Management Of Cysts Research Articles

Abstract #1394898: Ethanol Sclerosis of Recurrent Intrathyroidal Parathyroid Cyst

The incidence of parathyroid cyst varies between 0.08 % and 3.4 %. To date about 300 cases have been reported in the worlds’ literature. Parathyroid cysts may be functional or not, with functionating cysts tending to occur in men and at more advanced ages. Non-functionating parathyroid cysts are typically pure cysts that are usually asymptomatic unless they are large enough to cause compressive type symptoms. The treatment for a functionating parathyroid cyst is primarily surgical. We present the case of a 58-year-old Caucasian female who presented with a recurrent parathyroid cyst first being noted in 1993. Initial FNA drainage was reported to have yielded acellular, clear fluid (amount unknown) and fluid PTH was not assessed. A cycle of cyst re-accumulation and repeat FNA drainage occurred. Subsequent FNA drainage in 2008 yielded 20cc of clear fluid and 16.5 cc in 2013. The incidence of parathyroid cyst varies between 0.08 % and 3.4 %. To date about 300 cases have been reported in the world’s literature (1, 2). Parathyroid cysts may be functional or not, with functionating cysts tending to occur in men and at more advanced ages Non-functionating parathyroid cysts are typically pure cysts that are usually asymptomatic unless they are large enough to cause compressive type symptoms (1). The treatment for a functionating parathyroid cyst is primarily surgical. We present the case of a 58-year-old Caucasian female who presented with a recurrent parathyroid cyst first being noted in 1993. Initial FNA drainage was reported to have yielded acellular, clear fluid. A cycle of cyst reaccumulation and repeat FNA drainage occurred. In 2008, cyst fluid PTH was assessed to be 372 pg/ml. Serum calcium levels were consistently normal between 9.2 – 9.4 mg/dl and serum PTH 23.8 – 34 pg/ml from Oct 2012 through Dec 2017. In June 2017, patient returned with a sensation of left neck pressure. Ultrasound revealed a simple cyst encompassing most of the left thyroid lobe measuring 5.1 x 2.1 x 1.7 cm. To prevent recurrence, ethanol sclerosis of the cyst was performed. Follow up evaluation in 2020 revealed patient to feel well, having normal calcium and thyroid blood tests with US documenting resolution of the left intrathyroidal cyst. While treatment of the functionating parathyroid cysts typically remains surgical, there are additional options for non-functionating parathyroid cysts management to include non-surgical options such as sclerosis with ethanol or possibly tetracycline.

Adrenal cysts: an emerging condition.

Adrenal cysts are rare lesions representing approximately 1-2% of adrenal incidentalomas. The majority of these rare lesions are benign. Rarely, phaeochromocytomas and adrenal malignant masses can present as cystic lesions and can occasionally be difficult to distinguish from benign cysts. Histologically, adrenal cysts are subdivided into pseudocysts, endothelial cysts, epithelial cysts and parasitic cysts. The radiological appearance of an adrenal cyst is generally similar to that of cysts in the kidney. They are thus well demarcated, usually rounded, with a thin wall and homogenous internal structure, low attenuating (<20 Hounsfield Units) on CT, low signalling on T1-weighted MRI sequences and high signalling on T2-weighted MRI sequences, and anechoic or hypoechoic on ultrasonography. Benign adrenal cysts have a slight female predominance and are usually diagnosed between the ages of 40 and 60. Most adrenal cysts are asymptomatic and are detected incidentally, although very large adrenal cysts can lead to mass effect symptoms, with surgery required to alleviate the symptoms. Thus, conservative management is usually recommended for asymptomatic cysts. However, when uncertainty exists regarding the benign nature of the cyst, additional work-up or follow-up is needed. The management of an adrenal cyst should preferably be discussed at an adrenal multidisciplinary team meeting.

Management of Biliary Cysts in Adults: A Single-Center 10-Year Experience.

A choledochal cyst is a cystic dilatation of the biliary tree, also termed abiliary cyst, including an intrahepatic cyst as well. Magnetic resonance cholangiopancreatography (MRCP) is the gold standard investigation of choice for this pathology. Todani classification is most commonly used to classify choledochal cysts. A total of 30 adult patients with choledochal cysts presenting at our center from December 1, 2009, to October 31, 2019, were studied retrospectively. The mean age was 35.13 years ranging from 18 to 62 years with a male-to-female ratio of 1:3.29. Of the patients, 86.6% presented with abdominal pain. Total serum bilirubin was raised in six patients with a mean of 1.84 mg/dL. MRCP was done in all patients, which had almost 100% sensitivity. Two cases had anomalous pancreaticobiliary duct union. In our study, we found only type I and type IVA cysts according to the Todani classification (type IA = 56.3%, IB = 11%, 1C = 16%, and IVA = 17%). The mean size of the cyst was 2.37 cm. Complete cyst excision with Roux-en-Y hepaticojejunostomy was performed in all patients. Four patients had surgical site infections and two had bile leaks. One patient developed hepatic artery thrombosis. All complications were eventually managed conservatively. Mortality was nil in our study with the mean postoperative stay being 7.97 days. Adult presentation of biliary cysts is not an uncommon entity in the Indian population and should be considered as a differential diagnosis of biliary pathology in adult patients. Complete excision of cysts with bilioenteric anastomosis is the current treatment of choice.

Management of extrahepatic bile duct cysts.

Management of extrahepatic bile duct cysts.

Laparoscopic management of hydatid cysts using long ribbon gauze: An initial experience of 37 consecutive cases

ObjectiveThe laparoscopic approach is becoming the standard of care for many surgical disorders. However, in the case of hydatid cysts, laparoscopic management is challenging due to the risk of spillage of hydatid fluid, which can cause an anaphylactic reaction and recurrence. Here, we report our initial experience with laparoscopic partial pericystectomy of hydatid cysts using long ribbon gauze to decrease intra-operative spillage. MethodThis was a retrospective study (between January 2010 and December 2021) in the Department of Surgical Gastroenterology, Sanjay Gandhi Postgraduate Institute of Medical Science, a tertiary care referral center in northern India. Here, we have included 37 consecutive patients with hydatid cysts of the liver and spleen. Diagnosis was made by laboratory and imaging findings (abdominal sonography or contrast enhanced CT scans). All patients were managed with laparoscopic partial pericystectomy. Intraoperatively, a betadine-soaked long ribbon gauze, high-pressure suction canula, and an endo-bag were used in all patients. The collected data included patient demography, location, size, and number of cysts, WHO type, operative time, blood loss, postoperative complications, hospital stay and follow-up. ResultIn our series, the mean age was 38.4 ± 13.6 years, 15 (40.5%) were men and 22 (59.5%) were women. The right lobe of the liver was the most commonly affected site (21, 56.8%). The mean operative time was 80.0 ± 32.0 min, and intraoperative blood loss was 23.6 ± 11.5 mL. Bile leak was present in 6 (16.2%) patients. There was no mortality. The hospital stay was 5 (3, 9) days, and no recurrence was observed at a median follow-up of 36 months. ConclusionLaparoscopic partial pericystectomy using this technique is safe in the management of hydatid cysts. Simply, proper packing and safe removal of soaked gauzes can minimize the incidence of postoperative complications and recurrence.

MANAGEMENT OF AN INFECTED RADICULAR CYST OF THE MANDIBLE: A CASE REPORT

Among all odontogenic cysts, Radicular cyst is the most common inflammatory odontogenic cyst. They develop from epithelial rests of malassez in the PDL, as a result of inflammation. It is a true cyst that occurs in association with the root of the non-vital tooth. An inflammatory response occurs in the periapical tissue, leading to resorption of bone and formation of granulation tissue which are infiltrated by inflammatory cells. Though treatment of choice for smaller cystic lesions involves endodontic therapy, massive cystic lesions don't heal completely with non-surgical endodontic treatment. Massive cystic lesions need Endodontic treatment followed by surgical decompression treatment. In this case report, we present the diagnosis and surgical management of an infected radicular cyst of the mandible.

Surgical management of a giant paratubal cyst: a case report and review of the literature

BackgroundSurgical management of giant paratubal cysts can be challenging in the pediatric and adolescent population. Larger adnexal masses can heighten suspicion for malignancy, placing the ovary at risk of unwarranted removal, and larger masses sometimes necessitate larger surgical incisions which can increase postoperative pain and delay return to school and regular activities. We present the evaluation and management of a giant paratubal cyst containing 16 l of fluid in an adolescent, using a mini-laparotomy approach.Case presentationA 16-year-old patient presented with 1-month history of worsening nausea and increasing abdominal girth. Abdominal imaging revealed a 42-cm adnexal mass. A modified drainage technique with a mini-laparotomy incision was utilized, thereby preventing tumor spill while minimizing size of the surgical incision. Postoperative recovery was complicated by prolonged nausea, but the patient was discharged home 2 days after surgery and returned to school the following week.ConclusionThis case illustrates that giant adnexal masses can be managed using a mini-laparotomy approach, thereby expediting return to regular activities.

Management of Hydatid cysts of parotid glands

Hydatidosis (Echinococcosis) is a disease caused by infestation of hydatid cysts in any organ of body but mainly liver (70% of cases). Hydatidosis of salivary glands is rare and necessitate computerized tomography for diagnosis while fine needle aspiration remains controversial procedure.Materials and methods: 6 patients diagnosed with hydatid cysts of parotid glands. These cases were admitted and treated at the maxillofacial surgery Clinic of the “AL-Ramadi” Hospital in Iraq. 5 patients were female and 1 male with age group was between 30 -50 years. The patients complained of painless unilateral swelling in parotid region and who were diagnosed hydatid cysts using CT. All cases were treated by superficial parotidectomy with cystectomy and preservation of facial nerve.Results: All hydatid cysts are CE1- type with no recurrences were reported in any of these cases. The postoperative edema was the most common complication. Other complications were not seen.Conclusion: parotid hydatid cyst should be included in differential diagnosis of persistent parotid swelling especially those with history of hepatic hydatid cysts. Computerized tomography is the gold imaging that aid in diagnosis and classification of hydatid cysts. Most cases are CE1 type and Eosinophilia is a sign of concern in some patients. Surgical treatment remains the “gold standard” in therapy.

Diagnosis and Management of Choledochal Cyst in One Year-Old Baby: A Case Report

Background: Choledochal cysts (CC) are rare congenital anomalies of the biliary tract. The classic triad of jaundice, abdominal pain, and right upper quadrant mass are rare symptoms, mainly in children and adolescents. This study aimed to present the diagnosis and management of choledochal cyst cases in a baby girl.&#x0D; Case presentation: A 1-year-old girl, domiciled outside the city of Padang, was brought to the hospital by her parents with complaints of repeated vomiting for 1 day before being admitted to the hospital. This complaint has been accompanied by yellowish eyes and body, pale bowel movements, and dark brown urine since 3 months ago. The patient was never brought to the doctor for treatment. Since 1 month ago, the patient often feels pain in the abdomen and has a lump in the upper right abdomen. On the abdomen area, there was no distention, hepar was ¼-1/4 sharp edge, tenderness at the epicondrium area, no rebound tenderness, turgor was decreased, and no palpable mass. Abdominal ultrasonography presented a choledochal duct cyst with biliary obstruction. Abdominal CT scan with contrast revealed intrahepatic and extrahepatic biliaryectasis et causa suggestive of the choledochal cyst (Todani IVA) and hepatomegaly. The patient was consulted by the pediatric surgery division for further management and was advised to undergo surgery with the Roux En-y procedure. Follow-up after the patient underwent surgery showed clinical improvement. Symptoms of jaundice in the eyes and skin begin to decrease, as brownish stools and light brown urine.&#x0D; Conclusion: Surgical treatment with the Roux-en-Y procedure is the definitive treatment for choledochal cysts in this patient.

Decompression with or without Fusion for Lumbar Synovial Cysts—A Systematic Review and Meta-Analysis

The management of symptomatic lumbar synovial cysts (LSC) is still a matter of debate. Previous systematic reviews did not stratify data according to different treatment techniques or incompletely reported comparative data on patients treated with lumbar posterior decompression (LPD) and lumbar decompression and fusion (LDF). The aim of our study was to compare LPD and LDF via a systematic review and meta-analysis of the existing literature. The design of this study was in accordance with the 2020 Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. The review questions were as follows: among patients suffering from symptomatic lumbar synovial cysts (population) and treated with either posterior lumbar decompression or posterior decompression with fusion (intervention), who gets the best results (outcome), in terms of cyst recurrence, reoperation rates, and improvement of postoperative symptoms (comparison)? The search of the literature yielded a total of 1218 results. Duplicate records were then removed (n = 589). A total of 598 articles were screened, and 587 records were excluded via title and abstract screening; 11 studies were found to be relevant to our research question and were assessed for eligibility. Upon full-text review, 5 were excluded because they failed to report any parameter separately for both LPD and LDF. Finally, 6 studies for a total of 657 patients meeting the criteria stated above were included in the present investigation. Our analysis showed that LDF is associated with better results in terms of lower postoperative back pain and cyst recurrence compared with LPD. No differences were found in reoperation rates and complication rates between the two techniques. The impact of minimally invasive decompression techniques on the different outcomes in LSC should be assessed in the future and compared with instrumentation techniques.

Unusual application of topical brimonidine for the management of epithelial cysts

The mainstay management of progressive epithelial cysts spans from fine-needle aspiration of the cyst content to radical en bloc excision. Such a surgical approach may result in cyst rupture, recurrence, or collateral tissue damage. Based on previous experience, we aimed at evaluating the off-label use of topical brimonidine as a conservative measure for treating epithelial cysts of the iris and conjunctiva before commencing a surgical excision. We describe two different cases of epithelial cysts in which topical brimonidine was issued with successful outcome, making the more traditional surgical intervention redundant.

Surgical Procedure and Perioperative Management of a Giant Orbital Echinococcus Cyst during and after Pregnancy

Orbital cystic echinococcosis (CE) is a rare entity and most common in poor countries. Surgical management has been published in a few case reports [1], [2], [3], [4], [5], [6]. About 0.8 – 1 percent of all CE cases show an orbital involvement [4] and present typical radiological findings [6].

Management of adnexal cyst in an adolescent through the principles of Mutravaha srotorodha: An experience

Abstract: Adnexal cysts are any fluid-filled sac-like structures involved in the adnexa. These may include ovarian cysts as well as paraovarian cysts. Often, these cysts are physiological and regress under conservative therapy. The persistence of cysts is an indication of surgery. According to Ayurveda, Granthi (~nodular swelling) or sac like structures develop in female reproductive system due to accumulation of Kleda (~moistening). The improper excretion of Kleda is often due to Mutravaha srotorodha (~obstructive pathology of the urinary tract). Hence, Kledahara (~treatment for excess fluid accumulation), Lekhana (~therapeutic scrapping), and Shophahara (~treatment of swelling) drugs with specific action on Mutravaha srotas (~urinary tract) were found to be promising. In the present case report, an adolescent girl with an adnexal cyst (paraovarian cyst) of 5.3 cm × 4.8 cm (volume: 62.7 ml) non-responsive to allopathic treatment was diagnosed as Granthi in Sroni pradesha (~female pelvic region) associated with Mutravaha srotorodha. She was treated with internal medicines (Gokshuradi guggulu, Chandraprabha vati, Samshamani vati, Usheerasava, and Punarnavasava) for a period of four months from January 2, 2021 to April 13, 2021, and further from June 15, 2021 to July 05, 2021. Ultrasonography report after the completion of treatment showed no evidence of cyst. This case report provides some encouraging leads toward applying Ayurveda principles in the management of conditions such as adnexal cysts.

MP64-03 LOW METASTATIC POTENTIAL OF COMPLEX RENAL CYSTS: THE Case FOR ACTIVE SURVEILLANCE

You have accessJournal of UrologyCME1 Apr 2023MP64-03 LOW METASTATIC POTENTIAL OF COMPLEX RENAL CYSTS: THE Case FOR ACTIVE SURVEILLANCE Hannah Thomas, Shideh Abedi, Toronto, Canada, Thenappan Chandrasekar, PA Philadelphia, Kartik Jhaveri, Toronto, Canada, Johan Bjorklund, Stockholm, Sweden, Douglas Cheung, Michael Jewett, and Antonio Finelli Hannah ThomasHannah Thomas More articles by this author , Shideh AbediShideh Abedi More articles by this author , Toronto Toronto More articles by this author , Canada Canada More articles by this author , Thenappan ChandrasekarThenappan Chandrasekar More articles by this author , PA PhiladelphiaPA Philadelphia More articles by this author , Kartik JhaveriKartik Jhaveri More articles by this author , Toronto Toronto More articles by this author , Canada Canada More articles by this author , Johan BjorklundJohan Bjorklund More articles by this author , Stockholm Stockholm More articles by this author , Sweden Sweden More articles by this author , Douglas CheungDouglas Cheung More articles by this author , Michael JewettMichael Jewett More articles by this author , and Antonio FinelliAntonio Finelli More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003322.03AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: The incidence of incidentally-detected renal cysts is high, ranging from 12% to 61%. While well-defined clinical consensus exists for Bosniak I and II renal cysts, our understanding of best practices for surveillance and management of complex renal cysts remains contended. This study aimed to evaluate key patient and disease-specific outcomes of complex renal cysts across an updated, twenty-year cohort. METHODS: We performed a retrospective chart review of patients diagnosed with Bosniak IIF, III and IV renal cysts from 2001-2013 across three tertiary academic hospitals. Data from date of diagnosis to June 2022 was extracted, including demographics, cyst characteristics, biopsy and surgical/ablative intervention. Primary endpoints were radiologic upgrading (i.e. formal Bosniak upgrading or subjective worsening of radiographic features in same Bosniak class) and cancer-specific mortality. RESULTS: A total of 332 patients with complex renal cysts were included: Bosniak IIF (55.4%, 184/332), Bosniak III (36.4%, 121/332), Bosniak IV (8.1%, 27/332). The majority of patients were male (63.3%, 210/332). Most patients were managed with active surveillance, except Bosniak IV patients where 66.7% (18/27) underwent upfront nephrectomy. Rates of biopsy were similar among Bosniak III and IV groups (22.3%, 27/121 and 22.2%, 6/27). Median follow-up for Bosniak IIF, III and Bosniak IV cysts on active surveillance was 7.8 years (IQR= 3.9-12.4 yrs), 6.6 years (IQR= 3.7-10.1 yrs) and 4.6 years (IQR=3.7-8.6 yrs), respectively. Twenty-eight percent of surgical patients (19/67) experienced peri-operative complications. The rate of radiologic upgrading for Bosniak IIF, III and IV was 7.1% (13/184), 4.9% (6/121) and 3.7% (1/27), respectively (Table 1). Cancer-specific mortality remained at 0.3% (1/332). CONCLUSIONS: Overall, despite lengthy follow-up, the rate of radiologic progression and cancer-specific mortality for complex renal cysts remains low. This analysis challenges conventional views of upfront intervention, particularly for Bosniak III cysts. It appears safe to de-intensify surveillance for complex renal cysts along with transfer of care to primary care providers (with appropriate direction and triggers for re-referral), especially for patients with compatible goals of care. Source of Funding: None © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e881 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Hannah Thomas More articles by this author Shideh Abedi More articles by this author Toronto More articles by this author Canada More articles by this author Thenappan Chandrasekar More articles by this author PA Philadelphia More articles by this author Kartik Jhaveri More articles by this author Toronto More articles by this author Canada More articles by this author Johan Bjorklund More articles by this author Stockholm More articles by this author Sweden More articles by this author Douglas Cheung More articles by this author Michael Jewett More articles by this author Antonio Finelli More articles by this author Expand All Advertisement PDF downloadLoading ...

Management of the Bone Deformity Caused by Congenital Cyst of the Periorbital Area: Analysis of the Surgical Technique and a Short-term Outcome

The congenital periorbital cysts like dermoids/epidermoids, in rare cases, can require not only its’ excision but also correction/camouflage of the caused bone deformity. This management can require virtual surgical planning, osteotomy, and placement of the custom-made patient implant. In this report, the ultrasonography (USG) was proved as a highly effective imaging for the presurgical verification of the mass’s structure and establishment of the clinical diagnosis. The multi-slice computed tomography (MSCT), even on a two-slice MSCT machine, provided high-quality three-dimensional reconstruction of the area of bone deformation caused by the cyst and allowed for accurate surgical planning. A 20-year-old male patient with a congenital periorbital epidermoid cyst that led to the deformation of the lateral orbital rim was treated using the soft tissue volume-increasing technique for the correction of bone deformation following cyst removal. Analysis of the terminological diversity related with dermoid/epidermoid cysts is presented. Early diagnostics and management of congenital periorbital cysts can decrease the visual, orbital, and esthetic complications, as well as the need to perform bone reconstructive surgeries or other corrective surgical procedures.

Cysta Radicularis Magna Maxillae: A Case Report and 5-Year Follow-Up

BACKGROUND: An odontogenic cyst is a pathological, epithelial-lined cavity containing fluid or semi-fluid which arises from the epithelial remnants of tooth formation. These cysts may become increasingly obvious clinically as they increase in size, initially creating a bony hard swelling. As this gradually and slowly enlarges, the bony covering becomes increasingly thin, which clinically may be demonstrated on palpation. Management of jaw cysts as a pathology requires a serious and thorough approach, and it begins at the first examination of the patient. The most important starting point is to analyze and find out the cause of the change, the duration of development, and the presence or absence of clinical symptoms. The use of 3D CBCT analysis of the jawbones provides an answer for the modality of surgical treatment, the proximity to certain anatomical structures, and the way to resolve postoperative bone defects. CASE PRESENTATION: Twenty-three-year-old male, came with swelling on the left anterior side of the face, and above tooth 22. The swelling began 7 days earlier, and the patient had no other medical conditions and diseases. The radiographic examination shows radiopaque mass between and above the root of tooth 22 in the anterior maxilla, confluent with other large radiopaque mass to the other teeth of this zone. A radical surgical approach was considered for cyst removal, and bone regeneration techniques for replenishment of the bony defect. CONCLUSION: A radical surgical approach is the only treatment in most cases of large radicular cysts. It should be noted that the preoperative 3D analysis is also a key factor that dictates this radical approach. Bone augmentation techniques are a reliable and predictable method for filling in bone defects, and should always be combined and included in this treatment.

Contribution of 3D printing for the surgical management of jaws cysts and benign tumors: A systematic review of the literature

BackgroundThree-dimensional (3D) printing is now a widely recognized surgical tool in oral and maxillofacial surgery. However, little is known about its benefits for the surgical management of benign maxillary and mandibular tumors and cysts. PurposeThe objective of this systematic review was to assess the contribution of 3D printing in the management of benign jaw lesions. MethodsA systematic review, registered in PROSPERO, was conducted using PubMed and Scopus databases, up to December 2022, by following PRISMA guidelines. Studies reporting 3D printing applications for the surgical management of benign jaw lesions were considered. ResultsThis review included thirteen studies involving 74 patients. The principal use of 3D printing was to produce anatomical models, intraoperative surgical guides, or both, allowing for the successful removal of maxillary and mandibular lesions. The greatest reported benefits of printed models were the visualization of the lesion and its anatomical relationships to anticipate intraoperative risks. Surgical guides were designed as drilling locating guides or osteotomy cutting guides and contributed to decreasing operating time and improving the accuracy of the surgery. ConclusionUsing 3D printing technologies to manage benign jaw lesions results in less invasive procedures by facilitating precise osteotomies, reducing operating times, and complications. More studies with higher levels of evidence are needed to confirm our results.

The value of aspiration in the management of large adnexal cysts

The value of aspiration in the management of large adnexal cysts

62. Retrospective review of management of antenatal ovarian cysts at the Hospital for Sick Children

62. Retrospective review of management of antenatal ovarian cysts at the Hospital for Sick Children

Prospective Study of Ultrasonography and CA-125 with Post Operative HPE Report in Management of Ovarian Cyst in Tertiary Care Hospital

Prospective Study of Ultrasonography and CA-125 with Post Operative HPE Report in Management of Ovarian Cyst in Tertiary Care Hospital