Mean Cyst Size Research Articles

Histopathological and biochemical assessment of the therapeutic effect of gold nanoparticles on experimental chronic toxoplasmosis

Background: Toxoplasmosis is a zoonotic disease caused by the intracellular opportunistic protozoan,T. gondii that infects both vertebrate and invertebrate cells. Nanoparticles (NPs) provide promisingtherapeutic agents for effective treatment of parasitic diseases, by overcoming the drawbacks of lowbioavailability and poor cellular permeability of anti-parasitic drugs.Objective: To assess the therapeutic effect of gold (Au) NPs on experimentally infected mice with chronictoxoplasmosis.Material and Methods: Sixty-five laboratory-bred female Swiss albino mice were included. Five micewere left as control negative (non-infected non-treated), while the rest were experimentally infectedorally with avirulent T. gondii strain (ME49). Fifty days post infection (pi), infected mice were dividedinto 4 groups (15 mice each); group 1: control group (infected non-treated); group 2: treated withSpiramycin (Rovamycin); group 3: treated with low-dose AuNPs; and group 4: treated with high-doseAuNPs. Treatment was administered orally for 10 days. All mice were sacrificed sixty days pi. Assessmentof the therapeutic effect of AuNPs was achieved using parasitological, histopathological and biochemicalparameters. The first included estimation of the parasite tissue cysts numbers and size in impressionsmears from brain, liver and spleen; histopathological parameters evaluated inflammation, necrosis andhemorrhages in tissues. Liver transaminases: aspartate transaminase (AST) and alanine transaminase(ALT) were measured in sera of all groups as a biochemical parameter.Results: Statistically significant reductions were observed in the mean cyst count and size in brain, liver,and spleen of the infected treated group with high dose AuNPs (group 4) compared to the other infectedgroups. Histopathological examination of the brain, liver and spleen tissues showed that inflammatoryreaction was decreased in both AuNPs-treated groups in comparison to Spiramycin-treated group and thenon-treated mice. There was a significant reduction in the mean values of ALT and AST in mice treatedwith AuNPs high dose in comparison to other groups (P<0.05).Conclusion: AuNPs have a potentially therapeutic effect especially the high dose against experimentalchronic toxoplasmosis.

Preoperative Cyst Formation as a Predictive Feature of Spontaneous Regression of Retro-Odontoid Pseudotumor After Posterior Fusion

Although the spontaneous regression of pseudotumors after posterior fusion has been reported, the predictive factors remain unclear. We examined the radiological features that predict for the regression of retro-odontoid pseudotumors after posterior fusion, with a specific focus on cyst formation. We included 28 patients with a diagnosis of retro-odontoid pseudotumor using preoperative magnetic resonance imaging. The radiographic parameters and pseudotumor thickness were measured pre- and postoperatively. The regression rate for each pseudotumor was calculated. The presence of a cyst around the retro-odontoid pseudotumor was investigated. If present, the cyst thickness was measured. To elucidate the predictors for the postoperative regression of pseudotumors, the patients were divided into 2 cohorts: the regression group with a regression rate >40% and the no-regression group with a regression rate of <40%. Multivariate logistic regression analysis, including the demographic data and preoperative radiographic parameters as independent variables, was performed. The mean pseudotumor size had decreased significantly from 8.8 ± 3.6 mm preoperatively to 5.3 ± 2.0 mm postoperatively (P < 0.0001). The mean regression rate was 35.9% during a magnetic resonance imaging follow-up period of 8.6 months (range, 6-12 months). Cystic lesions were noted in 10 patients (35.7%) preoperatively. The mean cyst size was 4.7 ± 1.9 mm. All cysts were located dorsal to the pseudotumors and were involved at the maximum spinal compression levels. Nevertheless, all the cysts had disappeared postoperatively. Multivariate logistic regression analysis revealed that the pseudotumor regression group had had a significantly greater proportion of cysts (57.1% vs. 14.3%; odds ratio, 11.7; P= 0.013). The presence of cystic lesions protruding from retro-odontoid pseudotumors might serve as a predictive factor for the spontaneous regression of pseudotumors after posterior fusion.

Effectiveness and Safety of a Single 7-French Plastic Stent for Endoscopic Ultrasound-guided Pancreatic Pseudocyst Drainage and Long-term Follow-up Outcomes.

Background:Endoscopic ultrasound (EUS)-guided cystogastrostomy with a single 7-French (Fr) double-pigtail stent (DPS) is less popular due to the concern of stent patency. We aimed to assess the effectiveness, complications, and long-term outcomes of a single 7-Fr DPS in the endoscopic drainage of uncomplicated pseudocysts, containing no or minimal (<10%) debris.Methods:A retrospective review of patients with pancreatic pseudocysts, who underwent EUS-guided cystogastrostomy during 2010–2018, and a systematic review of the literature were conducted.Results:Of 45 patients, 14 patients underwent endoscopic drainage of uncomplicated pseudocysts using a single 7-Fr × 5 cm DPS. The mean cyst size was 10.2 ± 3.5 cm. Stent placement had a 100% technical and clinical success, defined as complete resolution of symptoms and regression of the cyst size by more than 50% at 8 weeks after drainage. The median follow-up was 42.4 months (range, 10–103). The pseudocysts resolved without recurrence in 92.8%. Spontaneous stent dislodgment was noted in 70% at a mean follow-up of 18 months. Additional interventions were required in 14% of cases due to stent occlusion and migration. A systematic review of literature related to EUS-guided cystogastrostomy using single and multiple plastic stents included 9 of 333 studies (222 patients). The analysis showed the pooled clinical success of 89% (95% confidence interval [CI], 82.0–94.2) and complication rate of 13% (95% CI, 5.7–21.8).Conclusion:Selected uncomplicated pseudocysts can be treated effectively with a single 7-Fr DPS as it provides comparable clinical success and long-term outcomes as using larger or multiple stents.

Is pancreatic-enteric drainage a definitive operation for pancreatitis associated pancreatic fluid collections?

Presenter: Patrick McLaren MD | Methodist Richardson Medical Center Background: Pancreatic pseudocysts and walled off pancreatic necrosis (WOPN) are complications of severe pancreatitis. Pancreatic-enteric drainage procedures have become standard therapy for symptomatic collections. However, conversion to a pancreatic resection, usually a distal pancreatosplenectomy, is needed in the event of treatment failure of drainage alone. The need for pancreatic resection following cyst-enteric drainage procedure is not well studied. We aimed to quantify the rate of conversion from surgical cystogastrostomy to pancreatic resection and identify predictors of failure. Methods: A single institution retrospective review was conducted to identify all patients undergoing cystogastrostomy between 2012-2020 using CPT procedure codes. Demographic, disease, and treatment characteristics were identified. Failure of surgical drainage was defined as need for subsequent pancreatic resection. Characteristics between failure and non-failure groups were compared using non-parametric statistical tests to identify predictors of treatment failure. Results: A total of 24 cystogastrostomies were performed over the 8-year study period for pancreatic pseudocyst or WOPN. The most common cause of pancreatitis was biliary (n=15, 63%). Cyst diameter ranged from 7.6 - 26.2 cm (mean 14.8 cm). Overall complication rate of cyst-enteric drainage procedure was 25% (3/24). There were no mortalities. All patients initially reported resolution of their symptoms, however, three patients (12.5%) required a subsequent distal pancreatectomy after surgical drainage. Mean time to resection from index operation was 14.7 months. Indication for resection was persistent recurrent abdominal pain in all resection patients. There was no difference between drainage alone and failure of drainage groups with respect to comorbidities: HTN (p=0.277), Diabetes (p=0.371), Tobacco use (p=0.249), and Weight loss at presentation (p=0.69). Mean cyst size at initial drainage was no different between drainage alone and failure groups (15.2cm vs 10.3cm, p=0.51). Estimated blood loss at initial operation was similar between groups (126 mL vs 166 mL, p=0.36). Conclusion: In our series, pancreatic drainage procedure was successful initial management of pancreatic fluid collections, with 12.5% requiring subsequent resection. Our data suggests that upfront drainage without resection offers a largely successful operation that allows for pancreatic tissue preservation with low mortality and morbidity. We did not identify any predictors of failure of initial drainage. Resection with distal pancreatectomy for WOPN and pseudocysts can be reserved for cases of failure of management with drainage alone.

Functional Ovarian cysts: Expectant management versus Oral contraceptives

Background: Ovarian cyst is a common problem in females of reproductive age group. Objective: To compare the expectant management and use of oral contraceptives for the management of ovarian cysts. Methodology: This was a comparative study, conducted in the department of Obstetrics and Gynecology, Sheikh Zayed Medical College, Rahim Yar Khan, from January 2017 to December 2018. A total of 870 females were included through non-probability, purposive sampling. Informed verbal consent was obtained. Ultrasound was performed to measure the cyst size, site, and characteristics. The lottery method was used to divide the patients into two groups. Patients in group E received expectant treatment (placebo) and in group OC, patients were prescribed hormonal treatment with combined oral contraceptive (COCP) having ethinyl estradiol 0.03mg and levonorgestril 0.15mg. Then patients were counseled and followed up for one month. After one month, USG was performed again to measure success as cyst resolution. The collected data was analyzed into SPSS 16. Both groups were compared for success by using the chi-square test, taking p-value &lt;0.05 as significant. Results: Mean age of females was 26.42±7.59 years. There were 488 (56%) married females while 382 (44%) were unmarried. Mean cyst size was 3.93±1.28cm. was achieved in 605 (69.5%) females, out of which 259 (59.5%) had expectant management while 346 (79.5%) had oral contraception. Success (Cyst resolution) was achieved in 605 (69.5%) females, out of which 259 (59.5%) had expectant management while 346 (79.5%) had oral contraception. (p=0.00). Conclusion: It was concluded that oral contraceptives are more effective and successful in the resolution of ovarian cysts as compared to expectant management.

Surgical management of pancreatic pseudocyst: a single-center experience

Aim Pancreatic pseudocyst is the commonest cystic lesion of the pancreas. It usually develops on a background of pancreatitis. Cyst recurrence is the most feared complication following surgical management of pancreatic pseudocyst. Patients and methods The authors reviewed the data of 48 patients who were managed surgically during the period between 2010 and 2019. Results Biliary pancreatitis was the commonest cause (24 cases − 50%). The mean cyst size was 13.5±6.4 cm (6–42 cm). Most lesions were located in the body and tail of the pancreas (32 cases − 66.7%). Open approach was performed in 45 (93.8%) cases whereas the remaining cases were performed laparoscopically. Cases were managed by cystogastrostomy (39 cases − 81.3%), cyst-jejunostomy (seven cases − 14.6%), combined procedures (one case − 2.1%), or central pancreatectomy (one case − 2.1%). Cholecystectomy was performed in 17 (35.4%) cases. Early postoperative morbidity was encountered in nine (18.8%) cases. After a median follow-up of 68 months, no recurrence was detected. One (2.1%) case developed incisional hernia, and another one (2.1%) had adhesive intestinal obstruction. Conclusion Surgical intervention for pancreatic pseudocysts is a safe and feasible approach. It offers the ability to deal with the primary cause during operation and excellent long-term outcome regarding pseudocyst recurrence.

Discrimination of papillary renal cell carcinoma from benign proteinaceous cyst based on iodine and water content on rapid kV-switching dual-energy CT.

We aimed to evaluate whether rapid kV-switching dual energy CT (rsDECT) can discriminate between papillary renal cell carcinoma (RCC) and benign proteinaceous cysts (BPCs) based on iodine and water content. Twenty-four patients with histopathologically proven papillary RCC and 38 patients with 41 BPCs were retrospectively included. Patients with BPCs were eligible for inclusion when the cysts were stable in size and appearance for at least 2 years or proved to be a cyst on ultrasound or MRI. All patients underwent delayed phase (70-90 s) rsDECT. Iodine and water content of each lesion was measured on the workstation. Of papillary RCC patients, 4 (16%) were female and 20 (84%) were male. Mean tumor size was 39±20 mm. Mean iodine and water content was 2.08±0.7 mg/mL and 1021±14 mg/mL, respectively. Of BPC patients, 9 were female and 29 were male. Mean cyst size was 20±7 mm. Mean iodine and water content was 0.82±0.4 mg/mL and 1012±14 mg/mL, respectively. There were significant differences between iodine and water contents of papillary RCCs and BPCs (P < 0.001). The best cutoff of iodine content for differentiating papillary RCC from BPC was 1.21 mg/mL (area under the curve [AUC]=0.97, P < 0.001, sensitivity 96%, specificity 88%, positive predictive value [PPV] 82%, negative predictive value [NPV] 97%, accuracy 91%,); the best cutoff of water content was 1015.5 mg/mL (AUC=0.68, P = 0.016, sensitivity 83%, specificity 56%, PPV 52%, NPV 85%, accuracy 66%). An iodine content threshold of 1.21 mg/mL accurately differentiates papillary RCC from BPCs on a single postcontrast rsDECT. Despite having a high sensitivity, water content has inferior diagnostic accuracy.

Calyceal diverticulum of the kidney in pediatric patients – Is it as rare as you might think?

Calyceal diverticulum (CD) is rarely diagnosed in children. It mimics other cystic lesions of the kidney and may be very difficult to identify. Displaying the communication of these fluid-filled cavities with the collecting system of the kidney via imaging methods is the key diagnostic method. The purpose of this study is to determine the presence of calyceal diverticulum in pediatric patients followed up due to simple renal cyst and/or parapelvic cyst. Patients who were newly diagnosed or being followed up with the ultrasonographic diagnosis of simple cyst(s) or parapelvic cyst(s) in the Department of Pediatric Nephrology of Izmir University of Health Sciences Tepecik Training and Research Hospital between December 2015 and July 2018 were included in the study. Age, gender, admission symptoms, recurrent urinary tract infections, stone disease, trauma history, accompanying urinary system and systemic anomalies, localization, and size of the cyst(s) at admission and during follow-up, treatment type and developing complications were noted. Contrast MR urography was applied to all patients. A total of 43 patients [mean age:132±54.9 (12-228) months] including 25 girls were enrolled in the study. The mean follow-up period was 36. 74±19 (1-90) months. The cysts were located mostly in the right kidney and also in the upper pole of the kidney. The mean cyst size was 20.4±11 (8-58) mm at admission, and comparably 20.3±8.6 (10-45) mm at the end of the follow-up. In contrast MR urography, a total of 16 cases were observed at first glance to be associated with pelvicalyceal system. However, in the postcontrast images taken at the 5th minute it was determined that 9 of them were compatible with calyceal diverticulum. Although it is thought that well-circumscribed solitary renal fluid collections may be thought to be a simple renal cyst at first glance, the differential diagnosis of calyceal diverticulum (CD) should be absolutely kept in mind. Contrast studies and late-phase postcontrast images are needed for the diagnosis of CD. Although the standard management of CDs in children is conservative, surgical intervention may be rarely required.

Natural course of Baker’s cysts in a total knee arthroplasty population

Aims and Objectives:Baker’s cysts are known to be a source of discomfort and pain due to pressure on adjacent structures. They are not uncommon in patients eligible for total knee arthroplasty (TKA). Since there is a paucity of medium-term studies that assess the natural course of Baker’s cyst following TKA, in this study we report the one- and five-year outcomes of patients to elucidate the state of their Baker’s cyst following TKA.Materials and Methods:In this prospective case series, 102 TKA patients were included. All patients who received surgery had a diagnosis of primary osteoarthritis and had preoperatively presented with a Baker’s cyst. Sonography was performed to evaluate the existence and the gross size of the cyst before TKA, and sonography was repeated at one and five years after TKA. Symptoms potentially attributable to the Baker’s cyst were recorded at each assessment. In addition, the five-year assessment included a sonographic assessment of the anterior aspect of the knee to identify joint effusion.Results:Ninety-one patients were available for the five-year assessment (with an 89% follow-up rate). After one and five years, Baker’s cyst was still present in 87 (85%) and 30 (33%) patients, respectively. Of those patients who retained a Baker’s cyst at one-year follow up, 31 patients (36%) had sustained popliteal symptoms. Of those patients who continued to have a Baker’s cyst at five years, 17 patients (56.7%) were still symptomatic. The probability of entering remission was dependent on the size of the Baker’s cyst at baseline (odds ratio, 1.41; p = 0.025). The mean preoperative cyst size was 14.5 cm2. At one and five years postoperatively, the mean cyst size was 10.6 cm2 and 9.9 cm2, respectively. At five years, no association between cyst size and popliteal symptoms was found.Conclusion:Five years after TKA, the majority of the Baker’s cysts that were present at baseline had gone into remission. The probability of going into remission was dependent on the size of the Baker’s cyst at baseline.

How safe and effective is laparoscopic decortication of simple renal cysts in elderly patients?

Objective: To investigate the assessment of feasibility and safety of laparoscopic decortication of simple renal cysts in elderly patients.Methods: The data of 114 patients who underwent laparoscopic decortication for simple renal cyst between October 2011 and May 2019 were retrospectively evaluated. Patients’ age, gender and ASA scores; operation time; cyst size and location; complications; hospital stays and success rates of operations were recorded.Results: The mean age of the patients were 73.8 ± 8.2 years. Forty-eight (42.1%) of the patients were female and 66 (57.9%) were male. Cysts were localized on the right side in 61 (53.5%) patients and on the left side in 53 (46.5%) patients; and mean cyst size was 72.83 ± 31.13 mm. Also, they were localized on the anterior in 88 (77.2%) patients and on the posterior of the kidney in 26 (22.8%) patients. Preoperative ASA score distributions were ASA-I in 12 patients (10.5%), ASA-II in 31 patients (27.2%), ASA-III in 68 patients (59.7%), and ASA-IV in 3 patients (2.6%). Mean operative time was 41.4 ± 5.6 min. Clavien grade 1 complications were observed in 5 (10.4%) patients. Median hospitalization time was 1 day. No recurrence was occurred in any patient in the postoperative period.Conclusions: Although laparoscopic surgery has some risks and complications for elderly patients, laparoscopic decortication can be applied safely and effectively in treatment of simple renal cyst in that patient population.

The fate of Baker’s cysts at mid-term follow-up after total knee arthroplasty

We report the natural course of Baker's cysts following total knee arthroplasty (TKA) at short- and mid-term follow-up. In this prospective case series, 105 TKA patients were included. All patients who received surgery had a diagnosis of primary osteoarthritis and had preoperatively presented with a Baker's cyst. Sonography and MRI were performed to evaluate the existence and the gross size of the cyst before TKA, and sonography was repeated at a mean follow-up time of 1.0 years (0.8 to 1.3; short-term) and 4.9 years (4.0 to 5.6; mid-term) after TKA. Symptoms potentially attributable to the Baker's cyst were recorded at each assessment. At the one-year follow-up analysis, 102 patients were available. Of those, 91 patients were available for the 4.9-year assessment (with an 86.7% follow-up rate (91/105)). At the short- and mid-term follow-up, a Baker's cyst was still present in 87 (85.3%) and 30 (33.0%) patients, respectively. Of those patients who retained a Baker's cyst at the short-term follow-up, 31 patients (35.6%) had popliteal symptoms. Of those patients who continued to have a Baker's cyst at the mid-term follow-up, 17 patients (56.7%) were still symptomatic. The mean preoperative cyst size was 14.5 cm2 (13.1 to 15.8). At the short- and mid-term follow-up, the mean cyst size was 9.7 cm2 (8.3 to 11.0) and 10.4 cm2 (9.8 to 11.4), respectively. A significant association was found between the size of the cyst at peroperatively and the probability of resolution, with lesions smaller than the median having an 83.7% (36/43) probability of resolution, and larger lesions having a 52.1% (25/48) probability of resolution (p < 0.001). At the mid-term follow-up, no association between cyst size and popliteal symptoms was found. At a mean follow-up of 4.9 years (4.0 to 5.6) after TKA, the majority (67.0%, 61/91) of the Baker's cysts that were present preoperatively had disappeared. The probability of cyst resolution was dependent on the size of the Baker's cyst at baseline, with an 83.7% (36/43) probability of resolution for smaller cysts and 52.1% (25/48) probability for larger cysts. Cite this article: Bone Joint J. 2020;102-B(1):132-136.

Hydatid cyst disease in children: 10-years experience at two tertiary centers from Northeast Anatolia of Turkey

Aim: Hydatid cyst remains a significant health problem in endemic regions such as Turkey. It can be observed at any age, but the diagnosis is usually made at adulthood. The aim of this study was to investigate the epidemiological findings of hydatid cyst cases in the pediatric age group in Turkey. Material and Methods: The records of the patients who received the diagnosis of hydatid cyst in the pathology departments of Ataturk University Faculty of Medicine and Erzurum Regional Training and Research Hospital between 2009–2019 were analyzed retrospectively. Data such as age, sex, location, size and number of cysts of the cases diagnosed with hydatid cyst between 0–16 years of age were analyzed statisticall.Results: Of the 1072 cases diagnosed with hydatid cyst, 32.7% (n=351) were within the age range of 0–16 years, 57.8% (n=203) were male and 42.2% (n=148) were female, with a mean age of 10.8 years (SD: ± 3.5; min: 1, max: 16). In 86.3% (n=303) of the cases, the cyst was found to be located in a single organ, whereas it was located in two different organs in 13.7% (n=48) of the cases. Involvement of the liver and lung was observed in 54.4% (n=191) and 50.4% (n=177) of the cases, respectively. Less involvement was observed in brain (n=10), kidney (n=9), spleen (n=5), retroperitoneal region (n=4), omentum (n=2), nasal cavity (n=1), thoracolumbar region (n=1), tail of the pancreas (n=1) and ulna diaphysis (n=1). In all cases, the mean cyst size was measured to be 7.4 cm (SD: ± 2.9; min: 1.5, max: 17) based on the largest cyst size.Conclusion: Hydatid cyst is also common in the pediatric age group. Hydatid cyst has been found to be more common in males in the pediatric age group in Turkey, with its most common localization being in the liver and lung.

Endoscopic ultrasound-through-the-needle biopsy in pancreatic cystic lesions: A large single center experience.

BACKGROUNDEstablishing a diagnosis of pancreatic cystic lesions (PCLs) preoperatively still remains challenging. Recently, endoscopic ultrasound (EUS)-through-the-needle biopsy (EUS-TTNB) using microforceps in PCLs has been made available.AIMTo assess the efficacy and safety of EUS-TTNB in the diagnosis of PCLs.METHODSWe retrospectively collected data of patients with PCLs who underwent both EUS-fine-needle aspiration (FNA) for cytology and EUS-TTNB at our institution since 2016. EUS-FNA for cytology was followed by EUS-TTNB in the same session. Evaluation of the cyst location, primary diagnosis, adverse events, and comparison between the cytologic fluid analyses and histopathology was performed. Technical success of EUS-TTNB was defined as visible tissue present after biopsy. Clinical success was defined as the presence of a specimen adequate to make a histologic or cytologic diagnosis.RESULTSA total of 56 patients (mean age 66.9 ± 11.7, 53.6% females) with PCLs were enrolled over the study period. The mean cyst size was 28.8 mm (12-85 mm). The EUS-TTNB procedure was technically successful in all patients (100%). The clinical success rate using EUS-TTNB was much higher than standard EUS-FNA, respectively 80.4% (45/56) vs 25% (14/56). Adverse events occurred in 2 patients (3.6%) who developed mild pancreatitis that resolved with medical therapy. Using TTNB specimens, 23 of 32 cases (71.9%) with intraductal papillary mucinous neoplasm were further differentiated into gastric type (19 patients) and pancreaticobiliary type (4 patients) based on immunochemical staining.CONCLUSIONEUS-TTNB for PCLs was technically feasible and had a favorable safety profile. Furthermore, the diagnostic yield for PCLs was much higher with EUS-TTNB than standard EUS-FNA cytology and fluid carcinoembryonic antigen. EUS-TTNB should be considered as an adjunct to EUS-FNA and cytologic analysis in the diagnosis and management of PCLs.

Single-center Experience of 24 Cases of Tailgut Cyst.

PurposeTailgut cysts are rare congenital or developmental lesions that arise from vestiges of the embryological hindgut. They are usually present in the presacral space. We report our single-center experience with managing tailgut cysts.MethodsWe conducted a retrospective analysis of 24 patients with tailgut cyst treated surgically at the Colorectal Surgery Department of Severance Hospital, Yonsei University, Seoul, South Korea, between 2007–2018.ResultsThis study included 24 patients (18 females) with a median age of 51.5 years (range, 21–68 years). Ten cases were symptomatic and 14 were asymptomatic. Cysts were retrorectal in 21 patients. Cysts were below the coccyx level in 16 patients, opposite the coccyx in 6, and above the coccyx in 2. Cysts were supralevator in 5 patients, had a supra- and infralevator extension in 18 patients, and were infralevator in 1. Ten patients were managed using an anterior laparoscopic approach, 11 using a posterior approach, and 3 using a combined approach. Mean cyst size was 5.5 ± 2.7 cm. Postoperative complications were Clavien-Dindo (CD) classification grade II in 9 patients (37.5%) and CD grade III in 1 (4.2%). The posterior approach group showed the highest rate of complications (P = 0.021). Patients managed using a combined approach showed a larger cyst size (P < 0.001), longer operation times (P < 0.001), and a greater likelihood of tumor level above the coccyx (P = 0.002) compared to other approaches. The tumors of 2 male patients were malignant: 1 was a neuroendocrine tumor treated with radiotherapy, while the other was a closely followed adenocarcinoma. Median follow-up was 12 months (range, 1–66 months) with no recurrence.ConclusionTailgut cysts are uncommon but can cause perineal or pelvic pain. Complete surgical excision via an appropriate approach according to tumor size, location, and correlation with adjacent pelvic floor muscles is the key treatment.

111 Clinical Utility of EUS-Guided Needle-Based Confocal Endomicroscopy of Pancreatic Cystic Lesions for Surgical Decision Making

INTRODUCTION: There is a need to assess the clinical impact of utilizing EUS-guided needle-based confocal endomicroscopy (nCLE) in the surgical management of PCLs. Hence, we sought to evaluate the concordance of diagnoses using the standard of care (SOC) clinical data with EUS-nCLE, and the impact on surgical resections of PCLs. METHODS: Subjects included consecutive patients enrolled in a prospective study (2015–2018) evaluating EUS-nCLE for the diagnosis of PCLs who underwent a clinically indicated EUS-FNA, along with EUS-nCLE. Data used to derive the SOC diagnosis included clinical history, cross-sectional imaging, EUS morphology, cyst fluid CEA, and cytology (based on hierarchical group assignment, Table 1). Decisions for patient management also involved multidisciplinary tumor board meetings. A final diagnosis of PCLs was defined for those with surgical histopathology or presence of established mutations in the cyst fluid (KRAS/GNAS: mucinous cyst, VHL: serous cystadenoma). The diagnostic concordance of EUS-nCLE alone with SOC was assessed. RESULTS: A total of 138 subjects with PCLs (mean cyst size 36.4 ± 15.7 mm) underwent SOC and EUS-nCLE. A final diagnosis was available in 93 subjects (surgical histopathology, n = 67, molecular markers in cyst fluid, n = 26). Diagnostic concordance was observed in 80 (86%) subjects, with a discordant nCLE diagnosis in the remaining 13 (14%) subjects. Among PCLs with discordant diagnoses (Table 2), EUS-nCLE was “clinically advantageous” in 11 subjects with successful downstaging of PCLs which were otherwise classified as mucinous by SOC, hence potentially preventing unwarranted surgery. In one subject, nCLE was “clinically advantageous” with successful upstaging of PCL (final diagnosis: IPMN), while SOC inaccurately classified the lesion as a non-mucinous PCL. EUS-nCLE was “clinically disadvantageous” in one subject (final diagnosis was mucinous cystic neoplasm) who were classified as a mucinous cyst by SOC, but nCLE did not reveal diagnostic image patterns. CONCLUSION: EUS-nCLE has a significant clinical impact by preventing at least one unwarranted pancreatic surgery for every ten subjects undergoing multimodality SOC evaluation. Hence EUS-nCLE should be considered for a comprehensive assessment of PCLs when FNA is being performed.

2932 Histological Diagnosis of Pancreatic Serous Cystadenomas Using a 22G Core Biopsy Needle: A Case Series

INTRODUCTION: Pancreatic Serous Cystadenoma or Pancreatic Cystic Serous Neoplasm (SCN) are a type of benign pancreatic tumor that account for 1-2% of all pancreatic masses. They are most often benign, with very rare malignant potential. SCN's will often have a cystic or honeycomb appearance on CT scan. In the past, the mainstay of diagnosing SCN has been via endoscopy ultrasound (EUS) with fine needle aspiration (FNA) to assess fluid for CEA levels and also for cytological analysis. However fluid can be difficult to obtain and often there is not enough cellularity for cytology. In this case series of 7 patients we performed fine needle biopsy (FNB) of the cell walls of pancreatic cysts as a technique for histological review. METHODS: We retrospectively reviewed medical records of patients who underwent EUS for FNA for fluid sampling of pancreatic cysts but due to microcystic nature a decision was made to proceed with FNB to obtain tissue for histology. FNB was done using 22 G FNB needle with slow stylet pull technique. The tissue was placed in formalin for histological analysis by an expert GI pathologist. RESULTS: A total of seven patients were evaluated. The mean age was 75 years old and 5 of the patients were female. All patients had one cyst that was sampled. The location of the cyst was on the head in 1 of the patients and body or tail of the other 6 patients. The mean cyst size was 31.1 mm (range 14-40 mm). There were no post procedure complications. All seven samples were adequate for histological analysis. Six out of the seven biopsy samples were consistent with serous cystadenomas. One samples showed benign pancreatic acinar tissue and stroma without malignancy. CONCLUSION: Management of pancreatic SCNs can be challenging as no follow up is recommended if the diagnosis is confirmed but lots of times a definite diagnosis cannot be made based on endosonographic and CT/MRI findings. These patients can be potentially subject to repeat imaging for surveillance. Here we show that pursuing FNB instead of FNA for microcystic lesions can yield enough tissue for histological diagnosis of SCNs and can alter management and avoid further imaging.

Evaluation of clinical, diagnostic and treatment aspects in hydatid disease: analysis of an 8-year experience.

Echinococcosis is still a common health problem. The aim of this study was to discuss our 8-year data in terms of diagnosis, treatment and follow-up of cystic Echinococcosis. A total of 178 patients who had hydatid cyst were analyzed retrospectively from the hospital records. The diagnosis of hydatid cyst was based on clinical-serological and radiological findings. Treatment response was evaluated with clinical, radiological and serological findings. A total of 178 medical records were evaluated; the male:female ratio was 0.73 and mean age 44.6±16.9 years. The most common symptom was abdominal pain (94, 52.8%). The mean cyst size was 9.5±3.9 cm. Eosinophilia was significantly higher in patients with complicated cyst (35.3%) (p=0.002). The average duration of hospitalization in surgical patients was shorter than non-surgical patients (p=0.026). There was no significant correlation between the preference of scolicidal agent (hypertonic saline, H2O2, povidone iodine) and recurrence in patients who underwent surgery (p>0.05). There was no significant difference between the patients who underwent radical and conservative surgery in terms of complication and recurrence (p=0.077, p=0.557). No significant difference was found between percutaneous and surgical treatment in terms of complication and recurrence (p=0.264, p=0.276). Even though considerable progress has been made, uncertainties remain in the diagnosis and treatment of Echinococcosis. Hence, standardized diagnostic and treatment procedures should be established with well-designed studies.

Pineal Cyst without Hydrocephalus: Clinical Presentation and Postoperative Clinical Course After Infratentorial Supracerebellar Resection

Surgical indications for patients with pineal cysts are controversial. There are absolute indications such as hydrocephalus or tectal compression; otherwise, it is difficult to decide whether surgery would be beneficial when symptoms are not distinct. We tried to clarify the indications and clinical course of patients after resection of pineal cysts without ventriculomegaly. We reviewed our database for all patients operated on for pineal cyst without ventriculomegaly from 2003 to 2018. We studied the presenting symptoms, cyst size, surgical approach, extent of resection, and clinical and radiologic follow-up. Follow-up ranged from 3 months to 14 years (mean 3.74 years). Forty-three patients underwent surgery for pineal cyst in absence of ventriculomegaly; 36 female patients, 7 male patients, mean age 25.63 years (±10.62 years, range 4-52 years). Presenting symptoms included headache (41/43), nausea and vomiting (31/43), dizziness (19/43), visual disturbances (10/43), and sleep disturbances (8/43). Mean cyst size was 15.7 mm (±4.9 mm, range 9-27 mm). In total, 41 of 43 patients reported a good outcome, represented by a Chicago Chiari Outcome Scale score of 11 or greater and only 2 of 43 patients reported a bad outcome, defined by Chicago Chiari Outcome Scale score of 10 or less. We suggest that pineal cysts without ventriculomegaly are an indication for surgery when patients present with headache and/or visual disturbances and other causes have been excluded. Resolution of symptoms and quality of life in our cohort may denote a good indication for resection. However, we must admit that there is still no evidence to recommend this technique as a treatment of headache in these patients.

Robotic fenestration of massive liver cysts using EndoWrist technology.

We present the short-term outcomes of robotic fenestration of symptomatic liver cysts using the EndoWrist One Vessel Sealer. Data from patients who underwent robotic deroofing were collected and analysed retrospectively. A total of 17 patients were treated. Mean cyst size was 14cm (median 15cm, range 6.3-24). Seven cysts were in posterosuperior or central segments. There were no mortalities or conversions. Blood loss was minimal in all but one case of 200ml. Mean operating time was 174minutes (median 170min, range 97-335). Mean hospital stay was 2.5days (median 2days, range 1-10). One patient developed a bile leak requiring ERCP. There are no recurrences with a median follow-up of 19months. Robotic fenestration can be safely performed and offers distinct advantages over the laparoscopic approach in the treatment of posterosuperior and perihilar cysts at the expense of longer operating times and increased cost.

Microsurgical, endoscopic, and shunt management of pediatric temporosylvian arachnoid cysts: a comparative study.

Arachnoid cysts (ACs) are most frequently located in the middle cranial fossa. Some patients are asymptomatic whereas others exhibit signs of increased intracranial pressure, seizures, or cognitive and behavioral symptoms. When ACs do require treatment, the optimal surgical technique remains controversial. This study was conducted to assess the most effective surgical treatment for these cysts. The authors retrospectively reviewed 240 temporal intracranial ACs managed over a 25-year period in their pediatric neurosurgical unit. Pre- and posttreatment results were clinically and radiologically assessed. A majority of male patients (74.6%) with an overall median age of 6.9 years were included. The mean cyst size was 107 cm3; the Galassi classification showed 99 (41.3%) type I, 77 (32.1%) type II, and 64 (26.7%) type III cysts. Forty-four ACs (18.3%) were diagnosed after rupture. Surgical management was performed by microsurgery (28.3%), endoscopic cyst fenestration (14.6%), cystoperitoneal shunting (CPS; 16.2%), or subdural shunting (10%). Furthermore, 74 children (30.8%) did not undergo operations. After a mean follow-up of 4.1 years, the mean percentage decrease in cyst volume and the overall rate of clinical improvement did not significantly differ. The endoscopy group had earlier complications and a shorter event-free survival (EFS) time (EFS at 3 years = 67.7%, vs 71.5% and 90.5% for CPS and microsurgery, respectively; p < 0.007) and presented with more subdural hematomas compared to the microsurgery group (p < 0.005). The microsurgery group also showed a tendency for longer cystocisternostomy permeability than the endoscopy group. Concerning the management of unruptured symptomatic temporal ACs, microsurgery appears to be the most effective treatment, with longer EFS and fewer complications compared to shunting or endoscopy.