Nonparasitic Cysts Research Articles

The safety and feasibility of laparoscopic partial splenectomy: analysis of perioperative indications from different vascular subtypes and improvement of surgical approach.

While laparoscopic splenectomy (LS) has been widely used in benign splenic tumor, more concerns have been raised for postoperatively short-term and long-term complications. Laparoscopic partial splenectomy (LPS) is a surgical option, to preserve splenic function, and reduce postoperative complications. The aim of our study was to retrospectively identify the safety and feasibility of LPS compared with LS in patients with splenic benign tumor. From 2014 to 2024, a total of 165 patients diagnosed with occupational splenic lesions underwent splenectomy, of whom 87 underwent LPS and 78 underwent LS. We compare the perioperative parameters and long term follow up between these two groups. The etiology of splenic space-occupying lesions was nonparasitic splenic cysts, followed by splenic lymphangioma and splenic hemangioma. Of the patients with LPS, 55 underwent conventional surgery with blockage of the splenic arterial branch and resection along the ischemic line (RAIL), and 32 underwent with our modified total splenic blood supply blockade followed by resection alone the tumor edge (RATE). The tumor size, the operative time and estimated blood loss were comparable between the LPS and LS groups. One patient developed abnormal signs during the LPS procedure and was promptly referred for LS. The LPS group had fewer pancreatic leakage, incision infection, and pulmonary infection. As for different vascular types, patients with LS under all branches of the splenic artery had a longer time to resume postoperative feeding. As for the comparison of RAIL and RATE, estimated blood and operative time were significantly reduced in patients receiving RATE. Postoperative complications were the same in patients underwent each surgical procedures. LPS is a viable approach for patients with splenic benign tumor. We introduce the tumor artery supply types to indicate the resection region. Our RATE technique has proven to be clinically effective and safety.

Sleeve Gastrectomy And Liver Cyst Unroofing In Morbid Obesity With Multiple Liver Cysts: A Case Report

Background: Obesity has become a major global health issue which leads to various complications, including hepatic diseases. However, we found a rare case of morbid obesity and symptomatic multiple liver cysts. Aim: This article aims to represent a rare case of morbid obesity and multiple liver cysts surgically managed by sleeve gastrectomy and liver cyst unroofing which were performed in a single surgery. Case report: 41-year-old female presented with morbid obesity and blunt intermittent abdominal pain in the right upper quadrant. Stage II hypertension, tenderness on the right upper quadrant of the abdomen and epigastrium were found in clinical assessment. Lipid profiles were shown to be elevated. Abdominal CT revealed fatty liver and multiple cystic lesions in all hepatic segments. Discussion: Non-parasitic liver cysts affect 2-18% of the global population, with a higher prevalence in females possibly due to hormonal factors. Obesity is associated with hormonal alterations, potentially leading to increased secretion of FSH and LH. Conclusion: Sleeve gastrectomy and liver cyst unroofing may be considered as a treatment strategy for patients with morbid obesity and multiple liver cysts.

Peribiliary cysts: uncommon mimickers of hepatic and biliary cystic lesions.

Peribiliary cysts (PC) are dilatations of the extramural peribiliary glands, with a very characteristic imaging pattern in the contexts of hepatobiliary diseases, idiopathic portal hypertension, adult-type polycystic disease of the liver and kidneys, solitary nonparasitic cysts, and systemic infections. The clinical relevance of PC is related to the fact that their presence may indicate underlying pathologies (such as those mentioned above) and may be considered as a potential marker of liver disease progression. Although imaging findings are quite characteristic, recognizing their main differential diagnoses, including malignancies, can be challenging but are essential to avoiding diagnostic errors.

A nonparasitic cyst of the spleen in children — is surgery a must? Two clinical cases

BACKGROUND: Non-parasitic splenic cysts is a rare pathology in children, accounting for 0.5–2% of all splenic diseases. Typically, most cysts, as a rule, are asymptomatic However, as the cyst is enlarging, clinical symptoms — such as pain, discomfort in the left abdomen, and nausea — may appear. These symptoms are indicators for surgical intervention. Splenic cysts larger than 5 cm have a higher risk of complications such as rupture, bleeding, and infection; therefore, surgical treatment is recommended in these cases. Some authors consider the surgical intervention to be appropriate for cysts sized greater than 4 cm. However, small size of splenic neoplasms can complicate their visualization and surgery, thus increasing the risk of intraoperative complications and recurrences. Currently, in cases of borderline sizes of asymptomatic non-parasitic splenic cysts, it is recommended to assess the dynamics of size changes, so as to find the optimal curative tactics for the patient. CLINICAL CASE DESCRIPTION: Two clinical examples of non-parasitic splenic cysts in children are discussed in the article. In the first case, a splenic formation with diameter 40 mm was found in a 5-y.o. girl; the diagnosis was confirmed at ultrasound and computed tomography examinations. At the recommended dynamic follow -up , it was found out that the cyst decreased to 5 mm in diameter. In the second case, a 14-y.o. boy was hospitalized for an elective surgery, because a splenic formation was diagnosed at the regular dispensary check-up. Ultrasound and computed tomography examinations of the abdominal cavity revealed a cyst of 45 mm on the visceral surface of the upper segment of the spleen. Laparoscopy failed to visualize the splenic cyst. The follow-up monitoring with a repeated ultrasound examination of the abdominal cavity in 3-6 months was recommended. Imaging diagnostic techniques have confirmed that cyst location and size remained unchanged. CONCLUSION: The two described clinical cases demonstrate the importance of dynamic follow-up monitoring in case of borderline-sized non-parasitic splenic cysts in children, as it helps to avoid unnecessary surgical interventions.

Minimally Invasive Methods of Treatment of Nonparasitic Spleen Cysts

Minimally Invasive Methods of Treatment of Nonparasitic Spleen Cysts

A case report of a large Splenic epidermoid cyst treated with partial splenectomy

Introduction and importance: Splenic epidermoid cysts are rare primary congenital cysts composed of an epithelial lining that represent a small proportion of nonparasitic splenic cysts. Despite their infrequency, there is a lack of uniform diagnostic and treatment guidelines for these cysts, emphasizing the need for further research and standardized reporting. Case presentation: A 45-year-old female presented with left upper quadrant abdominal pain, characterized by a pressing sensation. Physical examination revealed a palpable mass in the upper left quadrant. Laboratory test results were normal. Abdominal ultrasonography and CT tomography confirmed a large splenic unilocular cyst consistent with an epidermoid cyst. Surgical intervention involved aspiration of the cystic fluid, partial splenectomy, and pathological examination. The patient’s postoperative recovery was uneventful. Clinical discussion: The origin of splenic epidermoid cysts remains unclear, with theories suggesting entrapment of mesothelial cells during embryonic development. The clinical presentation varies with cyst size, often causing abdominal pain and a palpable mass. Diagnostic modalities include ultrasonography and CT scans. Surgical intervention is recommended for symptomatic or suspicious cysts to prevent complications. The chosen approach depends on cyst characteristics and patient factors. This case highlights the challenges and considerations in managing splenic epidermoid the cysts and emphasizes the need for individualized treatment approaches. Conclusion: This case contributes to the understanding of splenic epidermoid cysts and demonstrates a successful subtotal splenectomy as a treatment approach. Further research and standardized guidelines are essential to improve the management of these rare lesions and to provide better insights into their etiology and optimal treatment strategies.

Laparoscopic Spleen-Preserving Decapsulation of the Splenic Cyst: A Case Report

Worldwide the Incidence of Primary nonparasitic splenic cysts are rare. They were incidentally diagnosed while evaluating other diseases by imaging. We here by present our experience of a case of 23-year-old woman, with a primary nonparasitic splenic cyst. The patient underwent laparoscopic spleen-preserving decapsulation of the splenic cyst. The patient recovered well and had no postoperative complications.

Giant non-parasitic splenic cyst: a case report

BackgroundSplenic cysts are quite rare and asymptomatic. They may result from infection by a parasite, especially Echinococcus granulosus (hydatid cyst), or from non-parasitic causes. Since primary splenic cysts are not common, simple cysts can be misdiagnosed with a hydatid cyst in endemic areas.Case presentationWe reported a 14-year-old Iranian girl initially presented with a vague abdominal pain, which progressed to left shoulder pain, fullness, early satiety, and shortness of breath and remained undiagnosed for 7 months despite seeking medical attention. Finally, imaging revealed a massive splenic cyst measuring 220 mm × 150 mm × 160 mm raising concern for a hydatid cyst due to regional endemicity. Consequently, the patient underwent total splenectomy. However, histopathological examination surprisingly revealed a simple non-parasitic cyst.ConclusionsDetecting rare simple spleen cysts requires early ultrasonography (US) and careful reassessment of diagnoses for non-responsive or worsening symptoms. Distinguishing them from splenic hydatidosis, especially in endemic areas, demands thorough paraclinical evaluations and patient history regarding potential parasitic exposure. While total splenectomy is the primary treatment for these huge cysts, the optimal surgical approach should be tailored case by case. These insights emphasize a comprehensive diagnostic approach to enhance accuracy and optimize patient care for these uncommon cysts.

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.

Watchful waiting for large primary nonparasitic splenic cysts.

Primary nonparasitic splenic cysts (NPSC) are typically diagnosed incidentally. The management of large (≥ 5 cm) asymptomatic cysts remains controversial; there is a lack of evidence guiding management. The purpose of this study was to describe the outcomes of nonoperative management of large NPSC. Patients diagnosed with NPSC between January 2004 and December 2019 were identified at our academic institution. Adult patients with an NPSC of at least 5 cm who had at least 1 additional hospital visit were included. Data are presented as medians with interquartile ranges (IQR). We identified 512 medical records that included the term splenic cyst during the study period. Sixty-eight of the patients had no reported cyst size, 410 had cysts smaller than 5 cm, 1 patient underwent an elective splenectomy at another institution and 12 patients were excluded for other reasons; 21 patients with cysts of at least 5 cm were included in the study. Eight symptomatic patients underwent surgery at our institution. Of these, 2 presented acutely: 1 with hemoperitoneum who required admission for transfusions and later underwent elective laparoscopic splenectomy and 1 with increasingly severe abdominal pain who underwent laparoscopic cyst unroofing. The remaining 6 symptomatic patients had elective surgery for pain (4 cyst unroofing, 1 total splenectomy, 1 partial splenectomy). Thirteen patients were asymptomatic (10 female, median age 49.2 [IQR 38.1 to 64.6] yr). Two of these patients chose to undergo elective surgery. The remaining 11 asymptomatic patients, with a median initial cyst size of 8.0 (IQR 5.3 to 10.8) cm, were followed for a median of 31.0 (IQR 23.5 to 71.0) months. There was no change in median cyst size (0 [IQR -1 to 0] cm), and none of these patients underwent intervention for their NPSC. Asymptomatic patients managed nonoperatively for large NPSC did not become symptomatic or require intervention during the study period. This supports watchful waiting with serial radiologic and clinical monitoring for asymptomatic large NPSC.

Significance of morphological studies in the diagnostics of bilial intraepithelial neoplasia in nonparasitic liver cysts

Biliary intraepithelial neoplasia (BilIN) according to modern data is considered as an obligate precancer of the bile ducts. As BILIN progresses, cholangiocarcinoma often develops, characterized by a low five-year survival rate. The aim of this work is to describe the morphological characteristics of BilIN in the epithelium of nonparasitic liver cysts. The material is described after primary and repeated (15) surgical interventions in 99 patients. The morphological manifestations of intraepithelial neoplasia in non-parasitic dysontogenetic liver cysts were studied, their role in the development of liver cholangiocarcinoma was established.

Nonparasitic Splenic Cysts in Children: Outcomes after Sclerotherapy or Surgical Resection as Initial Management

Management of splenic cysts in children remains undefined. Sclerotherapy is an innovative, less invasive treatment. This study examined the safety and preliminary effectiveness of sclerotherapy for splenic cysts in children compared with those of surgical treatment. A retrospective review of pediatric patients treated for nonparasitic splenic cysts from 2007 to 2021 was performed at a single institution. Posttreatment outcomes for patients who underwent either expectant management, sclerotherapy, or surgery were reviewed. Thirty patients aged between 0 and 18 years met the inclusion criteria. Cysts in 3 of 8 patients who underwent sclerotherapy were either unresolved or recurred. Patients who underwent sclerotherapy and required surgery for residual symptomatic cyst had an initial cyst diameter of >8 cm. Symptoms resolved in 5 of 8 patients who underwent sclerotherapy, with a significantly reduced cyst size compared with that in patients with continued symptoms who underwent sclerotherapy (61.4% vs 7.0%, P = .01). Sclerotherapy is an effective treatment for splenic cysts, particularly those measuring <8 cm. However, surgical excision may be preferable for large cysts.

СОВРЕМЕННЫЕ АСПЕКТЫ НЕПАРАЗИТАРНЫХ КИСТ ПЕЧЕНИ

Methods: The relevance of nonparasitic cysts of the liver (NPCL) is related to their steadily increasing incidence, high recurrence rates, delayed diagnosis, and potential complications. In general, hepatic cysts (HCs) are classified into several types, including simple and complex, false and true. Simple cysts are mainly congenital but also occur in polycystic liver disease. Complex cysts include mucinous neoplasms, echinococcal cysts, hemorrhagic cysts, cystic hepatocellular carcinoma, and other rare lesions. Nonparasitic cystic liver lesions do not usually cause symptoms, and their characteristics are not specific. In 15% of cases, nonspecific signs (flatulence, nausea, dyspepsia) accompany pain. Diagnosis of NPCL is based on data from ultrasound, CT, or MRI of the abdominal organs. There still needs to be a consensus on surgical treatment indications or the effectiveness and feasibility of its various methods. Many surgical interventions for NPCL treatment include puncture drainage, multiple minimally invasive (laparoscopic) surgery options, and open methods. In clinical practice, laparoscopic fenestration, associated with fewer complications and faster recovery, has become widespread. However, significant progress has yet to be achieved in reducing NPCL recurrence rates despite advances in surgical treatment. Therefore, multiple studies are underway to improve treatment options for this medical condition. Keywords: Liver, cyst, nonparasitic cyst, pseudocyst, laparoscopic fenestration.

Robotic-assisted excision of splenic epidermoid cyst in an adolescent patient in a new robotic platform: A case report.

Laparoscopic management of non-parasitic cysts (NSCs) of the spleen is currently the standard of care. There is a paucity of data of robotic management of NSCs. Here, we report a case of a NSC in a 13-year-old male. The patient presented to us with the chief complaints of pain in abdomen and feeling of a left upper abdomen lump for the last 3 months. The spleen being an important organ for immunity, we decided to opt for splenic preservation. Since minimal access methods offer the best outcome and we wanted to go with a safe option, we settled for near-total cystectomy of the splenic cyst. Here, we review the literature regarding the surgical management of NSCs and discuss the robotic technique for the accomplishment of the surgery.

Non-Traumatic Pseudocyst of Spleen Presenting as Chronic Abdominal Pain: Case Report

Introduction: Splenic pseudo cysts are extremely uncommon. Most of these cysts are asymptomatic and may result from previous blunt abdominal trauma. We report an interesting uncommon case of a large splenic pseudo cyst without a history of previous abdominal trauma. Case Presentation: 44 years old female with normal BMI, married, non-smoker, non-alcoholic, and housewife. She had no past medical or surgical history and was not on any oral medications. She presented with upper abdominal pain and discomfort for 6 months. Irregular pain with mild intensity associated with shortness of breath, her physical examination was unremarkable. The abdominal ultrasound and contras-enchased CT showed a large splenic cyst occupying the lower pole of the spleen, Echinococcus multilocularis antibody test was negative (Titer&lt;1:16), Thus the Echinococcosis was excluded from the differential diagnosis. The differential diagnosis, in this case, was a non-parasitic splenic cyst. The patient underwent elective diagnostic laparoscopic with laparoscopic splenectomy. Discussion: The patient had an uneventful postoperative recovery course. He was discharged from the hospital on the third postoperative day (within the expected time frame), and instructed to avoid heavy lifting for a few months and to complete the post-splenectomy vaccination protocol. Conclusion: Pseudocyst of the spleen is quite uncommon in routine clinical practice and should be differentiated from more common lesions such as hydatid cysts, abscess of the spleen, etc. The Pseudocyst of the spleen is usually asymptomatic and is detected incidentally during the abdominal scan for other reasons. Splenectomy is the gold standard treatment for splenic pseudocysts. Partial splenectomy is the recommended procedure if at least 25% of splenic parenchyma is achievable.

OGBN P18 Laparoscopic Deroofing of a Liver Cyst

Abstract Background Laparoscopic deroofing is considered to be part of standard practice for simple nonparasitic liver cysts. Methods This “how to” video demonstrates an approach to the laparoscopic deroofing of a large, nonparasitic liver cyst. After the placement of umbilical, epigastric and a working right upper quadrant port, the cyst is aspirated. This allows easier handling of the cyst. A cystostomy is then created and a LOTUS or Harmonic scalpel is used to cut thru the cyst wall.Further suctioning of the cyst contents allows the cyst to collapse which facilitates handling of the tissue. Complete resection of the cyst can be achieved by dissecting close to the cyst wall which is then placed into an endobag prior to removal. It is important to ensure good haemostasis at the liver. Omentum may be placed in larger cavities to reduce dead space and prevent fluid collection. Results This patient made a good postoperative recovery and cytology and histology confirmed benign cyst. Conclusions This video demonstrates one approach to the laparoscopic deroofing of a large, simple, nonparasitic liver cyst.

Primary non-parasitic splenic cyst: US- and fluoroscopy-guided percutaneous management by alcohol sclerosis on six patients.

This manuscript aims to report on a retrospective analysis of six patients treated with combined US- and fluoroscopic-guided percutaneous alcohol sclerosis for primary non-parasitic splenic cysts. In this retrospective analysis, three females and three males affected by primary non-parasitic splenic cysts were included. All except one were symptomatic. Preoperative cyst diameter was in mean 113 mm (range: 67-210 mm). Ethanol 96% was adopted as sclerosant agent; the amount of ethanol injected corresponded to the 20%-30% of the cystic volume. US follow-up was planned at 2/4 weeks; MR follow-up was conducted almost at 6 months after the last treatment session. Technical success was considered as cyst disappearance or reduction of the maximum diameter <50 mm; clinical success, in those symptomatic cases, was considered as symptoms resolution or marked improvement. Eleven procedures had been performed: one in three patients, three in two patients and two in one patient. Technical success was 83.3%; clinical success was 80%. Only one patient, with a preoperative cystic diameter of 210 mm and despite three treatment sessions, had an increase in the cystic size and did not report symptoms improvement. In this sample, US-guided percutaneous alcohol sclerosis was a safe and effective spleen preserving option to treat primary non-parasitic splenic cysts.

Laparoscopic cystectomy for a giant splenic cyst in a 8-year old child

Introduction. Nonparasitic splenic cysts (PNSC) are rare, with a frequency of 0–2 % of all diseases of the spleen. Primary cysts account for about 30–40 % of all spleen cysts and are more common in children than in adults. Most cysts are asymptomatic. The usual clinical picture of large spleen cysts includes: pain or discomfort in the upper left abdomen, often accompanied by a feeling of overflow in the stomach. Spleen cysts larger than 5 cm are more prone to complications such as bleeding, rupture or infection, therefore surgical treatment is recommended. Development of endoscopic surgical techniques and modernization of imaging diagnostics have significantly changed management of spleen cysts. Thorough and accurate preoperative examination, precise location and topography of the cyst and surrounding structures increase chances for an organ-spearing surgical intervention. Nevertheless, in some cases, splenectomy is the only possible way of radical treatment. To date, the following types of intervention are most commonly applied: percutaneous cyst puncture with sclerotherapy, partial resection of the spleen and cyst fenestration which may be made both endoscopically and in the traditional way. Description of clinical observation. This article describes a clinical case of a giant spleen cyst revealed at the outpatient examination for abdominal pain. The child was hospitalized. During the inpatient examination, asymmetry of the abdominal wall was found; a densely elastic rounded formation was palpated in the left hypochondrium. The patient was thoroughly examined: ultrasound of the abdominal cavity which revealed a cystic formation of the spleen and MRI. ELISA test did not reveal antibodies to Echinococcus. Laparoscopic cystectomy was performed. Conclusion. This clinical case is an example of modern approach to the surgical treatment of giant non-parasitic spleen cysts with minimally invasive and organ-sparing tactics.

The application of titanium nickelide cryodestructors in the surgery of cystes and hemangiomas of the liver

The possibility of using titanium nickelide (TiNi) cryoapplicator in the surgery of nonparasitic cysts and liver hemangiomas was study.Material and methods. The analysis of the results of surgical treatment of patients with the use of TiNi cryoapplicator was carried out in 26 patients with nonparasitic liver cysts and in 31 patients with liver hemangiomas of various localization and diameter.Results. It was proved that the use of a TiNi cryoapplicator is as effective as a stationary cryoinstallation with a constant supply of a cryoagent (liquid nitrogen).Conclusion. The use of TiNi cryoapplicator increases the effectiveness of the action on cysts and hemangiomas of the liver, causing their cryodestruction and preventing the recurrence of these diseases, reduce blood loss and reduce trauma when using laparoscopic cryoprobes. In addition, when using the open access of Merzlikin– Paramonova, it becomes possible to manipulate with less trauma in the area of the diaphragmatic surface of the organ and the caval gates of the liver, which are difficult to access for surgical intervention from traditional incisions, especially when the pathological process is located in 7–8 segments of the liver.

Large splenic epithelial cyst: A rare presentation.

Introduction and importanceSplenic cysts are infrequent and most of them are related to parasitic diseases. Splenic epithelial cyst (SEC) is the most common type of primary non-parasitic splenic cysts. Its pathogenesis is not yet clear. Splenic cysts are usually asymptomatic and are detected incidentally during imaging exams or an exploratory laparotomy.Case presentationOur case is about a primary SEC discovered incidentally. An 18-year-old male patient without any personal and family medical history, presented with symptoms of upper urinary tract infection. Renal ultrasound was performed and found incidentally a solitary cystic lesion in the spleen. A laparoscopic partial splenectomy was made then. The specimen was sent for pathological examination and a diagnosis of primary (epidermoid) epithelial splenic cyst was given.Clinical discussionSEC is a rare pathology that could mimic other splenic cysts like hydatid cyst. The preoperative diagnosis of SEC can be suspected by ultrasonography, computed tomography or magnetic resonance imaging. However, histopathological examination is mandatory to confirm the diagnosis. A wide range of differential diagnoses is considered when we suspect clinically SEC because of its lower incidence.ConclusionActually, spleen-preserving surgery with minimally invasive methods such as laparoscopy is the gold standard for the treatment of SEC despite the risk of recurrence encountered with these techniques. However, different surgical modalities are discussed depending on the size and the location of the cyst and the patient's age.