Small Cysts Research Articles

Therapeutic Yoga for the management of Polycystic Ovarian Syndrome - A Review

Background: Polycystic ovarian disease is a lifestyle disorder with no specific etiology and it manifests as group of symptoms making its diagnosis difficult. PCOS is characterized by small cysts in the ovary where the women experience reproductive, psychological and hormonal imbalances which results in obesity, anovulatory cycle associated with Primary or Secondary infertility, hirsutism, irregular menstrual periods, excessive androgen levels, pregnancy related complications. The sedentary lifestyle, dietary variations, lack of exercise and stress are contributory factors. Decoding the exact cause of PCOS remains a challenge for scientists around the world. However, it's understood that PCOS is influenced by a combination of genetics and lifestyle factors. It is a multifaceted disorder that requires effective management to prevent possible long-term health issues. Stress is playing important factor in exaggerating PCOS. Therapeutic Yoga blends restorative gentle Yoga (supported postures), breath work (Paranayam) and meditation techniques combined in such a way that it is an excellent choice of treatment for PCOS. Treatment includes lifestyle modification, weight loss, stress management. Yoga can prove to be effective. Yoga poses stretch the pelvic area and Pranayama, meditation soothe the mind. Thus, Yoga regulates the endocrine glands in the body thereby beneficial in balancing of hormones. Yoga is one of the important refreshing and effective for bringing the body into balance and reducing stress.

Probiotic supplement for the treatment of polycystic ovarian syndrome.

Polycystic Ovarian Syndrome is one of the major prevalent causes of infertility reported worldwide nearly 6-26%, especially in girls hitting puberty and women at their childbearing age. The main clinical manifestations include irregular menstrual cycle, small cysts on one or both ovaries, chronic oligo-anovulation, and hirsutism. The etiological criteria are very complex and related to many factors like obesity, insulin sensitivity, inflammation, hyperandrogenism, diabetes mellitus type II, cardiovascular diseases, and dysbiosis of gut microbiota. The given review focuses on managing PCOS through probiotics by analyzing the effects on the symptoms of the disease. The probiotics effective in treating PCOS belong to Bifidobacterium, Lactobacilli, Clostridium, Enterococcus, and other Lactic acid bacteria. Its significance in PCOS is mainly due to the antagonizing of the growth of pathogenic microorganisms, increasing intestinal mucus layer production, reducing intestinal permeability, and modulating the gastrointestinal immune system. Also, their interaction with certain hormones such as insulin, androgen, and estrogen through short-chain fatty acids influences fertility. More research is necessary to validate these results. Probiotic supplements could be a viable option for treating PCOS in adults.

Small bowel duplication cyst in the pediatric population—when to operate?

IntroductionAimThe aim of the study is to determine the optimal timing for surgery in patients with small bowel duplications.MethodsA retrospective cohort study, including all patients younger than 18 years who were diagnosed with small bowel duplications from 2013 until 2024 in a single tertiary medical center, was performed. Patients’ demographics, duplication size and location, pathological results, and clinical outcomes were collected.ResultsSixteen patients (nine boys, seven girls) underwent laparoscopic-assisted resection of small bowel duplication at an average age of 3 years. A prenatal diagnosis was made in 11 patients, 10 (91%) of whom underwent elective surgery at a median age of 1.3 years. Overall, six patients required semi-elective or urgent surgery due to bowel obstruction, abdominal discomfort, or symptomatic anemia, with most (83%) lacking prenatal evaluation. Elective surgery patients had significantly smaller duplications (13 cm3 vs. 135 cm3). Post-operative recovery was satisfactory in all patients, with an average hospital stay of 6 days.ConclusionIn conclusion, asymptomatic, small duplication cysts in the small bowel of pediatric patients can be managed expectantly and can be operated after the first year of age. This approach is safe and allows for laparoscopic exploration in older infants, yielding satisfactory outcomes.

Osteochondral lesions of the talus with small cysts may not affect the outcome of arthroscopic microfracture: A systematic review and meta-analysis

Osteochondral lesions of the talus with small cysts may not affect the outcome of arthroscopic microfracture: A systematic review and meta-analysis

Awareness of nutrition-related effects among Saudi women diagnosed with polycystic ovary syndrome: a cross-sectional study

Objective: This study aimed to assess women's knowledge about polycystic ovary syndrome (PCOS) and associated nutritional recommendations, as well as identify factors influencing their awareness. Methods: A cross-sectional study was conducted with a sample of women, aged 18 to 45 years, who were surveyed on their general and nutritional knowledge of PCOS. Data were collected through a structured questionnaire that assessed participants' awareness of PCOS, its symptoms, nutritional management strategies, and sources of information. Demographic factors such as age, marital status, education, and occupation were also analyzed about knowledge levels. Results: A majority of participants (90.4%) had heard of PCOS, with 88.2% correctly identifying that PCOS involves multiple small cysts in the ovaries, and 82.4% recognizing the link between obesity and PCOS. However, less than half (43.7%) were aware that diabetes can cause PCOS. Regarding nutritional knowledge, 75.0% of participants believed that specific foods could help manage PCOS, but only 48.6% knew specific dietary recommendations. Younger women, single women, and those with higher education exhibited significantly better knowledge. Additionally, healthcare professionals were identified as the most common source of information. Conclusions: The study found that participants had good general knowledge of PCOS but lacked awareness of important nutritional strategies like low-glycemic-index foods, protein sources, and omega-3 fatty acids. It highlighted the need for targeted educational programs, especially for older, married women and those with lower education, to improve PCOS management.

OCT Patterns of Macular Edema in Intermediate Uveitis

Objective. To evaluate characteristic OCT morphological characteristic of initial presentation and chronic recurrent macular edema (ME) in patients with intermediate uveitis.Materials and methods. The study included 35 patients (46 eyes) with uveitic macular edema in intermediate uveitis. The first episode of macular edema was diagnosed in 20 patients (26 eyes), 15 patients (20 eyes) present with chronic recurrent macular edema. OCT was performed on the Optovue RTVue XR Avanti. The following OCT morphological characteristic were evaluated: integrity of IS/OS line, the presence of hyperreflective foci, inner nuclear layer cysts, Henle fibers layer cysts, small single cysts, diffuse retinal thickening without cystic changes, the presence of subretinal detachment.Results. Four OCT morphological variants of uveitic macular edema were identified: diffuse macular edema, small single cysts, cysts in Henle fibers layer and the inner nuclear layer with and without subretinal detachment. In the group with diffuse macular edema, the median duration of macular edema was 3 months, macular edema with Henle fibers cysts, inner nuclear layer cysts with subretinal detachment presented after 5 months (median), small single cysts and cystic changes in the layer of Henle fibers and the inner nuclear layer were detected at later times (12 and 36 months, respectively). A strong negative correlation was found between best-corrected visual acuity and central retinal thickness in chronic recurrent uveitic macular edema (correlation coefficient — 0.7, p = 0.0001), while a moderate negative correlation was established in macular edema at initial presentation (correlation coefficient — 0.55, p = 0.0031). Integrity of IS/OS line was observed significantly more often (p = 0.002) in chronic recurrent macular edema (10 (83.3%)) than at initial presentation (2 (16.6%)). In the presence of IS/OS disruption, best-corrected visual acuity was significantly lower (p = 0.016).Conclusion. Identified four OCT morphological variants of uveitic macular edema were characterized by different periods of its duration, which may reflect different stages of macular edema evolution. Chronic recurrent macular edema and ME at initial presentation in uveitis are distinguished by different OCT predictors, which should be taken into account in assessing the effectiveness of treatment and prognosis of visual acuity.

Vitamin D Dependent Rickets 2A With Alopecia: Three Cases With Novel Genetic Variants

ABSTRACTVitamin D‐dependent rickets type 2A (VDDR2A) is a rare cause of infantile‐onset alopecia, characterized by severe hypotrichosis, small cutaneous cysts, early‐onset treatment‐resistant rickets, and hypocalcemia. Alopecia, often starting a few weeks to months after birth, may be the presenting feature. We present three cases of VDDR2A with genetic variants in the vitamin D receptor (VDR) gene, their clinical features and biochemical parameters. This case series emphasizes that early identification of this rare cause of alopecia and treating the metabolic abnormalities can improve bone health.

Clinical features of atypical solid-type congenital pulmonary airway malformation (CPAM) type 1.

Type 1 congenital pulmonary airway malformation (CPAM) is characterized by large, dilated cysts that rapidly expand due to aeration immediately after birth, often necessitating surgical resection. In atypical cases of CPAM type 1, fetal T2-weighted magnetic resonance imaging (MRI) reveals a low-intensity solid lung mass containing multiple irregular T2 high-intensity areas. Data were retrospectively collected for infants with atypical CPAM type 1 born at our hospital between March 2002 and December 2022. Four infants were identified, all presenting with a low-intensity solid lung mass on T2-weighted fetal MRI and requiring respiratory support after birth. Chest X-rays showed reduced aeration within the mass. Three infants with CPAM volume ratios (CVRs) ≥1.6 underwent emergency surgery on day 1 or 2 due to respiratory failure, while the fourth infant had elective surgery on day 9. Histological examination revealed small CPAM type 1 cysts (inner diameter [I.D.] 1-10mm), lined by ciliated columnar epithelium and surrounded by a solid component composed of proliferative mucous cells and smaller cysts (I.D. 0.1-0.6mm), lined by ciliated low-columnar or cuboidal epithelium resembling CPAM type 2 cysts. We managed four cases of solid-type CPAM type 1 with consistent findings on fetal MRI, chest X-ray, and histology. Larger CVRs were associated with the need for early neonatal surgery. Given the volumetric effect on surrounding lung tissue, early surgical resection may be required for large lesions.

Alveolar Echinococcosis - Diagnostic challenges of a parasitic disease on the rise in Europe - a case report.

A 45-year-old male presented with jaundice, abdominal discomfort, and weight loss. Abdominal ultrasound revealed intrahepatic cholestasis and cholelithiasis indicative of Caroli-syndrome. Subsequent magnetic resonance imaging demonstrated a corresponding 5 × 4 cm polycyclic, calcified mass and a distant 12 mm subhilar stenosis of the common bile duct resembling cholangiocarcinoma. Calcifications seemed unusual and brought up differential diagnosis of echinococcosis. Serology revealed an echinococcus antibody-titer of 33 U (cut-off > 11.5 U). However, the clinical presentation with jaundice, weight loss, and a distant subhilar stenosis of the common bile duct without association to the intrahepatic process led to underestimation of the positive antibody-titer. Thus, the patient underwent right hemihepatectomy for potential cholangiocarcinoma. Dense infiltrative small cysts interspersed the resected right lobe of the liver. Histopathology revealed a granulomatous inflammation surrounding typical cuticulas, confirming hepatobiliary alveolar echinococcosis. Alveolar echinococcosis is considered as one of the neglected diseases by the World Health Organization, although incidence is rising worldwide and specifically in Germany. Our case illustrates hurdles in diagnosing alveolar echinococcosis and underlines the importance to be aware of classical and rare clinical manifestations.

Comprehensive Evaluation and Management of Liver Hydatid Cyst.

Hydatid cyst infection is a severe disorder caused by exposure to the infectious form of the Echinococcus granulosus parasite, which is widespread worldwide. This study examined a total of 125 patients who were diagnosed with hepatic hydatid cysts based on clinical and surgical evaluations. Patients with cysts larger than 5 cm displayed markedly elevated levels of ALT, AST, and ALP in comparison to those with smaller cysts. The heightened levels suggest a disturbance in liver functionality resulting from the infection. Furthermore, the patients exhibited elevated serum bilirubin levels. An evident differentiation was observed between patients with cysts over 5 cm in size and those with smaller cysts, indicating have a higher effect on liver function in individuals with bigger cysts. A total of 225 hepatic hydatid cysts were diagnosed using CT scans. The predominant cyst phases seen were Stage I and II, accounting for 58% and 45% of cases, respectively. Upon diagnosis, 79% The cysts range in size from 5 to 10 cm. CT imaging provides additional features that aid in the identification of type I unilocular echinococcosis. However, it is important to note that no single imaging feature is clearly diagnostic of this type of cyst.. Nevertheless, imaging techniques can assist in differentiating these cysts from non-parasitic liver cysts. On the other hand, Type II, III, and V hydatid cysts can be accurately identified by their distinct imaging characteristics.

Recurrent GRHL fusions in a subset of sebaceoma: microscopic and molecular characterisation of eight cases.

Sebaceous neoplasms constitute a group of adnexal tumours, including sebaceous adenoma, sebaceoma and sebaceous carcinoma. Although mismatch repair deficiency may be observed, the nature of the genetic alterations contributing to the development of most of these tumours is still unknown. In the present study, we describe the clinical, microscopic, and molecular features of eight sebaceomas with GRHL gene rearrangement. Among these sebaceomas, four occurred in women and four in men; the median age was 63 years (range = 29-89). The tumours were located in the head and neck area in all cases. Microscopic examination revealed a well-demarcated lesion located in the dermis with focal extension into the subcutaneous tissue (three cases). The neoplasms displayed macronodular (eight cases), cribriform (seven cases) and organoid (six cases) growth patterns, occurring in combination. The tumours were mainly composed of immature basophilic cells associated with scattered mature sebocytes. Numerous small infundibular cysts were present in seven cases. Mitotic activity was low (none/one to four mitoses/mm2). Immunohistochemistry showed positivity for androgen receptor and p63. Preserved expression of MLH1, PMS2, MSH2 and MSH6 was observed in all cases. RNA-sequencing revealed RCOR1::GRHL2 (three cases), BCL6::GRHL1 (two cases), a BCOR::GRHL2 (one case), RCOR1::GRHL1 (one case) and TLE1::GRHL1 (one case) fusion transcript. Methylation analysis demonstrated that GRHL-fused sebaceomas form an independent cluster and highlight the proximity of such tumours with poromas with folliculo-sebaceous differentiation. In conclusion, we report recurrent fusions of the GRHL genes in a distinctive subset of sebaceomas harbouring infundibulocystic differentiation, a frequent organoid growth pattern and lack of mismatch repair deficiency.

Drug repurposing for hard-to-treat human alveolar echinococcosis: pyronaridine and beyond.

Human alveolar echinococcosis is a hard-to-treat and largely untreated parasitic disease with high associated health care costs. The current antiparasitic treatment for alveolar echinococcosis relies exclusively on albendazole, which does not act parasiticidally and can induce severe adverse effects. Alternative, and most importantly, improved treatment options are urgently required. A drug repurposing strategy identified the approved antimalarial pyronaridine as a promising candidate against Echinococcus multilocularis infections. Following a 30-day oral regimen (80 mg kg−1 day−1), pyronaridine achieved an excellent therapeutic outcome in a clinically relevant hepatic alveolar echinococcosis murine model, showing a significant reduction in both metacestode size (72.0%) and counts (85.2%) compared to unmedicated infected mice, which revealed significantly more potent anti-echinococcal potency than albendazole treatment at an equal dose (metacestode size: 42.3%; counts: 4.1%). The strong parasiticidal activity of pyronaridine was further confirmed by the destructive damage to metacestode tissues observed morphologically. In addition, a screening campaign combined with computational similarity searching against an approved drug library led to the identification of pirenzepine, a gastric acid-inhibiting drug, exhibiting potent parasiticidal activity against protoscoleces and in vitro cultured small cysts, which warranted further in vivo investigation as a promising anti-echinococcal lead compound. Pyronaridine has a known drug profile and a long track record of safety, and its repurposing could translate rapidly to clinical use for human patients with alveolar echinococcosis as an alternative or salvage treatment.

Uterine cysts in mares

This work is aimed at studying the etiology, prevalence, diagnosis, treatment of uterine cysts and their difference from the embryo during ultrasound examination. Endometrial cysts are often the cause of infertility and indicate pathological changes in the uterus, occurring in older mares. There are two types of uterine cysts: endometrial glandular cysts and lymphatic lacunar cysts. Endometrial cysts are usually smaller than lymphatic cysts located in the endometrium and are composed of endometrial glands. Lymphatic cysts cause obstruction of the lymphatic channels and appear as single or multilobular structures. Cysts can result from chronic degenerative changes in the endometrium and their clinical significance varies. For example, in terms of fertility, their influence is related to size, conditioning, content and location in the uterus. The presence of small cysts often indicates matte structures. In addition, larger or more active cysts have an impact on the course of pregnancy. Single large or small cysts can lead to embryonic pregnancy failure, which is the most difficult recognition of maternal pregnancy. Careful testing methods can effectively monitor the mare's condition and ensure the prospects for a successful pregnancy. This pathology is diagnosed using rectal and ultrasound examinations. There are many treatment options: they can be removed by surgery, hysteroscopic biopsy forceps, snare, laser (diode, CO2 or Nd/YAG laser), electrocoagulation or injection of 70 % ethanol (sclerotherapy method). But unfortunately, many cysts are prone to relapse. Sometimes the presence of cysts can interfere with the diagnosis of pregnancy or lead to an erroneous diagnosis of “multiple pregnancy”, since cysts under ultrasound exposure appear as filling fluid structures in the endometrial lumen. For this reason, it is important to be able to diagnose, predict consequences and treatment options in the mare.

What We Know So Far About ECG for Pancreatic Pseudocysts.

Background: Endoscopic cysto-gastrostomy (ECG) has become the treatment of choice for pancreatic pseudocysts (PPCs). Endoscopic drainage of PPCs requires the creation of an anastomosis between the lumen of the PPCs and the lumen of the gastrointestinal tract. Various types of stents are used for this purpose. The aim of the study is to compare the indications, quantity, and results of using double pigtail plastic stents (DPPSs) and lumen-apposing fully covered metal stents (LAMSs) in ECG. Methods: A retrospective analysis was conducted of 39 patients (24 men, 15 women) treated for PPCs in the Department of Digestive Tract Surgery and the Department of Gastroenterology and Hepatology between October 2018 and February 2023. The mean age of patients was 51.13 (28-77). Data about etiology, cyst diameter, type, and complications of the stents were collected. Results: DPPSs were placed in smaller cysts (108 vs. 140 millimeters, p = 0.04) and were maintained for a longer duration compared to LAMSs (106 vs. 34 days, p = 0.001). Cyst recurrence was reported less frequently in patients with a LAMS (0 (0%) vs. 4 (19.05%), p = 0.05) and the therapeutic success was non-significantly higher in the LAMS group compared to the DPPS group (100% vs. 85.71%), p = 0.095. Conclusions: Both DPPSs and LAMSs are characterized by high therapeutic success and low complication rates in patients undergoing ECG for PPCs.

Autopsy of a 45-year-old Man with Liver Failure Due to Polycystic Liver Disease

A 37-year-old man with autosomal dominant polycystic kidney disease (ADPKD) was admitted to our hospital with a liver volume of 8,000 cm3. Hepatic arterial embolization was performed using a microcoil but was ineffective. Eight years later, the hepatomegaly progressed to liver failure and death. At autopsy, the liver weighed 21.5 kg, and the entire liver had been replaced by cysts; in the few remaining areas of liver parenchyma, microscopic, small cysts of various sizes and fibrosis were evident, with only a few normal hepatocytes observed. Hepatic arterial branches developed; however, the portal vein could not be observed.

Integrin alpha1 beta1 promotes interstitial fibrosis in a mouse model of polycystic kidney disease.

Fibrosis is the cause of end-stage kidney failure in patients with Autosomal Dominant Polycystic Kidney Disease (ADPKD). The molecular and cellular mechanisms involved in fibrosis are complex and anti-fibrotic therapies have so far failed to make an impact on patient welfare. Using unbiased proteomics analysis on the Pkd1 nl/nl mouse, we found that expression of the integrin α1 subunit is increased in this model of ADPKD. In human ADPKD tissue and two single cell RNA kidney disease datasets, ITGA1 was also upregulated. To investigate the functional role of this integrin subunit in ADPKD, we generated a Pkd1 nl/nl Itga1 -/- mouse. We observed a significant reduction in kidney volume and kidney dysfunction in mice lacking the integrin α1 subunit. Kidneys from Pkd1 nl/nl Itga1 -/- mice had smaller cysts and reduced interstitial expansion and tubular atrophy. Picrosirius red staining identified a restriction in collagen staining in the interstitium and the myofibroblast marker α smooth muscle actin was also downregulated. Myofibroblast cell proliferation was reduced in Pkd1 nl/nl Itga1 -/- mice and primary fibroblast cultures demonstrated an abrogated fibrogenic phenotype in integrin α1-depleted fibroblasts. These results highlight a previously unrecognised role for the integrin α1 subunit in kidney fibrosis.

Growth dynamics of Rathke's Cleft cyst: a risk score system for surgical decision making

ObjectiveRathke's cleft cysts (RCCs) exhibit variable growth patterns, thus posing a challenge in predicting progression. While some RCCs may not cause symptoms, others can insidiously cause pituitary dysfunction, which is often irreversible, even following surgery. Hence, it is crucial to identify asymptomatic RCCs that grow rapidly and pose a higher risk of causing endocrinologic dysfunction. This enables timely surgical intervention to prevent permanent damage. Our study examines the growth rate of RCCs, identifies factors that accelerate growth, and discusses the clinical implications of these findings.MethodsA retrospective analysis of a prospectively maintained electronic database revealed 45 patients aged 18–80 years who underwent endoscopic endonasal surgery (EEA) for RCCs between 2010 and 2022 at our center. Of these, 20 required early operative intervention. The remaining 25 patients were followed closely clinically and radiologically before requiring surgery (initial conservative management group). We conducted an analysis of the factors predicting growth over time in this group. Using a regression model, we constructed a risk score system to predict RCC growth over time.ResultsPatients in the initial conservative group had smaller cysts and were generally older than those in the early surgery group. Patients with preoperative pituitary dysfunction showed a higher median growth of 1.0 mm in the longest diameter compared to those with normal pituitary function, with an increase of 0.5 mm. A sum of annual cyst growth of all (z, y, x) diameters, at a rate of 3 mm or greater, was associated with a clinically significant increase in the risk of pituitary dysfunction, exceeding 50%.The most significant factors predicting rapid growth in RCCs were smoking status, age, and T1-weighted magnetic resonance imaging (MRI) intensity of cysts. Smoking was the most critical risk factor for rapid cyst growth (p = < .001). Our risk score system accurately predicted RCC growth with a 74% accuracy rate, 73% sensitivity, and 75% specificity.ConclusionOur analysis showed a strong link between active smoking and the rapid growth of RCC. This novel finding has significant preventive implications but needs validation by a large population database. Surgical intervention for RCC currently is often reserved for symptomatic cases. However, utilizing our risk-based scoring system to predict rapidly growing cysts may indicate early surgery in minimally symptomatic patients, thereby potentially preserving pituitary function.

Duodenal Adenocarcinoma Arising from Brunner’s Glands, A Rare Case Report

Abstract Introduction/Objective Malignancies arising from the Brunner’s glands in duodenum are exceedingly rare with very few cases reported in the literature. Here, we reported a case of duodenal adenocarcinoma of Brunner’s gland origin that obstructed duodenum and extended to involve the pancreatic head. Methods/Case Report A 48-year-old woman came to the Emergency Department of our hospital with epigastric and right upper quadrant abdominal pain. CT imaging demonstrated a heterogeneously enhancing 8.4 x 5.4 x 6 cm mass involving the duodenal lumen, wall, and pancreatic head. An endoscopic ultrasound showed a large fungating, infiltrative, and ulcerative mass in the second portion of the duodenum distal to the ampulla but not involving it. The pancreatic and common bile ducts were uninvolved. Her endoscopic ultrasound biopsy was positive for adenocarcinoma. CA19-9 levels were normal. The patient received chemotherapy with subsequent Whipple procedure. Gross examination revealed an exophytic, tan-white mass with the epicenter in the duodenal wall obstructing the duodenal lumen and extending to involve the pancreatic head inferiorly. The mass was predominantly solid with a few small mucus cysts. Light microscopy demonstrated moderately differentiated adenocarcinoma with prominent necrosis and inflammation. There are intestinal-type, gastric-type and indeterminate types of epithelia in the carcinoma. There are areas in the duodenal wall where a continuous transition from benign Brunner’s glands to dysplastic glands and then to adenocarcinoma is present. Neither adenoma in the overlying duodenal mucosa nor abnormalities in the pancreatic parenchyma is observed. Immunohistochemical stains showed that the neoplastic cells are positive for CAM 5.2, AE1/AE3, and CK7, while only patchy positivity with CK20 and CDX2. Taken together, a diagnosis of duodenal adenocarcinoma arising from Brunner’s glands was rendered. Results (if a Case Study enter NA) N/A Conclusion More cases are needed in order to establish standard treatment guidelines and determine prognostic factors.

Small cyst size and lack of growth as negative predictors of malignant transformation in low-risk intraductal papillary mucinous neoplasms of the pancreas: A systematic review and meta-analysis.

For branch-duct intraductal papillary mucinous neoplasms (BD-IPMNs) without worrisome features (WFs) or high-risk stigmata (HRS), current guidelines recommend surveillance. However, these intraductal papillary mucinous neoplasm (IPMNs), especially the small and stable-sized ones, carry a low risk of malignant transformation. Our aim was to assess whether small cyst size and absence of rapid growth provide reassurance against the development of WFs/HRS and malignancy (high-grade dysplasia (HGD) or pancreatic cancer (PC)). PubMed/Medline, Embase, the Cochrane Library and the Web of Science Core Collection were systematically searched from inception to May 2023 to identify studies investigating surveillance outcomes of low-risk BD-IPMNs. Studies assessing baseline cyst size and/or growth in relation to WFs/HRS and/or HGD/PC were included. The Newcastle-Ottawa scale tool was used to assess study quality. Of the 1937 identified manuscripts, 21 studies were eligible for inclusion. The quality of these studies was considered reasonable. A negative association between cyst size and WFs/HRS development was found in 11 out of 13 relevant studies, but only one out of nine studies reported a negative association between size and malignancy. Regarding cyst growth, four out of six studies described a negative association with the development of WFs/HRS, and all six reported a negative association with malignancy. The pooled relative risk (RR) of developing WFs/HRS or malignancy for cysts ≤15mm was 0.37 (95% CI 0.25-0.57) and the RR of developing malignancy for cyst growth <2-2.5mm/year was 0.04 (95% CI 0.02-0.09)). This systematic review and meta-analysis shows that small and stable-sized low-risk BD-IPMNs are associated with a markedly low progression rate, with stable cyst size being the most reassuring feature. Because of substantial heterogeneity in definitions and reported outcome measures, prospective studies are needed to confirm that surveillance of small and stable sized cyst can be de-intensified or even discontinued.

6784 A Case of Euthyroid Hyperthyroxinemia due to Thyroid Binding Globulin Excess Syndrome

Abstract Disclosure: A.S. Iyer: None. Background: Congenital thyroid binding globulin (TBG) excess is a rare phenomenon associated with elevated serum total T3 and total T4 concentrations but normal serum concentrations of free thyroid hormones, with clinically euthyroid patients. While TBG excess can be caused by pregnancy, estrogen-secreting tumors, and estrogen therapy, congenital TBG excess follows an X-linked pattern, with hemizygous males most affected, and heterozygous females showing a spectrum of disease due to random inactivation of one X chromosome. Clinical Case: A 39-year-old Caucasian female presented as a referral from the Gastroenterology clinic due to concern for thyroid resistance syndrome. Symptoms included chronic constipation (improving with Miralax®), gradual weight gain of 8 pounds in one year, fatigue, and palpitations. She reported that her total thyroid hormone levels have always been elevated, with other thyroid labs remaining within normal limits, along with family history of similar labs noted in her two sons, father, and paternal grandmother. Upon initial encounter, TSH was 1.637 (0.430-3.550 uIU/mL), total T4 15.4 (4.8-11.7 ug/dL), total T3 231 (80-200 ng/dL), free T4 0.97 (0.70-1.25 ng/dL), free T3 3.2 (1.7-3.7 pg/mL), and albumin 4.2 (3.5-5.0 g/dL). The patient was not on oral contraceptive pills and she denied any pregnancies in the last three years. Thyroid ultrasound showed a normal-appearing homogeneous thyroid gland with a small cyst with colloid and no cervical lymphadenopathy. Initial differential diagnosis included TBG excess syndrome versus familial dysalbuminemic hyperthyroxinemia. Permission was obtained from the patient to access one of her son’s medical records from age 8-weeks old when he was also evaluated for abnormal thyroid labs. TSH was 2.144 (0.350-6.500 uIU/mL), total T4 28.2 (5.0-12.0 ug/dL), free T4 1.55 (0.8-1.8 ng/dL), and free T3 4.0 pg/mL (no reference available). Thyroid binding globulin was found to be elevated at 81 (12-26 mcg/mL) in her son and found to be elevated to 78.0 (13.5-30.9 mcg/mL) in this patient, confirming a diagnosis of TBG excess syndrome. Conclusions: TBG excess syndrome should be considered in the differential of patients with high total T3 and total T4 levels with normal levels of free T3, free T4, and TSH, especially in individuals who have a known family history and who have minimal or nonspecific symptoms. Definitive diagnosis will make further testing and treatment unnecessary. However, if these patients develop hypo- or hyperthyroidism, then use of TSH and free levels of T4 and T3 is necessary to direct management and avoid confusion. Reference: Pappa, T., and S. Refetoff. “Thyroid hormone transport proteins: Thyroxine-binding globulin, transthyretin, and albumin.” Reference Module in Neuroscience and Biobehavioral Psychology, 2017, https://doi.org/10.1016/b978-0-12-809324-5.03494-5. Presentation: 6/2/2024