Multiloculated Cyst Research Articles

Epithelioid hemangioendothelioma with extensive cystic change and CAMTA1 rearrangement

Epithelioid hemangioendothelioma (EHE) is a rare vascular neoplasm that has the ability to recur locally and metastasize. Thus, it is important to distinguish this tumor from other epithelioid vascular neoplasms. A 47-year-old man presented to our hospital with a pelvic mass with severe ischialgia and weight loss. Surgical resection was performed, and the mass was found to have dark red multiloculated cysts with hemorrhage and calcification. The histopathologic examination showed a central sclerotic, hypocellular zone and a peripheral cellular zone. Only the peripheral portion of the wall revealed nested tumor cells in light blue myxoid stroma. These tumors are typically composed of short strands or cords of bland epithelioid cells with occasional intracytoplasmic lumens embedded in a myxohyalinized stroma. The tumor cells were positive for CD31 and CD34 and negative for factor VIII-related antigen, CK (AE1/AE3) and S-100. The tumor nuclei showed distinct break-apart signals with individual green and/or red signals, indicating the presence of CAMTA1 rearrangement. In this study, we report a case of EHE that was difficult to diagnose based on histology alone. Therefore, we also performed fluorescence in situ hybridization, and found that the tumor harbored a CAMTA1 gene rearrangement, which confirmed the diagnosis.

Recurrent supraclavicular hydatid cyst

Figure 1: A nuclear magnetic resonance revealed a 4 × 3-cm-sized multiloculated cyst. The lesion lay anteromedially to the trapezius muscle; inferiorly, it was in contact with the distal part of the left clavicle and scalene muscles that appeared lightly medially dislocated. The left external jugular vein was placed medially to the cyst, while the left subclavian artery and vein were caudally located at a distance of 10 mm. The cyst was hyperintense on T1-weighted black-blood images not suppressed in fat suppression sequences (transversal A and frontal B view, respectively). Thus, a recurrent hydatid disease was hypothesized. No albendazole therapy was administered after the previous operation.

Tuboovarian Abscess Caused by Hydatid Cyst: A Rare Case

Primary lesions of hydatid cysts caused by Echinococcus granulosus, are frequently localized in liver, followed by lungs, muscles, kidneys, spleen and bones. Pelvic inoculations are rare and usually occur as a secondary infection. In this report, a case of primary hydatid cyst in the abdomen, spleen and pelvic organs, clinically mimicking tuboovarian abscess, was presented. A nineteen-years-old female patient was admitted to the gynecology outpatient clinic with the complaint of abdominal pain for two days. The case was considered as tuboovarian abscess according to the initial examination findings and hospitalized for treatment and follow-up. In transabdominal ultrasound examination, 44 x 43 mm thin-walled septated cysts in the left ovary and 65 x 65 mm thin-walled multiloculated cysts in the spleen were detected. Abdominal computerized tomography also yielded multivesicular cystic masses in spleen, front abdominal wall and the left ovary. Since the clinical and vital findings worsened, she initially underwent ovarian cystectomy by laparoscopy, then abdominal cystectomy and splenectomy. The operation material examined macroscopically was compatible with hydatid cyst with the characteristics of a germinative membrane and hydatid sand. The diagnosis was confirmed by histopathological examination. The patient was discharged without complication on post-operative sixth day, with a recommendation of albendezol (15 mg/kg/day, 3 months) treatment. Since the patient had undergone emergency surgery, indirect hemaglutination (IHA) test had not been performed pre-operatively. However, post-operative third month serum sample revealed a positive (1/32) IHA titer. In conclusion, hydatid cyst should be kept in mind in the differential diagnosis of patients with abdominal pain, in response to the high prevalence of the parasite in our country.

Isolated torsion of the fallopian tube with hydrosalpinx mimicking a multiloculated ovarian cyst: Whirlpool sign on preoperative sonography and MRI

Isolated torsion of the fallopian tube is a rare case of lower abdominal pain. Early diagnosis of such cases is crucial because it allows for the possibility of salvage surgery and the prevention of irreversible vascular damage. However, diagnosis is rarely made before surgery due to nonspecific clinical and imaging features. We report a case of isolated tubal torsion with specific imaging findings on preoperative ultrasonography, color Doppler ultrasonography, and magnetic resonance imaging that was misdiagnosed as a multiloculated ovarian cyst at a local hospital.

The Giant Grape-Like Enterogenous Cyst Extending from the Upper Cervical Canal to the Ambient Cistern: Case Report and Literature Review

Objective and Importance: The authors report the first known case of a giant multiloculated grape-like enterogenous cyst extending from the upper cervical canal to the ambient cistern. Clinical Presentation/Methods: We report the case of a 40-year-old male who had a prior transmastoid craniotomy at an outside facility 14 months prior with an indeterminate diagnosis, who presented to the University of New Mexico with recurrent headaches and nausea. Scans demonstrated a giant multiloculated cystic lesion in the right cerebellopontine angle that extended superiorly and inferiorly with brainstem compression and hydrocephalus. Intervention/Results: We took the patient to the operating room for a retrosigmoid suboccipital craniectomy for tumor resection. Post-operatively, the patient improved but required ventriculoperitoneal shunting for continued communicating hydrocephalus. Conclusion: This is the first known case of a giant multiloculated grape-like enterogenous cyst extending simultaneously from the upper cervical canal to the ambient cistern. Enterogenous cysts should be considered on the differential diagnosis of giant grape-like lesions extending from the cervical canal to the prepontine cistern.

Multiloculated epidermoid cyst of spleen: a case report

Splenic epidermoid cyst is a rare cystic disease of spleen. Primary cysts of the spleen lined by epithelium or endothelium are usually seen in young adults. A 23-year-old woman with abdominal distension presented at the surgery outpatients of our hospital. Splenomegaly was detected on physical examination and elective surgery was performed. The multiloculated cyst was 10x6 cm on macroscopic examination and creamy material was drained. Immunohistochemical examination of the cyst lined with epithelium was Cytokeratin and CEA positive and calretinin, BerEP4, HBME-1 and F8 negative and it was reported as 'epidermoid cyst'. We discussed the etiopathogenesis of our case in light of the theories regarding its development.

A Case of Congenital Cystic Adenomatoid Malformation Infected withMycobacterium avium-intracellulareComplex

We present a case of congenital cystic adenomatoid malformation (CCAM) in a 25-year-old male who was presented with chronic cough. Chest radiography revealed an abnormal mass-like shadow in the right lower pulmonary zone. A contrast enhanced computed tomography showed an 11 cm solid, cystic mixed mass on the right lower lobe. A right lower lobectomy was performed by video-assisted thoracoscopic surgery without complications. The gross specimen showed a massive cavitation with multiloculated cysts of varying size, consistent with CCAM, along with noticeable granulomatous inflammation. Non-tuberculosis mycobacteria were isolated from a bronchial wash specimen, and the resected tissue homogenates were positive for Mycobacterium avium-intracellulare complex by polymerase chain reaction.

Supratentorial intraventricular solitary schwannoma. Case report and literature review

The objectives of this study were to present a case of a solitary intraventricular schwannoma with a review of the literature and to analyse the current theories of its origin. A 16-year-old male patient, without any pathological, genetic or familial history of significance, presented with symptoms of intracranial hypertension and progressive left brachiocrural paresis. The magnetic resonance image showed a bulky intraventricular space-occupying lesion emerging from the posterior horn of the right lateral ventricle, with an irregular nodular component intimately connected to the choroid plexus, and a multiloculated cystic component extending beyond the ventricle. A right parietal craniotomy was performed, revealing a multiloculated cyst with xantochromic fluid and a soft brownish red nodule. The lesion was dissected surrounding the periphery and coagulating a vascular pedicle related to the wall of the right lateral ventricle and its choroid plexus. Total excision was achieved. The pathological exam reported an intraventricular schwannoma (WHO grade 1). The patient evolved favourably, with no recurrence at 36-month follow-up. The literature describes less than 45 cases of schwannomas not associated to cranial nerves of the following locations: intramedullary, leptomeningeal and only 12 intraventricular cases. The three theories explaining the origin of this last group describe: (1) a neoplastic transformation of peripheral nerve fibres, (2) a neoplastic transformation of autonomic neural tissue located within the intraventricular choroid plexus and (3) an abnormal embryogenesis leading to a failed migration of the neural crest cells. Complete resection is the therapeutic goal for this benign pathology to avoid recurrence.

Laparoscopic Large Ovarian Cystectomy, Appendectomy, and Removal through a Natural Orifice in a 16 Year Old Female

To demonstrate a stepwise approach to the laparoscopic excision of an 18cm ovarian cyst in a 16 year old female. This video demonstrates the laparoscopic excision of an 18 cm mucinous, multiloculated right ovarian cyst and appendix are described using 5 mm laparoscopic abdominal incisions. The cystectomy was performed through four 5 mm laparoscopic abdominal ports and a 12 mm posterior colpotomy. Controlled entry into a large ovarian cyst and no-spill evacuation of the cyst fluid are demonstrated. The laparoscopic appendectomy is performed with an Endo GIA stapler. Laparoscopic closure of the posterior colpotomy, and survey of the pelvis complete the procedure. Laparoscopic management of a benign ovarian cyst with preservation of the ovary is an acceptable and preferable method in young reproductive age females.

Successful laparoscopic removal of mesenteric and omental cysts in toddlers: 3 cases with a literature review

Mesenteric and omental cysts are rare benign intraabdominal anomalies with uncertain etiologies. Surgical removal is the preferred treatment owing to complications related to cyst enlargement. A 1-year-old boy with an intrauterine diagnosis of a cystic mass adjacent to his stomach and liver, a 3-year-old girl, and a 3-year-old boy with an incidental diagnosis of intraabdominal cysts were scheduled for laparoscopic surgery. The mass of the 1-year-old boy was a multiloculated cyst originating from the lesser omentum, the incidental mass in the girl was a multiseptated cyst located in the jejunoileal mesentery, and the incidental mass of the 3-year-old boy was a uniloculated cyst originating from the ileal mesentery. All the cysts were excised either laparoscopically or in a laparoscopy-assisted manner. The laparoscopic or laparoscopy-assisted excision of the mesenteric and omental cysts seems to be a feasible, safe, and cost-effective surgical procedure with shorter operative times, even in toddlers.

Multiloculated extra-intradural spinal meningeal cyst associated with intradural tethering of the spinal cord

Multiloculated extra-intradural spinal meningeal cyst associated with intradural tethering of the spinal cord

English

Torsion of Bilateral hydrosalpinx of the fallopian tube is a rare case present with lower abdominal pain 1, 2, 4 . Early diagnosis of such cases is crucial because it allows the possibility of salvage surgery and the prevention of irreversible vascular damage. However, diagnosis is rarely made before surgery due to non-specific clinical and imaging features. It was misdiagnosed as a multiloculated ovarian cyst at a local hospital. Familiarity with fallopian tube disease and the imaging appearances of both the normal and abnormal fallopian tube is crucial for optimal diagnosis and management in emergent as well as ambulatory settings. 3,4.

Epicardial Cysts: Report of Two Rare Cases

Epicardial cysts originating directly from the epicardium are seen very rarely. Complete surgical excision is recommended when these cysts are detected. If cysts compress surrounding vital structures, cardiopulmonary bypass (CPB) should also be considered. We report herein 2 cases of multiloculated epicardial cysts, both of which were successfully excised, 1 with CPB.

Cellular Fibroma of the Ovary with Multiloculated Macroscopic Characteristics: Case Report

Ovarian fibroma is the commonest benign tumor of the ovarian stroma. The cellular subtype accounts for around 10% of ovarian fibromatous tumors. The cellular fibroma is a tumor of uncertain malignant potential that may recur or be associated with peritoneal implants. Usually these are solid tumors, sometimes with small areas of cystic degeneration. This case is reported to highlight an unusual feature for an ovarian fibroma: the tumor was predominantly cystic with a small solid part; the multiple cavities contents consisted of viscous liquid that solidified under room temperature. The multiloculated cysts, the mucinous contents, and the solid areas simulated a borderline mucinous ovarian tumor on both CT scan and gross pathologic examination.

Retiform Hemangioendothelioma Developed on the Site of an Earlier Cystic Lymphangioma in a Six-Year-Old Girl

Retiform hemangioendothelioma (RH) is a rare low-grade malignancy angiosarcoma, with a high rate of local recurrence and a low metastatic risk. A 6 year-old girl with a large cervical cystic lymphangioma diagnosed by ultrasound and Doppler ultrasound, which showed a large multiloculated anechoic cyst with no flow. The lymphangioma was treated with injections of Picibanil (OK-432). The tumor regressed, but after a year, she developed a poorly limited infiltrated plaque spreading out regularly over her chest, back, and shoulder. The biopsy showed a poorly limited dermal and subcutaneous vascular proliferation composed of elongated arborising vessels lined with ovoid endothelial cells in a hobnail pattern. In addition, the deep part of the lesion showed typical features of a papillary intralymphatic angioendothelioma pattern (PILA) or Dabska tumor. The endothelial cells strongly expressed podoplanin (D2-40). A diagnosis of RH with focal areas of PILA was reached. The girl died 8 months after surgery of hypovolemic shock in a context of diffuse lymphangiomatosis with pulmonary localization. To our knowledge, RH has hardly ever been described in children. This entity exhibits a continuum with the PILA, sharing not only morphological and immunohistochemical similarities but also its ability to develop in a context of a vascular anomaly, particularly a lymphangioma. The role of Picibanil in the development of this tumor can be discussed.

Combined intraoperative magnetic resonance imaging and navigated neuroendoscopy in children with multicompartmental hydrocephalus and complex cysts: a feasibility study

The rationale for using endoscopy to treat complex cysts and multiloculated hydrocephalus is to combine several CSF compartments into a minimum number, establish a connection to functioning CSF compartments (that is, ventricles), and decrease shunt dependency. The aim is to decrease the number of proximal shunt catheters, the number of shunt revisions, and in selected cases even to avoid a shunt. In cases of distorted anatomy and multiloculated cysts, endoscopy may be problematic because of orientation issues. Standard navigation becomes useless soon after CSF loss due to brain shift. Therefore, the concept of "real-time" navigation and intraoperative imaging in combination with endoscopic surgery has been previously suggested. The goal of the present study was to assess the feasibility and efficacy of combining intraoperative MR (iMR) imaging and navigated neuroendoscopy in infants. The authors report their experience in treating 5 infants (aged 6-14 months), who underwent surgery for multicystic hydrocephalus presenting with shunt malfunction (4 patients) and a quadrigeminal fetal arachnoid cyst (1 patient). In all infants, a low-field portable iMR imaging system (0.12-T PoleStar N-10/0.15-Tesla PoleStar N-20) was used in conjunction with navigated endoscopy. The authors used e-steady, T1-weighted, and T2-weighted sequences (acquisition time 24 seconds to 3.5 minutes). The iMR imaging system provided clear images that correlated with the endoscopic appearance of the cystic membranes in all patients, and the images were helpful in determining trajectories and redefining targets. The iMR images documented brain shift and changes in CSF spaces during surgery. There were no intraoperative complications or technical difficulties of visualization. No infection or any other immediate postoperative complication occurred. Patients were followed up for 9 months to 7 years. The infant presenting with the quadrigeminal cyst remains shunt free since surgery, and the patients with multicystic hydrocephalus have 1-2 shunts each. Following endoscopic, iMR imaging-guided surgery, shunt catheter positioning was found to be optimal and as planned according to the postoperative imaging. Navigated neuroendoscopy and iMR imaging may complement each other, offering an advantage over other modalities in complicated cases of hydrocephalus. Whenever targets and trajectories need to be redefined, the iMR images provided an updated navigation data set, allowing accurate navigation of the endoscope and minimizing the number of CSF compartments. Direct vision through the endoscope provides microanatomical details for the optimization of fenestration and catheter positioning. The combined usage of the two modalities may transform a conventional procedure into a visually controlled real-time navigated process.

Morphological and functional analyses of two infants with obstructive renal dysplasia

Renal dysplasia associated with urinary tract obstruction comprises two distinct phenotypes, i.e., multicystic dysplastic kidney (MCDK) and obstructive renal dysplasia (ORD). MCDK is a common manifestation in infants with renal dysplasia, which is characterized by multiloculated thin-walled cysts with no functional parenchyma and an atretic ureter owing to pyelocalyceal occlusion early in fetal life. In contrast, ORD is an extremely rare condition which is caused by severe obstruction of the distal ureter or urethra. Here, we report two infants with ORD. Both patients manifested unilateral kidney enlargement with multiple cortical cysts, mild hydronephrosis, and marked dilatation of the ipsilateral ureter. Contralateral kidneys and urinary tracts revealed no apparent radiological abnormalities. Serial ultrasonographic studies of fetal and neonatal kidneys in both cases revealed that ureteral dilatation was evident at gestational week 16 and 27, respectively, and most of the cortical cysts disappeared within 1-3months after birth. The functions of the affected kidneys were severely impaired but evident at the time of birth. These manifestations were consistent with a diagnosis of ORD, and were distinct from the features of MCDK. Our observation of fetal and infantile kidneys in these two cases provides us with a better understanding of the pathogenesis of ORD.

Thymic basaloid carcinoma with aggressive invasion of the lung and pericardium: Report of a case

We report a case of basaloid carcinoma of the thymus, invading the lung and pericardium. The patient was a 72-year-old man who suffered thoracic trauma in a fall and was taken to his family physician. Computed tomography revealed a huge mediastinal tumor with cystic components, pressing into the lung. He was referred to our hospital, where magnetic resonance imaging showed suspicious invasion of the pericardium and mediastinum. We made an assumed diagnosis of a mediastinal malignancy and performed mediastinal tumor resection. The tumor was adherent to the lung, pericardium, and left innominate vein. The final pathological diagnosis was a basaloid carcinoma of the thymus. Basaloid carcinoma is often a component of a multiloculated thymic cyst (MTC) and should be considered when MTC is identified within an anterior mediastinal tumor.

Cystic Lesions of the Thorax

Traditional management of cystic lesions involving the mediastinum or lung parenchyma consists of surgical resection. Endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) has been reported to successfully treat bronchogenic cysts. We present 2 cases in which EBUS-TBNA was performed to aid in making the diagnosis. Endobronchial ultrasound imaging and TBNA were successful in both cases. The mediastinal cyst was therapeutically managed with complete aspiration in one case, whereas in the other an intraparenchymal cyst was found to be multiloculated and could only be partially aspirated and required surgical excision. EBUS-guided real-time aspiration of intrathoracic cysts can be both diagnostic and therapeutic in simple mediastinal bronchogenic cysts that can be fully aspirated. However, surgical resection may be required for multiloculated intraparenchymal cysts that cannot be aspirated completely. EBUS guidance helps to identify multiloculation and completeness of the aspiration.

Fetal suprarenal masses: cases series from a tertiary referral centre

IntroductionFetal suprarenal masses are diagnosed incidentally on antenatal ultrasound. Differential diagnosis includes adrenal haemorrhage, neuroblastoma of the adrenal medulla, adrenocortical adenoma and pulmonary sequestration. Post-natal follow-up and characterisation is necessary...