Management Of Cysts Research Articles

ACR Lung-RADS v2022: Assessment Categories and Management Recommendations

The ACR created the Lung CT Screening Reporting and Data System (Lung-RADS) in 2014 to standardize the reporting and management of screen-detected pulmonary nodules. Lung-RADS was updated to version 1.1 in 2019 and revised size thresholds for nonsolid nodules, added classification criteria for perifissural nodules, and allowed for short-interval follow-up of rapidly enlarging nodules that may be infectious in etiology. Lung-RADS v2022, released in November 2022, provides several updates including guidance on the classification and management of atypical pulmonary cysts, juxtapleural nodules, airway-centered nodules, and potentially infectious findings. This new release also provides clarification for determining nodule growth and introduces stepped management for nodules that are stable or decreasing in size. This article summarizes the current evidence and expert consensus supporting Lung-RADS v2022.

Case Report: Introduction of antibiotic releasing calcium sulfate bone void filler beads (Stimulan) for management of an infected cyst of the maxilla

Radicular cysts are the most common odontogenic cyst arising from epithelial cell rests of Malassez in the periodontal ligament and proliferate peripherally as a result of inflammation caused by infection at the root apices. They slowly grow apically causing bone resorption and displacement of the adjacent teeth which radiographically is seen as a radiolucent unilocular lesion. Management of such bone defects can be done by using various bone graft substitutes such as autogenous, allografts, xenografts and alloplasts. Taking account of the benefits of using synthetic bone graft substitutes, the following case represents the successful management of a radicular cyst, which includes endodontic treatment and cyst enucleation, chemical cauterization followed by introduction of antibiotic (Vancomycin) releasing calcium sulfate filler beads into the defect.

Surgical Management of Choledochal Cyst in Male Adolescent, Case Report

Common bile duct cysts are a rare medical condition, which is characterized by dilation of the intrahepatic and extrahepatic bile ducts. The main clinical presentation is abdominal pain, jaundice and a palpable abdominal mass. They are premalignant lesions, so the treatment of choice is complete surgical resection with long-term follow-up. The following report relates a male adolescent treated surgically with good results

Surgical management of thyroglossal cysts: 10-year experience of a tertiary paediatric surgical unit.

Surgical management of thyroglossal cysts: 10-year experience of a tertiary paediatric surgical unit.

Laparoscopic management of giant adrenal cyst: a case report

Laparoscopic management of giant adrenal cyst: a case report

Lumen-apposing metal stent for the management of symptomatic hepatic cyst

Lumen-apposing metal stent for the management of symptomatic hepatic cyst

Management of Nasoalveolar Cyst by Transnasal Endoscopic Marsupialization

Introduction: A nasoalveolar cyst is a benign nonodontogenic mass situated in the anterior region of the maxilla. They are often located submucosally in the anterior nasal floor giving rise to swelling in the nasolabial area at the base of nasal alae. Traditionally, the approach of choice was intraoral sublabial marsupialization, however the trend is shifting to lesser invasive and scarless transnasal endoscopic marsupialization.
 Materials and Methods: This is a retrospective observational study comprising of 16 patients who underwent microdebrider assisted endoscopic transnasal marsupialization of nasoalveolar cyst.
 Results: 16 patients underwent endoscopic transnasal marsupialization under general anaesthesia. They were followed up for 6-16 months (mean 9.43) and none of them had any recurrence.
 Conclusion: The traditional treatment for the same has been by external approach. However, a scar in this area of face is not acceptable for many. Also, it is not easy to excise the whole cyst in toto. In our experience, microdebrider assisted endoscopic transnasal marsupialisation is an easier, faster, safer, and equally efficacious technique to treat nasolabial cyst without any recurrence. 
 Key words: nasoalveolar cyst; nasolabial cyst; endoscopic marsupialization

Adamantinomatous craniopharyngioma: evolution in the management.

In spite of the continuous progresses in pediatric neurosurgery, adamantinomatous craniopharyngioma (AC) remains a challenging tumor due to its proximity to optic pathways, pituitary gland, hypothalamus, and Willis' circle, which can result in significant endocrine, cognitive, and neurological morbidity after treatment with subsequent impact on the patient's quality of life (QoL). The relevance that QoL has today explains the changes in the management of AC observed over the time. The goal of the present article is to provide a historical background, to show the milestones in the changes of the AC treatment, and to analyze the current main options to manage such a challenging tumor. The pertinent literature has been reviewed. Moreover, a comparison between the past and recent personal series is reported. Three main eras have been identified. The first (named Cushing era) was characterized by the need to realize a harmless surgery and to define the best way to approach AC; the second (microscope era) was characterized by a tremendous technical and technological development, with remarkable results in term of safe tumor resection and control but relatively poor QoL outcomes; and the third one (current period) is characterized by an increasing integration between surgery and adjuvant treatments, with relatively minor tumor control but significant improvement of QoL (comparable overall survival). The authors' experience reflects these changes. Two groups of children were compared: 52 cases (mean follow-up: 17.5 years) belong to the historical series (group 1, 1985-2003, aggressive surgical management) and 41 (mean follow-up: 8.5 years) to the current one (Group 2, 2004-2021, integrated management). No significant differences between the two groups were detected about recurrence rate, surgical mortality, and overall survival. However, Group 2 showed significant lower rates of postoperative panhypopituitarism, obesity, and visual deterioration. Radical surgery allows for a good AC control with a low rate of recurrence but high risk of permanent morbidity. Despite the greater number of recurrences and surgeries, the more conservative policy, based on a combination of treatments, seems to provide the same tumor control with a better QoL. The advances in trans-nasal and trans-ventricular endoscopy, in proton therapy and in the management of the AC cyst are the main factors that allowed such an improvement.

Double posteromedial portals versus single posteromedial portal for arthroscopic management of popliteal cysts

BackgroundAs a common disease in orthopedic clinics, popliteal cysts often coexist with intra-articular lesions. Compared with traditional open surgery, arthroscopic treatment of popliteal cysts is less traumatic, and intra-articular lesions can be treated. The ‘one-way valve’ mechanism of the popliteal cyst can be removed by expanding the communication between the articular cavity and the cyst to avoid cyst recurrence. In terms of arthroscopic techniques, the comparison of clinical effects between the double posteromedial portal (DPP) and single posteromedial portal (SPP) has rarely been studied. The purpose of this retrospective study was to compare the clinical effects of DPP and SPP.MethodsA total of 46 consecutive patients with symptomatic popliteal cysts who underwent arthroscopic treatment were included in this study and followed for approximately 1 year. All patients were divided into two groups according to the arthroscopic portals (DPP group and SPP group). The cyst size, Lysholm score and Rauschening–Lindgren (R–L) grade were evaluated before the operation for all patients, and the intra-articular lesions, operative time and complications were recorded after operation. At the last follow-up, the Lysholm score and R–L grade were recorded, and magnetic resonance imaging was used to evaluate the outcome of the cyst. The clinical data of the two groups was statistically compared and analyzed.ResultsThere were no significant differences in preoperative cyst size, Lysholm score or R–L grade between the two groups (P > 0.05). The operation time of the DPP group (67.52 ± 18.23 min) was longer than that of the SPP group (55.95 ± 16.40 min) (P = 0.030), but the recurrence rate of cysts in the DPP group (0%) was obviously lower than that in the SPP group (19.0%) (P = 0.046). There were no significant differences in the Lysholm score, R–L grade or complication rate between the two groups at the last follow-up (P > 0.05).ConclusionArthroscopic treatment of popliteal cysts using double posteromedial portals was a safe and effective surgical method.Trial registration: ChiCTR, ChiCTR2200060115. Registered 19 May 2022, https://www.chictr.org.cn/showproj.html?proj=133199

Diagnosis and Management of Pericardial Cysts

Diagnosis and Management of Pericardial Cysts

Molecular analysis with pancreaseq® in evaluation and management of pancreatic cysts: A cohort of 28 patients.

Herein, we present the PancreaSeq® results of 28 patients and emphasize the usefulness of molecular testing in evaluation of pancreatic cysts. A total of 10 (35.7%) non-diagnostic, 6 (21.4%) negative, 5 (17.8%) atypical, and 7 (25%) were positive for mucinous cystic neoplasm (MCN) pancreatic cyst aspirates were analyzed with PancreaSeq® at Mayo Clinic, Jacksonville between September 2021 and February 2023. Three non-diagnostic, two negative, three atypical, and two positive for MCN cysts were positive for KRAS and GNAS mutations. They were interpreted as intraductal papillary mucinous neoplasm (IPMN) with low risk for progression to high-grade dysplasia/adenocarcinoma. One negative case was positive for KRAS and GNAS mutation and RNF43 copy number alteration. It was interpreted as IPMN with a low risk of progression. Two non-diagnostic, one negative, and two positive for MCN cysts were positive for KRAS mutation. All were interpreted as IPMN/MCNs with low risk of progression. One positive for MCN case was positive for GNAS mutation and ALK fusion and one positive for MCN case was positive for GNAS mutation, ALK fusion, and RNF43 copy number alteration. Both were interpreted as IPMN and their risk of progression was interpreted as not well understood. One atypical case was positive for KRAS and TP53 mutation and was interpreted as IPMN/ MCNs with a high risk of progression. VHL mutation was present in one non-diagnostic case. It was interpreted as serous cystadenoma and the risk for progression was low. Molecular analysis of pancreatic cysts with PancreaSeq® is useful in accurate diagnosis, especially when cytologic material is non-diagnostic and helps improve patient management.

Ayurvedic treatment regime of Ovarian Cyst: A Case Report

Introduction: Ovarian cysts are fluid-filled sacs that develop on or within the ovaries, which are part of a woman's reproductive system. Most ovarian cysts are benign (non-cancerous) and do not cause any symptoms. However, in some cases, ovarian cysts can grow larger, rupture, become painful, or cause other complications. Hormonal contraceptives and Surgery only the treatment follow by modern system of medicine. A hormonal contraceptive contributes untoward effect. In Ayurveda it can be correlated with Granthi (Kaphaja Granthi). Methods: In this present case study, a 36 years old woman patient consulted to the OPD with the complaint of Pelvic pain come and go, Bloating in the abdomen, Changes in menstrual patterns, and Pain during sexual intercourse. She had also brought her ultrasonography (USG) and finding suggested a right ovarian complex cyst measuring 36mm×36mmx34mm. She was supposed to be treated with traditional ayurvedic formulations; the case was treated for three months with a combination of different traditional Ayurvedic drugs, with the goal of relieving symptoms and dissolving the ovarian cyst. This patient was treated with traditional Ayurvedic formulations like Varunadi Kashyam, Guggulu Panchapala Churnam, Dashmoola Kwatha, Ajmoodadi Choorna. Result: Only Ayurvedic medicines were used during the course of the treatment. Follow-up USG showed complete disappearance of cyst and symptoms also subsided to a great extent. Discussion: The present study emphasizes the role of Ayurveda in bringing a positive result in the management of ovarian cyst.

Trans corneal aspiration for management of primary iris cysts in the standing horse

Trans corneal aspiration for management of primary iris cysts in the standing horse

Comparative analysis of laparoscopic and open surgical techniques for nonparasitic splenic cyst management in children: a proposed prediction index.

In this research, our goal is to carry out a retrospective assessment of patients who received surgical treatment for nonparasitic splenic cysts (NPSCs) and to propose an innovative index (Karakuz Index) for predicting the optimal surgical approach. This study is a retrospective analysis of 48 pediatric patients who underwent surgical treatment for nonparasitic splenic cysts. The patient population was divided into two groups based on the surgical approach: open surgery (n=37) and laparoscopic surgery (n=11). Of the 256 patients with nonparasitic splenic cysts (NPSCs), 48 patients underwent surgical treatment (18.8%). The average age was 11.4±4.2 years, and the majority were female (52%). Surgical approaches included laparoscopic (23%) and open surgery (77%), with cystectomy, partial splenectomy, and total splenectomy performed (48%, 23%, and 29%, respectively). The Karakuz Index, a novel metric, also showed significant differences between the two groups. Histopathological findings and recurrence rates were similar between both approaches (p=0.335 and p=0.229, respectively). The Karakuz Index demonstrated a sensitivity of 60% and a specificity of 91% at a cut-off value of 16. The novel Karakuz Index demonstrated promising discriminatory capacity and requires further research in larger studies.

Management of Perineal Epidermoid Cyst in a 20-year-old Female

Epidermoid cysts are cutaneous or subcutaneous masses caused by the implantation of epidermal elements into the dermis. This case report presented an epidermal cyst of the perineum clinically mimicking endometriosis in a female patient. A 20-year-old virgo female patient was admitted to our clinic with complaints of severe pain, especially in the right leg, and postmenstrual bleeding for three years. In the transrectal ultrasound, a 54*39 mm cystic lesion with dense internal echo was detected in the medial neighborhood of the pelvic floor right obturator internus muscle. Since the cystic lesion detected in the contrast-enhanced pelvic MRI was evaluated as an epidermoid cyst and no significant endometrioma or endometriosis focus was detected, an operation was planned. Surgical excision should be performed not only for symptom relief and diagnosis but also to exclude rare malignancy. However, it is vital to master the pelvic and perineal anatomy along with careful surgery.

Role of Denosumab in the Management of Aneurysmal Bone Cysts

Background The management of aneurysmal bone cysts (ABCs) has evolved and less invasive methods have been tried. Denosumab is a monoclonal antibody that inhibits osteoclasts. It is effective in giant cell tumours of bone (GCT) and based on the immunohistochemical similarity and relationship between GCTs and ABCs, Denosumab may also be effective in the treatment of ABCs. Aim of the Work This study aims to assess the therapeutic importance, effectiveness and side effects of denosumab administration in the management of aneurysmal bone cysts. Materials and Methods Embase, Cochrane Library, and MEDLINE/PubMed databases were searched for the articles published from Jan. 2013 to May 2021 that reported the efficacy and safety of denosumab in patients with aneurysmal bone cysts (ABCs). Results Thirteen studies were reviewed, involving a total of 40 patients who had aneurysmal bone cysts and were treated with denosumab. Of the 13 studies, 82.5% of the patients were from case series studies (33 patients) and 17.5% were from case reports (7 patients). The clinical response rate for denosumab as a treatment for aneurysmal bone cysts was 94.7%, with statistical significance (P < .0001). No treatment-related deaths occurred in the reviewed studies. Conclusion We conclude that denosumab represents an effective treatment option for patients with ABC especially when high surgical morbidity is expected. Although denosumab therapy is associated with minimal complications, however, relapse following cessation of treatment is still possible. Finally, denosumab is a potentially safe and promising modality for medically managing ABCs that requires further investigation with prospective clinical trials.

Perioperative management of maxillary cyst and genetic analysis in a patient with glycogen storage disease type 1a: A rare case report

AbstractBackgroundGlycogen storage disease type 1a (GSD1a) is an autosomal recessive genetic disease with symptoms such as hypoglycemia, lactic acidosis, and bleeding tendency.Case PresentationA 15‐year‐old male patient underwent cystectomy under general anesthesia. He had GSD1a. Despite perioperative blood glucose control, lactic acidosis worsened. No abnormal bleeding or infections were observed. A homozygous mutation of c.648G>T was detected by genetic testing for glucose‐6‐phosphatase (G6PC).ConclusionPerioperative complications specific to this disease should be managed.

European Paediatric Surgeons' Association Consensus Statement on the Management of Neonatal Ovarian Simple Cysts.

Neonatal ovarian simple cyst management from the pediatric surgical aspect is unclear on cyst size, follow-up, and preferred surgical approach. Therefore, this topic was selected for the 2022 Consensus Session meeting of the European Paediatric Surgeons' Association (EUPSA). The literature was reviewed on a predefined set of questions relating to the management of the neonatal ovarian simple cysts by a panel of 7 EUPSA members, on current evidence-based opinion and practice outlined. Each question (1) outcomes of fetal interventions in neonates after birth and consensus on size/timing of intervention, (2) consensus on the type of interventions, and (3) complications in neonatal ovarian cysts and follow-up recommendations in nonoperated/operated cysts, was presented with available evidence to congress session participants. The management approach was agreed by participants and comments were accounted to formulate the consensus statement. There is still limited data on potential benefits and complications of prenatal ultrasound-guided aspiration; however, neonates after such procedures should be followed for 6 months. Neonates with simple ovarian cysts larger than 4 cm should be offered surgical interventions within the 2 weeks of life with complete laparoscopic cyst aspiration and fenestration with bipolar instruments being the preferred approach. Ultrasound follow-up after surgical intervention after 3 months and with the conservative approach after every 3 to 4 months until 1 year. A peer-reviewed consensus statement for the management of neonatal ovarian simple cyst was formulated based on current evidence and peer practice. The EUPSA recognizes that the statement can be useful for pediatric surgeons in decision making for this pathology.

Management of advanced metacarpal aneurysmal cysts: Surgical technique

The hand is a rare site for aneurysmal bone cysts (ABCs). Depending on their degree of invasiveness, treatment of ABCs ranges from medical therapy to surgical curettage and bone filling. In the most advanced cases, bone resection and reconstruction, with or without adjuvant or neoadjuvant treatment, are indicated.We describe a technique involving segmental bone resection and structural iliac graft reconstruction with carpo-metacarpal plate arthrodesis, for the management of advanced ABC involving the base of the metacarpals. The radio-clinical results of two patients operated on using this technique are presented, at 18 and 36 months.At the last follow-up, the results showed a QDASH of 15 and 10, and a PRWE of 9 and 11. Satisfaction was 10/10 in both cases. Grasp strength was 25 kg and 42 kg versus 28 kg and 40 kg on the opposite side. Pinch strength was 6 kg and 11 kg versus 7 kg and 10 kg. Metacarpophalangeal flexion was 80° and 90°. Extension was complete in both cases. Radiographs showed good graft fusion, with no lysis or signs of ABC recurrence at the last follow-up.Segmental bone resection and iliac autograft reconstruction with carpo-metacarpal plate arthrodesis represents a therapeutic option in the management of advanced ABCs of the metacarpal base.

Marsupialization as an Organ Preservation Measure in Management of Odontogenic Cyst

Objective: Odontogenic cysts are a category of intra-osseous lesions that occur frequently. Marsupialization can be the maintherapeutic option for patients with large cysts or lesions to preserve crucial anatomical structures. The goal of this study was to treatindividuals with odontogenic cystic lesions conservatively using the marsupialization method.Methods: Twenty-two patients participated in this research as part of a cross-sectional study designed for statistical purposes. Thestudy included males and females between the ages of 6 and 80 with biopsy-proven odontogenic cysts.Results: After the treatment of 22 patients, data were collected and analyzed statistically. The statistical analysis was performed withthe use of Microsoft Excel and SPSS (Statistical Package for the Social Sciences). The Spearman coefficient was used to evaluate thecorrelation between patient age and marsupialization duration and the correlation between cyst size and marsupialization duration, while the Kruskal-Wallis test was used to illustrate the link between cyst type and marsupialization duration. Moreover, the Mann-Whitney U test was used to assess statistical variations between variables.Conclusions: Marsupialization is a conservative, noninvasive procedure that is effective in reducing the cyst’s size until it is fullyresolved or reaches a certain point suitable for excision by enucleation. The marsupialization treatment was also advantageous inpreserving teeth, bones, the inferior alveolar nerve, the maxillary sinus, and the nasal cavity. The main purpose of this study was topreserve the vital structures that were compromised by the different types of odontogenic cysts, and the treatment strategy successfully achieved that goal.