Nonparasitic Cysts Research Articles

Milzzyste ? seltene ursache einer oberbauchexpansion Splenic cyst ? a rare cause of upper abdominal tumour

Cysts are rare lesions of the spleen, and may be divided into parasitic and non-parasitic types. After the parasitic cysts, the second most frequent group is the (secondary) posttraumatic form of non-parasitic cysts. The primary form (congenital and neoplastic) of the latter is the least frequent. Whereas splenectomy was the treatment of choice for lienal cysts until a few years ago, a change has occurred in the techniques of splenic salvage. Against the background of a case report of a primary epidermoid cyst the etiology, diagnostic measures, and the recent developments in conserving spleen surgery are discussed.

Treatment of Symptomatic Non‐ParasiticLiver Cysts–Surgical Treatment VersusAlcohol Injection Therapy

Fourteen patients with benign symptomatic non-parasitic cysts of the liver were either surgically treated, had alcohol injected into the cysts, underwent deroofing of the cyst or in 5, a cystectomy was done. Alcohol was injected into 6 patients and there has been no recurrence for as long as 5 years and 8 months after the treatment. Liver dysfunction occurred in 3 patients given blood transfusion during the surgery and/or postoperative course, an elevated temperature (over 39℃) occurred in one patient. Adverse effects of alcohol injections were minor and transient. Based on our experience, the injection of alcohol is an effective treatment for benign symptomatic cyst of the liver. When a malignancy is suspected on imaging and/or cytologic studies, or when alcohol administration is ineffective, then surgery is indicated.

Spontaneous rupture of nonparasitic cyst of the liver

A case of spontaneous rupture of a nonparasitic liver cyst, documented by serial computed tomography scans, is reported. The patient was closely followed clinically after the rupture of the cyst and was treated conservatively, without surgical intervention. No peritonitis developed. This unusual complication of nonparasitic simple liver cysts may not always require surgery.

Part II: Benign liver tumors

This article discusses the most important benign liver tumors, both in adult and pediatric patients. A pathologic discussion of each neoplasm is included to provide a basis for understanding the radiologic-pathologic correlation that is used throughout the monograph. The benign liver tumors are presented according to their frequency. Therefore, hemangioma, the most common primary benign liver neoplasm, is discussed first, followed by focal nodular hyperplasia, hepatocellular adenoma, and the benign primary pediatric tumors—infantile hemangioendothelioma and mesenchymal hamartoma. Finally, a brief discussion of nodular regenerative hyperplasia and other rare hepatic masses is included. Bile duct cyst (simple, non-parasitic cyst of the liver) is not included since it is not a neoplasm. Likewise, cystadenoma is not discussed since it originates from the biliary duct cell and is appropriately included in the biliary neoplasms category.

SURGICAL TREATMENT OF NONPARASITIC HEPATIC CYST

Twelve patients with nonparasitic hepatic cyst (NPHC) who were treated surgically have been studied. Thehepatic cysts were classified according to their morphologic features into three groups in clinical prctice; 1. solitary, 2. scattered, and 3. polycystic types. It was recommended in this study that surgical management of symptomatic NPHC was guided by the type of the cyst and its content. Fenestraton operation is recommended for polycystic liver, and deroofing operation, for solitary and the main cyst of scattered type as the first choice, when theses cysts contain colorless or yellow clear fluid. Small cysts of scattered type are treated with ethanol injection under ultrasonically guided puncture. If the content of the cyst is brownish, turbid or mucinous, complete extirpation of a cyst or hepatectomy should be considered case-by-case.

Case report: a non-parasitic huge hepatic cyst with obstructive jaundice treated with absolute ethanol

Case report: a non-parasitic huge hepatic cyst with obstructive jaundice treated with absolute ethanol

Nonparasitic Splenic Cysts: Changing Trends in Surgical Management

Nonparasitic Splenic Cysts: Changing Trends in Surgical Management

Epithelial (True) Splenic Cysts

Nonparasitic cysts of the spleen are classified as primary or epithelial cysts if their inner surface has a cellular lining. Depending upon the pattern of the inner surface cell layer, the primary splenic cysts are divided into mesothelial or epidermoid subtypes. In order to study their pathogenesis, five epithelial splenic cysts (two with mesothelial lining, and three with foci of stratified squamous epithelium) were investigated by scanning and transmission electron microscopy and by immunohistochemistry. In places, the squamous epithelium was continuous with a flattened mesothelial layer. Furthermore, within the stratified epithelium, a continuous spectrum of cytodifferentiation from mesothelial to squamous cells was found. Thus, the epidermoid splenic cyst seems to be a variant of the mesothelial cyst with focal squamous metaplasia. Rupture of the splenic capsule with hemosiderin deposits and infoliation of the mesothelium was seen in one case, implying a traumatic genesis. In addition, stoma-like channels providing connections between the lumen of the cyst and the sinus of the adjacent splenic tissue were detected by scanning electron microscopy. As with other cystic lesions, the influx of blood cells and proteinaceous fluid from these stomata may contribute to the growth of the cysts, which are usually of considerable size when surgically removed.

TREATMENT OF NON-PARASITIC HEPATIC CYSTS WITH ETHANOL INFUSION

Four patients with non-parasitic hepatic cyst were treated by ultrasonically guided alcohol infusion, and regression of the cysts was observed in all four by ultrasonography (US) and CT. The first patient, a 73-year-old woman who had been under observation for liver cirrhosis and hepatic cyst at the department of internal medicine, developed right epigastric pain following a contusion on the epigastrium. CT revealed a cyst of about 11 × 9 cm in the right hepatic lobe. Based on the diagnosis of intracystic hemorrhage, cyst drainage was performed under US, and alcohol was infused into the cyst after bleeding had been controlled. The second patient, a 62-year-old man, visited our hospital because of a feeling of abdmoinal distention. A cyst of about 24 × 18 cm was detected in the right hepatic lobe by CT. The patient underwent US-guided cyst drainage, aspiration of colorless clear cystic fluid and then alcohol infusion. The third patient, an 89-year-old woman, was found to have a cyst of 13 × 10 cm in the right hepatic lobe during preoperative examination for colorectal cancer. Alcohol infusion was performed following cyst drainage. In the fourth patient, a 54-year-old woman, US and CT showed gallbladder stones and two hepatic cysts (3 × 3 cm and 4 × 4 cm). During cholecystectomy the patient received US-guided intracystic alcohol infusion. Besides a mild feeling of inebriation, no serious complications were observed in the four patients.

Diagnosis and therapy of non-parasitic splenic cysts in children

Splenic cysts of various types are rare surgical abnormalities. The diagnostic and therapeutic procedures are discussed with special reference to the author's clinical material consisting of six children with non-parasitic cysts. Sonography and, in special cases, CT are the most important methods of examination. The desirability of conserving the spleen, while removing the cyst, is stressed.

Nonparasitic cysts of the liver. The case for conservative surgical management.

The recommended treatment for nonparasitic hepatic cysts (NPHC) has been either resection or drainage into a Roux loop of jejunum. From 1970-1984 a more conservative approach to NPHC was adopted in 22 patients with large symptomatic cysts. Seventeen patients were treated with simple unroofing without complication. By comparison, two of three patients treated by Roux-en-Y drainage developed infected hepatic cysts that required subsequent surgical drainage. Patients treated by external drainage without unroofing or hepatic resection had either cyst recurrence or complications. In conclusion, wide unroofing is the treatment of choice for NPHC even when the cyst fluid is bile stained.

TWO CASES OF NONPARASITIC HEPATIC CYST TREATED WITH ABSOLUTE ETHANOL INJECTION UNDER ULTRASONICALLY GUIDED PUNCTURE

Two patients with large nonparasitic cysts of the liver were treated with absolute ethanol injection under ultrasonically guided puncture. The first patient, a 63-year-old woman, was admitted to our hospital with the complaints of sense of fullness and epigastralgia. On the ultrasonogram, a cystic mass, 14×9cm in size, was seen in the left lateral segment of the liver. The second patient, a 56-year-old woman, was hospitalized with the complaints of general fatigue and anorexia. Ultrasonogram revealed a cystic mass, 12×9cm in size, in the right lobe of the liver. Neither, cyst showed malignant findings. Both patients were treated with absolute ethanol injection under ultrasonically guided puncture. After the treatment, no major complications were observed, and remarkable shrinkage of both cysts was seen on the ultrasongram. There was no recurrence over a period of two years. As this procedure was simple and harmless, this treatment for hepatic cysts may be considered as an alternative to surgery.

Nonparasitic splenic cysts: a report of 52 cases with radiologic-pathologic correlation.

We reviewed 52 cases of splenic cysts on file at the Armed Forces Institute of Pathology. There were 24 true (epidermoid) and 28 false (posttraumatic) cysts. The history and clinical presentations, including pain, splenomegaly, or mass, were similar in both groups. Radiologic manifestations included splenomegaly and the occasional identification of a distinct mass by conventional radiography even in the absence of calcification. The lesions produced a photopenic defect on nuclear scintigraphy and were avascular on angiography. Sonography and CT demonstrated a cystic lesion with occasional septations, wall trabeculation, and low-level internal echoes. Three false cysts demonstrated solid and cystic components on sonography and CT, corresponding to organizing hematoma within the cyst. Splenomegaly or a splenic mass of a predominantly cystic nature with no clinical evidence of echinococcus suggests the diagnosis of splenic cyst. Reliable radiologic distinction between true or false splenic cyst does not seem possible. Complex mass may represent a "transition" between hematoma and false splenic cyst.

Biliary cystadenoma in a young child

Biliary cystadenomas are rare slow-growing multiloculated lesions which arise from the liver, mainly in middle-aged females, and are occasionally complicated by malignant transformation into cystic adenocarcinoma. This paper reports a case occurring in a 1-year-old male child. The typical radiological appearances that would enable a preoperative diagnosis to be made are described. Careful review of the histological features suggests that the biliary cystadenoma and the slightly less rare, solitary multilocular nonparasitic cyst of the liver in childhood are the same lesion.

Benign bile duct tumours, non-parasitic liver cysts and liver damage in males

Pathogenetic associations between benign hepatic tumours and liver damage were studied in an autopsy series of 91 males with high incidence of alcoholism. Information on the consumption of alcohol was obtained by interviewing a family member or a close friend of the deceased. The reported use of alcohol correlated well with the increase of fatty and fibrotic changes and with the occurrence of liver cirrhosis, alcoholic hepatitis or pancreatitis. Benign bile duct tumours (bile duct adenomas and von Meyenburg's complexes) (n = 26) were associated with the occurrence of bridging (P less than 0.0005) and periportal (P less than 0.025) fibrosis of the liver and, independently from these, with chronic pancreatitis (P less than 0.05) and with non-parasitic liver cysts (n = 14) (P less than 0.01). The weight of the liver was greater (P less than 0.01) in males with focal nodular hyperplasia (n = 3). Cavernous hemangioma (n = 19) occurred independently of the parameters studied. None of the tumours showed significant correlation to liver cirrhosis, alcoholic hepatitis, fatty liver or diseases of the gallbladder. The results are in line with observations on the reactive nature and connections to fibropolycystic liver disease of benign bile duct tumours in laboratory animals and in man. Their presence in human liver specimens should be taken into account as a sign of liver damage, in this study related to heavy use of alcohol or to chronic inflammation of the pancreas.

A Case of Congenital Solitary Nonparasitic Cyst of the Liver in Neonate

A Case of Congenital Solitary Nonparasitic Cyst of the Liver in Neonate

Congenital solitary nonparasitic cyst of the liver: A rare cause of a rapidly enlarging abdominal mass in infancy

Congenital solitary nonparasitic cyst of the liver is an uncommon lesion rarely presenting in infancy. It is therefore seldom included in the differential diagnosis of a rapidly enlarging abdominal mass. The cystic nature of the lesion may be confirmed by ultrasound. Total excision when possible is the treatment of choice. Otherwise partial excision or partial excision with marsupialization offers a satisfactory alternative. Congenital solitary nonparasitic cyst of the liver is an uncommon lesion rarely presenting in infancy. It is therefore seldom included in the differential diagnosis of a rapidly enlarging abdominal mass. The cystic nature of the lesion may be confirmed by ultrasound. Total excision when possible is the treatment of choice. Otherwise partial excision or partial excision with marsupialization offers a satisfactory alternative.

A Case of Solitary Nonparasitic Cyst of the Liver

A Case of Solitary Nonparasitic Cyst of the Liver

Solitary nonparasitic cysts of the liver in childhood: A. M. Feller, P. Reifferscheid, and A. Flach. Z Kinderchir 32:321–328, 1981

Solitary nonparasitic cysts of the liver in childhood: A. M. Feller, P. Reifferscheid, and A. Flach. Z Kinderchir 32:321–328, 1981

Solitary nonparasitic hepatic cysts.

We reviewed eight cases of nonparasitic solitary hepatic cysts found in two community hospitals during a ten-year period ending in 1978. Diagnostic evaluation consisted primarily of ultrasonography, arteriography, liver scan, and upper gastrointestinal contrast studies. Six symptomatic patients were operated upon and two nonsymptomatic patients were observed. There have been no recurrences or operative deaths in this series. It is concluded that (1) solitary hepatic cysts are not as rare as previously thought; (2) the tools of ultrasonography, arteriography, and liver scan may be expected to increase diagnostic accuracy; and (3) operative therapy must be individualized to both the general condition of the patient and the location of the cyst.