative mortality occurred in one case owing to anaphylaxis following intraoperative rupture of the cyst.ConclusionSurgical excision of the whole hydatid cyst without rupture is the treatment of choice to avoid the life-threatening complications of CNS hydatid rupture.

Ultrastructural morphology of the Myxobolus dermatobius Ishii 1915 (Mixosporea: Myxobolideae) microspores infecting eyes of Nile tilapia (Oreochromis niloticus) in Egypt.

A total of 1,000 cultured Nile tilapia (Oreochromis niloticus) were collected from different governmental and private fish farms and examined for detection of myxosporean parasites infection. The infected fishes showed slight unilateral exophthalmia with whitish cyst in the eye. Numerous white cysts like plasmodia of Myxobolus dermatobius were recovered from the eye of the examined fishes with low prevalence rate (1%). Small intact cyst was isolated, fixed in 3% glutaraldehyde in 0.1 M sodium cacodylate (pH 7.4) and prepared for transmission electron microscopy examination. Ultrathin sections myxospores of M. dermatobius revealed pair of capsulogenic cells at the apical pole of the developing myxospore. Single sporoplasm containing a single nucleus and sporoplasmosomes fills nearly all the space beneath the polar capsules. The later were pyriform in shape, each one had homogenous dense core and 4 turns of polar filaments. Ultrastructural characteristics of the present myxospore were described and discussed in detail.

Intact and Perforated Pulmonary Hydatid Cyst: A Comparative Study from Damascus, Syria.

BackgroundHydatidosis is a major health problem around the world, especially in the Mediterranean region. Cysts can break open or develop secondary bacterial infections, altering the clinical presentation.MethodsPatients who underwent hydatid cyst surgery at Al-Mouassat University Hospital in Damascus, Syria between January 2006 and December 2017 were evaluated. Cases involving isolated hepatic cysts were excluded. The patients were divided into those with perforated hydatid cysts (group 1) and those with intact hydatid cysts (group 2).ResultsThis study included 224 cases 113 in group 1 (50.4%) and 111 in group 2 (49.6%). The median chest tube duration, hospitalization time, and postoperative complication rate were higher in group 1 than in group 2 (p=0.003, p=0.002, and p=0.006, respectively). In both groups, the most common symptom was cough (present in 178 patients in total [79.5%]), while chest pain (121 patients [54%]) and dyspnea (113 patients [50.4%]) were also common. Cough, hemoptysis, fever, and expectoration of cystic contents were significantly more frequent in group 1 than in group 2 (p<0.001).ConclusionThe early discovery and treatment of intact pulmonary hydatid cysts reduced the hospitalization time, chest tube duration, and postoperative complication rate. Relative to intact cysts, perforated cysts are more complex and are associated with more expensive and time-consuming surgical treatment.

A case of Echinococcus granulosus hepatic hydatid cyst together with pyogenic liver abscess in a Nepali patient.

Hydatidic disease (echinococcosis) is a significant health problem in Nepal. In humans, mainly involves liver and commonly remains silent without symptoms or causing only mild pressure symptomatology. However, inadequate invasive medical procedures may cause the rupture of the cyst with serious complications, anaphylactic shock and death. Herein, we report the case of a Nepali patient who had been treated of a hepatic abscess with percutaneous drainage and antibiotics in a previous hospitalization. Study by drain fluid, ultrasonography and the magnetic resonance imaging revealed the presence of an intact Hydatidic cyst in the liver concomitantly with a percutaneously draining abscess (with free hooklets and a drain tube). This emphasizes the importance of putting the Hydatidic cyst into the differential diagnosis of liver abscess, especially in non-endemic areas.

Morphological Change and Cell Disruption of Haematococcus pluvialis Cyst during High-Pressure Homogenization for Astaxanthin Recovery

Haematococcus pluvialis accumulates astaxanthin, which is a high-value antioxidant, during the red cyst stage of its lifecycle. The development of a rigid cell wall in the cysts hinders the recovery of astaxanthin. We investigated morphological changes and cell disruption of mature H. pluvialis cyst cells while using high-pressure homogenization for astaxanthin extraction. When treated with French-press-cell (pressure, 10,000–30,000 psi; passage, 1–3), the intact cyst cells were significantly broken or fully ruptured, releasing cytoplasmic components, thereby facilitating the separation of astaxanthin by ethyl acetate. Fluorescence microscopy observations using three different fluorescent dyes revealed that a greater degree of cell breakage caused greater external dispersion of astaxanthin, chlorophyll, lipids, proteins, and carbohydrates. The mechanical treatment resulted in a high cell disruption rate of up to 91% based on microscopic cell typing and Coulter methods. After the ethyl acetate extraction, the astaxanthin concentration significantly increased by 15.2 mg/L in proportion to the increase in cell disruption rate, which indicates that cell disruption is a critical factor for solvent-based astaxanthin recovery. Furthermore, this study recommends a synergistic combination of the fast instrumental particle-volume-distribution analysis and microscope-based morphologic phenotyping for the development of practical H. pluvialis biorefinery processes that co-produce various biological products, including lipids, proteins, carbohydrates, chlorophyll, and astaxanthin.

Intact Pulmonary Hydatid Cyst: Is Bronchoscopic Removal Possible?

In the current technical note, the structure of pulmonary hydatid cysts has been presented and the included layers have been discussed. Then, some critical notes have been provided for the management of intact pulmonary hydatid cyst which should not be removed by bronchoscopic approaches due to high rates of possible complications of tearing; however, it has been performed by some cases available in the literature which is not acceptable.

Sudden death and hydatid cyst: A medicolegal study.

The discovery of a hydatid cyst at autopsy poses the problem of its involvement in the mechanism of death. The aim of this study is to analyse the epidemiological and etiopathogenic characteristics of death attributed to hydatid disease, to discuss the mechanism of death and to propose preventive measures. This is a retrospective descriptive study of 26 cases of death with hydatid cyst autopsic discovered, collected at the forensic department of Fattouma Bourguiba University Hospital of Monastir (Tunisia) over a period of 27 years (from 1990 until 2017). In 26 cases, hydatid cyst was observed during autopsy of sudden death cases, which corresponds to 0.33% of the total of autopsies in this period. Of the 26 victims, 13 (50%) were men; the mean age was 43 years. Most victims were from rural zones (18 cases). In 20 cases, the complicated cyst was hepatic. It was cardiac in two cases. Of all cases, three cysts were cracked, and nine were broken. Of the 26 cases, only 15 were implicated in the death mechanism. Death was attributed to anaphylaxis in 12 cases, hydatid pulmonary embolism in 1 case, cardiac arythmia in one case and hemothorax in one case. Sudden death is the most dangerous complication of the hydatid cyst which can be discovered at autopsy. Several causes may explain its occurrence, the most common of which is anaphylactic shock.

Urachal Mucinous Cystic Tumor of Low Malignant Potential with Concurrent Sigmoid Colon Adenocarcinoma

Urachal mucinous tumors are rare neoplasms with behaviour that can range from relatively benign to malignancy that can spread distantly or throughout the peritoneum as pseudomyxoma peritonei or peritoneal carcinomatosis. Here we describe a unique case of urachal mucinous cystic tumor of low malignant potential confined to an intact cyst at the dome of the urinary bladder, without rupture or peritoneal spread. The urachal mucinous tumor was an incidental finding on a staging CT scan performed for sigmoid colon adenocarcinoma. We believe that this case illustrates a potential diagnostic pitfall which could have prognostic and therapeutic implications. Due to the intestinal phenotype of these neoplasms, a urachal tumor of low malignant potential could be mistaken for metastatic spread from a colonic adenocarcinoma in the rare situation such as this case, where the two neoplasms occur concurrently.

Polyphasic Rhabdomyositis in California Sea Lions (Zalophus Californianus): Pathology and Potential Causes.

A myositis syndrome has been recognized for more than a decade in California sea lions (CSLs; Zalophus californianus) but a detailed description of the lesions and potential causes of this condition is lacking. The tissues of 136 stranded CSLs with rhabdomyositis were examined. Rhabdomyositis was considered incidental in 67% (91/136) of the CSLs, and a factor contributing to the animal stranding (significant rhabdomyositis) in 33% (45/136). Of the 91 cases with incidental rhabdomyositis, lesions consisted of a few small foci of lymphohistiocytic inflammation. Of the 45 cases with significant rhabdomyositis, 28 (62%) also presented with major comorbidities such as leptospirosis (2 animals) and domoic acid toxicosis (6 animals), whereas 17 (38%) had severe polyphasic rhabdomyositis as the only major disease process associated with mortality. In these animals, most striated muscles had multiple white streaks and diffuse atrophy. Microscopically, there was myofiber necrosis surrounded by lymphocytes and histiocytes admixed with areas of myofiber regeneration, and/or moderate to severe rhabdomyocyte atrophy usually adjacent to intact Sarcocystis neurona cysts. At the interface of affected and normal muscle, occasional T lymphocytes infiltrated the sarcoplasm of intact myocytes, and occasional myofibers expressed MHCII proteins in the sarcoplasm. S. neurona antibody titers and cyst burden were higher in animals with significant polymyositis antibody titers of (26125 ± 2164, 4.5 ± 1.2 cysts per section) and active myonecrosis than animals with incidental rhabdomyositis antibody titers of (7612 ± 1042, 1.7 ± 0.82 cysts per section). The presented findings suggest that S. neurona infection and immune-mediated mechanisms could be associated with significant polyphasic rhabdomyositis in CSLs.

Dumb-Bell Shaped Hydatid Cyst in the Parotid Gland – A Rare Presentation

Human echinococcosis is a zoonotic infection caused by the tapeworm of the genus Echinococcus and transmitted by dog and other canine animals. It is a serious problem in tropical areas and is seen in many parts of Bangladesh. In children lungs are the most common site of infection, whereas in adults liver is infected most frequently. Primary hydatid cyst of the parotid gland is extremely rare, even in the endemic areas and very few cases are reported in parotid gland The disease is prevalent in most part of the world, though it is most extensive in the sheep and cattle raising areas. FNAC is contraindicated in suspected hydatid cyst cases due to risk of hypersensitivity reaction and additional precaution of intact cyst excision is mandatory in such cases to prevent recurrence and anaphylaxis reaction. A 30 year old female patient presented with gradually increasing painless large smooth cystic swelling of the right parotid region with trismus. CT scan showed a huge dumb bell shaped cystic lesion in the superficial and deep lobe of the parotid gland that is compatible with hydatid cyst. The parotid tumor was surgically removed by midline mandibulotomy approach. Pathological study of the cystic lesion confirmed hydatid disease of the parotid gland.TAJ 2017; 30(1): 73-77

High-efficiency cell disruption and astaxanthin recovery from Haematococcus pluvialis cyst cells using room-temperature imidazolium-based ionic liquid/water mixtures

Energy-saving, high-efficiency cell disruption is a critical step for recovery of thermolabile antioxidant astaxanthin from Haematococcus pluvialis cyst cells of rigid cell-wall structure. In this study, as room-temperature green solvents, 10 types of 1-ethyl-3-methylimidazolium ([Emim])-based ionic liquids (ILs) were compared and evaluated for their abilities to disrupt H. pluvialis cyst cells for astaxanthin/lipid extraction. Among the 10 ILs tested, 3 [Emim]-based ILs with HSO4, CH3SO3, and (CF3SO2)2N anions were selected based on astaxanthin/lipid extraction performance and synthesis cost. When pretreated with IL/water mixtures, intact cyst cells were significantly torn, broken or shown to release cytoplasmic components, thereby facilitating subsequent separation of astaxanthin/lipid by hexane. However, excess IL pretreatments at high temperature/IL dosages and longer incubation times significantly deteriorated lipid and/or astaxanthin. Under optimized mild conditions (6.7% (v/v) IL in water solution, 30 °C, 60 min), almost complete astaxanthin recoveries (>99%) along with moderate lipid extractions (∼82%) could be obtained.

Mesenteric cysts revisited: An ever-intriguing issue

Background: Mesenteric cysts continue to intrigue the surgeons and radiologist alike. Patients and Methods: Our records were reviewed to identify mesenteric cysts, diagnosed in the period from February 2014 to September 2016. Results: We identified one male and four females, with a median age of 44 years. Abdominal pain was the presenting feature in all patients. ultrasound was done in four cases, where the cyst was missed in one case, and no clue to its nature was given in the remaining three, while computed tomography suspected the diagnosis in four patients and failed in one. Laparoscopic excision was attempted in only one patient, but eventually, all patients underwent open surgical excision. In four patients, the cyst was removed intact, while in the fifth, a minor wall break occurred, resulting in limited spillage of cyst contents. Histopathological examination showed simple mesothelial cyst in three cases, a pseudocyst in the fourth case and a cystic lymphangioma in the fifth. All patients tolerated surgery well, and up to the time of writing this paper, no recurrence was reported. Conclusion: Mesenteric cysts, with its numerous types, continue to intrigue the concerned physicians. Regardless of the approach, excision of the intact cyst should be the aim, most conveniently by open surgery. Although laparoscopy could be employed, this should be entertained with caution, to avoid cyst rupture or leaving part of the wall behind, thus predisposing to recurrence.

Eruption cyst associated with right maxillary deciduous first molar

A one and half-year-old boy presented to dental outpatient department with a soft tissue mass hanging from the right upper back milk tooth region for the past 2 days. The patient was asymptomatic and there was no fluid discharge. On clinical examination, it was found that the mass is friable with a size of 0.5 x 0.5cm and the roof of the mass was seen ruptured and hanging from the sides of the erupting right deciduous maxillary first molar (A). A diagnosis of eruption cyst was made. Eruption cyst usually present as solitary swelling on the alveolar ridge mucosa. The treatment of the intact eruption cyst will be surgical excision and exposure of the unerupted primary teeth. In our case, eruption cyst is ruptured and wait and watch instruction was given and in the next follow-up, cyst was disappeared and the tooth was seen erupting normally.

The relation between the location and the perforation rate of lung hydatid cysts in children

The pressure, size, and central or peripheral location of lung hydatid cysts are the most studied topics among the factors affecting perforation. The aim of this study is to investigate the relation between the location and the perforation rate of lung hydatid cysts in children. 197 patients under the age of 16 years, who were operated between January 2000 and December 2016 due to pulmonary hydatid cysts, were evaluated retrospectively. Patients who had giant hydatid cysts (n=27), bilateral hydatid cysts (n=24), and more than one cyst in one lung (n=12) were excluded to create a more homogeneous group to enable investigation of the relation between the location and the perforation rates of hydatid cysts. Finally, 134 patients who had only one hydatid cyst were classified into two groups: Group 1 with perforated cysts and Group 2 with intact hydatid cysts. 70.9% of the patients were male. In total, 134 cysts were detected and 41% were perforated. The highest perforation rates were detected in the right middle lobe (70%) and the lingula (66.7%). There was a statistically significant difference between the location of the cysts and the perforation rates (p=0.018). Also hydatid cysts located in the right middle lobe and the lingula had higher postoperative complication rates than hydatid cysts located in the upper and lower lobes (p=0.018). We recommend surgical treatment as soon as possible in children with hydatid cysts located in the right middle lobe and lingula to prevent the risk of perforation.