Thick-walled Cysts Research Articles

Smoking-Related Interstitial Lung Disease in a Non-Smoker

SESSION TITLE: Fellow Case Report Poster - Diffuse Lung Disease I SESSION TYPE: Affiliate Case Report Poster PRESENTED ON: Tuesday, October 25, 2016 at 01:30 PM - 02:30 PM INTRODUCTION: Pulmonary Langerhans cell histiocytosis (PLCH) is an uncommon diffuse cystic lung disease that occurs almost exclusively in young adult smokers. We present a case of PLCH in a non-smoker. CASE PRESENTATION: A 23-year-old male presented with acute onset of sharp, left-sided chest pain and shortness of breath. His past medical history was significant for two episodes of left-sided pneumothoraces, which were managed with chest tube placement. He did not have a history of current or prior cigarette smoking. He did not have a significant second-hand cigarette smoke exposure. On presentation, his vitals were stable. Physical examination revealed decreased breath sounds on the left side of the chest. Chest X-ray showed left-sided pneumothorax and bilateral diffuse interstitial infiltrates. He was treated with chest tube placement. CT of the chest revealed bilateral, multiple thick and thin walled cysts in the upper and middle lung fields with relative sparing of the bases. Video-assisted thoracoscopic lung biopsy (VATS) was obtained and mechanical pleurodesis was performed to treat his recurrent pneumothorax. Immunohistochemical staining for S-100 protein was positive in the Langerhans cells, consistent with PLCH. DISCUSSION: PLCH is a rare interstitial lung disease characterized by infiltration and proliferation of Langerhans cells. It occurs mostly in young adults, 20-40 years of age. Cigarette smoking is considered to be the inciting factor. There are no direct experimental data that support the role of cigarette smoke in the pathogenesis of PLCH. But, there are several observational studies, suggesting that the disease may be causally related to smoking. A history of current or previous cigarette smoking is identified in up to 97 percent of patients. PLCH has also been described in association with malignancy especially bronchogenic carcinoma and Hodgkin’s lymphoma. It is extremely rare in non-smokers and the etiology remains unknown. CONCLUSIONS: The overwhelming majority of adult patients with PLCH smoke cigarettes or were exposed to substantial second-hand smoke. PLCH has been described under the spectrum of smoking-related interstitial lung diseases. PLCH in non-smokers is not well studied. Reference #1: Suri H, Yi E, Nowakowski G, et al. Pulmonary langerhans cell histiocytosis. Orphanet J Rare Dis. 2012; 7: 16. doi: 10.1186/1750-1172-7-16 PMCID: PMC3342091 Reference #2: Abbott G, et al. Pulmonary Langerhans cell Histiocytosis1. Archives of the AFIP. DOI: http://dx.doi.org/10.1148/rg.243045005 DISCLOSURE: The following authors have nothing to disclose: Sathish Kumar Krishnan, Kumar Shah, Gurminder Dhillon No Product/Research Disclosure Information

Clinical comparison of two subtypes of cystic vestibular schwannoma: surgical considerations and outcomes

Cystic vestibular schwannoma (CVS) is classified as Type A and Type B based on the overall cyst location and cyst wall thickness in magnetic resonance imaging. A retrospective analysis was performed to compare surgical considerations and outcomes between Type A and Type B groups of CVS. We selected 188 patients diagnostic for CVS with surgical resection, and divided them into Type A and Type B groups. General information, preoperative symptoms, the result of neuroimaging, and audiological tests were recorded. Surgical approach, completeness of tumor resection, and intraoperative facial nerve (FN) integrity were taken down. After operation, the short-term and long-term FN functions, complications, and recurrence rate were evaluated. The total tumor removal rate in Type A group was higher than that in Type B group (86.1 vs 72.5%, p=0.021). Anatomical FN integrity was preserved in 173 patients (92.0%), with no significant differences between Type A and Type B. FN function was better in Type A group at hospital discharge. Besides, a good FN function rate was inversely proportional to the tumor size. The long-term FN function and all of the complications had no significant differences between the two groups. Patients in the Type B group are prone to have a lower total tumor removal rate and transient FN dysfunction. The long-term FN function was similar in both groups. Tumor size is another important indication of FN function. All postoperative complications occurred in patients with a tumor larger than grade 3, regardless of the subtypes of CVS.

Evaluation of risk factors for the recurrence of ovarian endometriomas

ObjectivesTo evaluate the risk factors for the recurrence of ovarian endometrioma after laparoscopic cystectomy. Study designReproductive aged patients who underwent laparoscopic ovarian endometriotic cystectomy and with histopathologically confirmed diagnosis of ovarian endometrioma were evaluated retrospectively. Histopathologic specimens were reevaluated and histopathologic characteristics of ovarian endometriotic cysts (thickness of cyst wall, thickness of fibrosis [ToF], thickness of ovarian tissue, the number of follicles per cyst, the depth of penetration [DoP] of endometrial tissue into the cyst wall) were determined. Along the determined histopathologic findings, demographic characteristics (age at surgery, number of pregnancies), clinical symptoms (dysmenorrhea, infertility), intraoperative findings (revised American Society for Reproductive Medicine [rASRM] stage), imaging features (bilaterality, cyst diameter), and biochemical parameters (Ca125, Ca19.9, Ca15.3) were evaluated as possible risk factors for the recurrence of endometrioma. The variables with p<0.2 in univariate analysis were introduced into regression analysis to determine the risk factors for recurrence. ResultsThere were statistically significant differences in age group (≤35 years and >35 years), the ToF and DoP between patients with recurrence and those with no recurrence. In Cox regression analysis, age ≤35 years and DoP were significant risk factors for presence of recurrence. DoP, ToF, preoperative cyst diameters in ultrasonographic examination were inversely correlated with recurrence interval. In multivariate regression analysis, the DoP was found the only significant risk factor for the recurrence interval. 1.2mm of DoP was found as the optimum cut off value for presence of recurrence according to Youden index criteria in ROC curve analyze. The sensitivity (62.9%), specificity (75%) were obtained at the cut off value of 1.2mm for DoP. ConclusionHistopathological features of ovarian endometriotic cyst may have important roles on predicting the recurrence of the endometrioma. Predicting the recurrence risk of particular patient is very important in future management of the disease. Knowing the recurrence risk of an endometrioma will help in deciding the optimal treatment modalities for each individual patient. High risk patients should be offered appropriate treatments according to the clinical status without delay and low risk patients should be protected from overtreatment.

Long-term follow-up of neoplastic pancreatic cysts without high-risk stigmata: how often do we change treatment strategy because of malignant transformation?

*Objective: Patients with potentially premalignant neoplastic pancreatic cysts without high-risk stigmata usually enter a surveillance program. Data on outcomes of such surveillance programs are scarce. We aimed to evaluate the resection rate and malignancy rate during follow-up.Material and methods: From our prospective database (2006–2015) of patients with pancreatic cysts, we analyzed patients with pancreatic cysts without high-risk stigmata with at least six months follow-up.Results: In total, 146 patients were followed for a median of 29 months (IQR 13.5–50 months). In 124 patients (84.9%), no changes in clinical or imaging characteristics occurred during follow-up. Thirteen patients (8.9%) developed an indication for surgery after a median follow-up of 25 months (IQR 12–42 months). Two patients did not undergo surgery because of comorbidity, 11 patients (7.5%) underwent resection. Indications for surgery were symptoms (n = 2), development of a pancreatic mass (n = 1), a new nodule (n = 2), thickened cyst wall (n = 1), pancreatic duct dilation (n = 3), and/or suspicion of mucinous cystic neoplasm (MCN) (n = 3). Postoperative histology showed one pancreatic malignancy not originating from the cyst, three mixed type-intraductal papillary mucinous neoplasm (IPMN), one side branch-IPMN, two MCN, one neuroendocrine tumor, one serous cystadenoma, one inflammatory cyst, and one lymphangioma. The highest grade of cyst dysplasia was borderline dysplasia.Conclusions: Most neoplastic pancreatic cysts without high-risk stigmata at initial presentation show no substantial change during 1–4-year follow-up. Only 7.5% of patients underwent surgery and less than 1% of patients developed pancreatic malignancy. This indicates that additional markers are needed to tailor treatment of pancreatic cysts.

Hemorrhagic Corpus Luteum With Generalized Abdominal Pain in Patients With Idiopathic Thrombocytopenic Purpura

Introduction: Idiopathic thrombocytopenic purpura is a platelet autoimmune hemostatic disorder. In this study, an ITP case with abdominal signs and hemorrhagic corpus luteum is presented.Case Presentation: The patient is a 28-year-old nonpregnant woman admitted to ED for constant acute abdominal pain, accompanied by nausea and vomiting. ITP was the prominent disease in her medical history which had been treated by corticosteroids. On physical examination, the patient had stable vital signs. Important paraclinic results were hemoglobin 8 g/dL and platelet count (7000 per microliter). Free fluid was reported in primary trans-abdominal sonography and CT scan. Finally, hemorrhagic corpus luteum was diagnosed in further radiologic studies.Conclusions: Hemorrhagic corpus luteum is known to simulate a number of medical, surgical and gynecological conditions that cause acute abdomen. Sometimes it may have unusual presentations. Moreover, hemorrhagic corpus luteum (cysts) is not always identified during sonography and their diagnosis is often challenging as a result of variations in their size, the thickness of cyst wall, and internal echo pattern. As such, it is suggested to consider both internal and gynecologic spontaneous hemorrhages even in controlled ITP and more attention is paid to gynecologic disorders in abdominal pain management.

Comparison of the international consensus guidelines for predicting malignancy in intraductal papillary mucinous neoplasms

This study sought to evaluate the predictors of malignancy in the 2012 international consensus guidelines for intraductal papillary mucinous neoplasms (IPMNs) and validate their diagnostic value relative to the 2006 guidelines. Between 2002 and 2014, 177 consecutive patients who underwent curative resection of IPMN were reviewed. Based on the 2012 guidelines, high-risk stigmata (mural nodule with enhancement, main pancreatic duct [MPD] ≥ 10 mm, and obstructive jaundice) and worrisome features (cyst size ≥ 30 mm, thickened cyst wall, mural nodule without enhancement, MPD 5-9 mm, an abrupt change in MPD diameter, and lymphadenopathy) were assessed, and predictive and diagnostic values were analyzed statistically. Multivariate analysis identified obstructive jaundice (odds ratio [OR], 23.9; P < .0001), abrupt change in MPD diameter (OR, 3.01; P = .017) and lymphadenopathy (OR, 5.84; P = .027) as independent predictive factors, with an accuracy of 69.8, 67.4, and 66.3%, respectively. Operative intervention was indicated in 156 patients (94.0%) using the 2006 guidelines, and in 130 (78.3%) using the 2012 guidelines. The accuracy of the 2006 guidelines was 35.5% compared with 44.8% for the 2012 guidelines. The area under the curve (AUC) for the 2006 and 2012 guidelines was 0.65 and 0.67, respectively; ΔAUC was 0.02, which was not statistically significant. When the worrisome features were combined with high-risk stigmata, the AUC increased to 0.79. Obstructive jaundice, abrupt change in MPD diameter, and lymphadenopathy were independent predictive factors in the 2012 guidelines with high accuracy. Using the new guidelines, the number of patients with IPMN managed with observation and the predictive accuracy increased.

Development of dual fluorescent stage specific reporter strain of Toxoplasma gondii to follow tachyzoite and bradyzoite development in vitro and in vivo

Toxoplasma gondii is a protozoan that infects 30% of humans as intermediate hosts. T Sexual reproduction can occur only within the intestinal tract of felines, however, infection in other mammals and birds is associated with asexual replication and interconversion between the tachyzoite and bradyzoite stages. Bradyzoites are slow growing forms found in tissue cysts in latent infection. Recently, our group described the biological behavior of the EGS strain that forms thick walled cysts spontaneously in tissue culture, constituting a useful tool for examining the developmental biology of T. gondii. To further improve the usefulness of this model, we constructed genetically modified EGS parasites that express fluorescent tags under the control of stage specific promoters. The promoter regions for SAG-1 (tachyzoite specific), BAG-1 and LDH-2 (bradyzoite specific) were amplified by PCR and plasmids were constructed with mCherry (redT) and sfGFP (greenB) sequences, respectively. Strains of parasites were selected using FACS to arrive at single fluorescent and dual fluorescent strains of EGS expressing tags in a stage specific manner. In cell cultures, vacuoles labeled by immunofluorescence assay using anti-CST-1 a marker for T. gondii cyst wall contained parasites that were positive for BAG1-GFP and negative for SAG1-mCherry. Tachyzoites and bradyzoites harvested from the mice expressed stage specific mCherry and GFP proteins, respectively. These new dual fluorescent transgenic EGS strains are a promising tool to elucidate the mechanisms of T. gondii differentiation both in vitro and in vivo.

Apolocystis proventus sp. nov. (Apicomplexa: Monocystinae) a New Species of Aseptate Gregarine from Egyptian Earthworms: Pheretima californica and Pheretima elongata (Annelida: Oligochaeta)

A new acephaline gregarine is described from the earthworms Pheretima californica and Pheretima elongata . The gregarine was either embedded in the pharyngeal glandular tissue or found free in the coelomic fluid around the pharyngeal region in front of the crop. Adult trophozoites measured 48–65 µm in diameter and are mostly active with a wavy pellicle. Heterogeneity in the endoplasm of active trophozoites was observed. Gametocysts measured 56–81 µm in diameter, with a characteristic thick cyst wall. Navicular sporocysts measured 5.8 ± 0.2 × 3.5 ± 0.4 µm, with small truncate plugs.

A Rare Case of Huge Unilocular Autoamputated Extra-ovarian Dermoid Cyst

Ovarian dermoid cysts are one of the commonest benign, pelvic tumours. However, presence of dermoid cysts at extra-ovarian locations is very rare. The extra-ovarian dermoid cysts can be of ovarian origin or may also originate from non-ovarian sites like omentum, retroperitoneum, mediastinum, etc. We report one such rare case of extra-ovarian dermoid cyst observed in a 70-year-old postmenopausal woman at department of Gynaecology of our hospital. Her ultrasonographic observations showed a large well defined cystic lesion predominantly in the left adnexa extending into the midline with internal echoes within, which was later confirmed with MRI. Following this, she underwent a total abdominal hysterectomy with vertical midline incision. Intraoperatively, she was found to have a large tumour of 3.25kg (28cm x 26cm x 11cm) with adhesion to the omentum on its anterior upper and posterior aspects. The surface of the oval mass was smooth with few adherent lobules of fat in some areas. Its gross cut section showed a thick walled uniloculated cyst with yellow areas and thick creamy white fluid. Cyst wall had a bony hard area and two balls of hair were also noted in side. The pedicle of the tumour seen to arise from the left side broad ligament close to left ovary. Uterus was atretic with an intramural fibroid. The dermoid appears to be derived from its autoamputation from one of the pelvic organs; probably ovary. It is unique in its size and vastness occupying the major part of the lower half of the abdominal cavity.

Imaging of mesothelioma of tunica vaginalis testis.

To describe the imaging findings in a series of patients with mesothelioma of the tunica vaginalis testis. We reviewed clinical data, imaging findings and follow-up information in a series of 10 pathology-proven cases of mesothelioma (all had US; 2 had MR) of the tunica vaginalis. A variety of patterns could be observed, the most common (5/10) being a hydrocele with parietal, solid and hypervascular vegetations; one patient had a septated hydrocele with hypervascular walls; one had multiple, solid nodules surrounded by a small, physiological quantity of fluid; one a cystic lesion with thick walls and vegetations compressing the testis; two had a solid paratesticular mass. MR showed multiple small nodules on the surface of the tunica vaginalis in one case and diffuse thickening and vegetations in the other one; lesions had low signal intensity on T2-w images and were hypervascular after contrast injection. A preoperative diagnosis of mesotheliomas presenting as solid paratesticular masses seems very difficult with imaging. On the contrary, the diagnosis must be considered in patients in whom a hydrocele with parietal vegetations is detected, especially if these show high vascularity. Mesotheliomas of the tunica vaginalis are rare, often challenging to diagnose preoperatively. Most common finding is a complex hydrocele with hypervascular parietal vegetations. Septated hydrocele, nodules without hydrocele, a thick-walled paratesticular cyst are less common. Preoperative diagnosis may allow aggressive surgical approach and, possibly, a better prognosis.

Treatment of Ovarian Cysts in Buffaloes with Emphasis to Echotexture Analysis

The present study was conducted on 31 buffalo-cows aged 3-10 years and diagnosed rectally as they had follicular cyst. The previous diagnosis of the follicular cyst was confirmed by ultrasonography and serum progesterone assay. Ultrasound images of the ovarian follicles, both mature and cystic follicles, were individually identified and monitored and were subsequently digitized for computer analysis of echotexture [mean pixel value (MPV) and pixel heterogeneity (PH)] of the follicle antrum and wall. Animals were classified into two groups (Treated, n=20 and control, n=11). The treated buffalo-cows injected i.m with 100mg progesterone oily in nature followed by i.m injection of 5000 IU HCG at days 5. Out of the twenty treated animals 14 buffaloes responded and diagnosed as they had luteinized cyst. Out of the 14 animals that had luteinized cyst 9 buffaloes injected with 25 mg of PGF2α at day 14 and the other 5 buffaloes left as control. The 6 non responded buffaloes were classified into two subgroups each (n=3), one of them injected with HCG and the other left as control without any treatment. The time elapsed till luteinization of the follicular treated group was significantly different (32.67 ± 1.45 days and 15.71 ± 0.75 days respectively). The recovery rate was 27.27 % in control animals and 70% in treated ones. Days elapsed till appearance of estrus was significantly shorter in treated buffaloes (22.20 ± 1.19 days) in comparison to the control ones (56.33 ± 2.03 days). The conception rates were 33.33% and 66.67% in control and treated group respectively. Days elapsed from the treated animals (36.50 ± 1.47 days) compared to the control ones (64 days). Serum progesterone level was significantly different in treated animals comparing to the control ones. Changes in echotexture of bovine ovarian follicles assessed by computer analysis of ultrasound images has revealed a significant increase in echotexture parameters (MPV & PH) in cystic follicles compared with preovulatory follicles. PH of the antrum and wall of luteinized cystic follicles increased significantly compared to preovulatory and cystic follicles. Ultrasonography examination and echotexture analysis has revealed a presence of positive correlation between the cyst wall thickness and progesterone level which consequently aids in the treatment protocol. From the present study, it could be recommended that accurate diagnosis of the ovarian cyst was done by ultrasonography in combination with echotexture characteristics of ultrasound images together with progesterone profile 2 weeks postpartum early as soon as possible; and the animals should be re-examined with 7-10 days if possible for re-treatment of non responded cases if necessary.

Image Case:Hepatic Hydatid Cyst ; an Incidental Finding in Patient with Blunt Abdominal Trauma

We reported a 13 years old male with blunt abdominal trauma presented with right upper quadrant pain at Emergency Department, Zagazig University Hospitals. It was diagnosed as hepatic hematoma and treated conservatively. Two weeks later, on abdominal ultrasound examination the liver showed large left lobe cyst with separated tissues and daughter cyst inside the sand consistent with Hydatid cyst (Figure 1), the case was further studied by abdominal CT that showed thick walled cyst (Figure 2) and confirmatory MRI was done (Figure 3).

Multiple, thin-walled cysts are one of the HRCT features of airspace enlargement with fibrosis

PurposeAirspace enlargement with fibrosis (AEF) has been identified pathologically as a smoking related change. We sought to identify the HRCT findings of AEF and search for distinguishing features from honeycombing. Materials and methods50 patients (47 males; mean age 69) were evaluated. All had undergone lobectomy for lung cancer and had confirmed AEF and/or usual interstitial pneumonia (UIP) by pathological evaluation. HRCT findings were first evaluated preresection for resected lobes, and then correlated with the subsequent pathological findings in the resection specimens. Three groups were devised: one with AEF alone to determine the HRCT findings of AEF, a second with AEF and UIP and third with UIP alone. HRCT features of AEF and honeycombing were compared. ResultsThere were 11 patients (10 male; mean age 69) with AEF alone, 24 patients (22 male; mean age 69) with AEF and UIP, and 15 patients (15 male; mean age 68) with UIP alone. The HRCT on the AEF alone showed subpleural (but not abutting the pleura) multiple thin-walled cysts (MTWCs) in 7 and reticular opacities in 3. The HRCT in AEF and UIP showed MTWCs in 10, reticular opacities in 17; and honeycombing in 5. Among these 35 patients with the pathological finding of AEF (with or without UIP), 17 showed MTWCs. The maximum cyst wall thickness of MTWCs (mean 0.81mm) was significantly thinner than that of honeycombing (mean 1.56mm). MTWCs did not locate in lung base and was distant from the pleura. HRCT findings correlated with gross findings on both cysts and honeycombing. No MTWCs were seen in the 15 patients with UIP, 8 of 15 had honeycombing on CT. ConclusionsWe confirmed that HRCT features of AEF were MTWCs and/or reticular opacities. MTWCs might be distinguished from those of honeycomb change. While we prefer the term MTWCs, these sorts of changes have probably been confused with/interpreted as honeycombing and/or empysema in the past.

Intrapulmonary bronchogenic cyst mimicking primary lung cancer with atypical radiological findings

Introduction: bronchogenic cyst is a congenital disease secondary to abnormal budding of the bronchial tree during embryonic development. It usually develops in the mediastinum and is rarely seen in the lung parenchyma. A diagnosis is often made before surgery because of its typical cystic appearance in computed tomography scan and magnetic resonance imaging scan. case report: A 71-year-old female presented with an abnormal shadow in her right lung on a chest radiograph. she underwent right upper lobectomy, under the suspicion that the nodule was primary lung cancer. Pathological examination showed an intrapulmonary bronchogenic cyst with a thickened cyst wall containing hyalinized fibrous tissue and lymphocyte infiltration. conclusion: Even an asymptomatic bronchogenic cyst might have been affected by an infectious event in the past, and could reveal a variety of atypical radiological findings.

Enteric duplication cyst located at the posterior tongue: a rare case report and review of the literature.

The lingual localization of an enteric duplication is extremely rare but may present with respiratory and feeding problems that require emergency intervention. A 7-month-old boy was brought to our clinic with feeding difficulties and tongue swelling. Physical examination showed a cystic lesion located near the left side of the tongue base that caused tongue protrusion to the contralateral side. During surgery, a 3-cm diameter opaque thick-walled cyst was found to be very closely adherent to the base of tongue, which was excised in its entirety. Following surgery, the patient fed during the early postoperative period and no complications were observed other than hypersalivation. On histological examination, a cystic lesion lined with intestinal mucosa and goblet cells was found. We present the rare case of a duplication cyst of the posterior tongue, with a literature review.

Correlation between ovarian chocolate cyst and serum carbohydrate antigen 125 level and the effect of ultrasound-guided interventional sclerotherapy on serum carbohydrate antigen 125 level.

This study was to investigate the correlation between ovarian chocolate cysts and serum carbohydrate antigen (CA)-125 levels and to demonstrate the effect of ultrasound-guided interventional sclerotherapy (UGIS) on serum CA-125 levels. Based on the serum CA-125 level, as determined by chemiluminescence detection prior to UGIS, 105 patients with ovarian chocolate cysts were divided into the normal group (CA-125 ≤ 35 U/mL, 45 patients) and the abnormal group (35 U/mL < CA-125 ≤ 200 U/mL, 60 patients). There were six clinical indicators including age, disease duration, dysmenorrhea history, child-bearing history, abortion history and surgical history. The ultrasonography characteristics were cyst diameter, cyst wall thickness and the side on which the cyst occurred. The correlations between serum CA-125 levels pretreatment and the clinical indicators and ultrasonography characteristics was analyzed. The serum CA-125 levels pretreatment, 3 months post-treatment and 6 months post-treatment were compared. The pretreatment serum CA-125 levels of the 105 patients positively correlated with disease duration (r = 0.3932, P = 0.0040), dysmenorrhea history (r = 0.2351, P = 0.0111), cyst diameter (r = 0.3415, P < 0.0001) and cyst wall thickness (r = 0.4263, P < 0.0001). Compared with the pretreatment level, the mean serum CA-125 level in the abnormal group at 3 months post-treatment was significantly lower (P < 0.01), and at 6 months post-treatment, the mean serum CA-125 level had decreased to a normal level (P < 0.01). UGIS significantly decreased abnormal serum CA-125 levels in patients with ovarian chocolate cysts.

Podoplanin expression in the cyst wall correlates with the progression of intraductal papillary mucinous neoplasm.

A thickened, enhanced cyst wall on imaging examinations is one of the "worrisome features" described in the consensus guidelines for management of intraductal papillary mucinous neoplasm of the pancreas (IPMN). Podoplanin (PDPN) expression by cancer-associated fibroblasts is known to be an indicator of poor prognosis in some types of cancer. We performed immunohistochemical staining for alpha-smooth muscle actin (α-SMA) in IPMN lesions and determined the pathological wall thickness by measuring the thinnest and thickest α-SMA-positive parts of the wall of the largest cyst in each case, and the mean of these two values was recorded as the wall thickness. The thickness of the pathological wall increased with progression from IPMN with low-grade dysplasia to IPMN with an invasive carcinoma. The pathological wall was thicker in IPMN with main duct involvement, nongastric-type IPMN, and IPMN with mural nodules. We also stained for PDPN and assessed the thickness of cyst wall staining as for α-SMA. The thickness of the PDPN-positive cyst wall varied in a pattern similar to the thickness of the α-SMA-positive pathological cyst wall. PDPN-positive stromal fibroblasts in the invasive component of IPMN-IC were evaluated as a ratio to α-SMA-positive fibroblasts. A high ratio (>50 %) of PDPN-positive stromal fibroblasts was a predictor of poor outcome. PDPN expression in the cyst wall correlates with the progression of IPMN. PDPN may be a significant prognostic marker of IPMN-IC.

Description of Metchnikovella spiralis sp. n. (Microsporidia: Metchnikovellidae), with notes on the ultrastructure of metchnikovellids.

The present paper reports results of a transmission electron microscopy study of a new metchikovellid microsporidium. It was isolated from gregarines Polyrhabdina sp. inhabiting guts of polychaetes Pygospio elegans sampled at the White Sea silt littoral zone. Free sporogony (FS) occurred in the life cycle of the microsporidium alongside sac-bound sporogony (BS). Free spores resided in a parasitophorous vacuole and were of typical metchnikovellidean structure, uninucleate and oblong. They measured on sections 2·0-3·2×1·3-1·9 μm. The life cycle included pre-sporogonial stages represented by dikaryotic cells and 4-nucleate cells with coupled nuclei. A multinucleate sporogonial plasmodium of FS split in numerous (>10) sporoblasts. In BS segregation of sporoblasts occurred within thick-walled cysts by internal budding. Spore sacs of this microsporidium, measuring on average 11·6×4·7 μm, were limited by a thick electron-dense wall, externally ornamented with spirally wound cords of dense material. These oval spore sacs contained eight barrel-shaped spores, comparable in size and ultrastructure to FS spores. Ultrastructure of both types of spores and intracellular development of the new microsporidium and Metchnikovella spp. were similar, suggesting they belong to the same genus. In this paper we describe a new species Metchnikovella spiralis and discuss morphology of metchnikovellids in the context of putative evolutionary history of Microsporidia.

Mo1439 Management Strategy of Pancreatic Cyst Patients Based on Integrated Molecular Pathology in 492 Patients: the Final Results of a Multicenter Study

retrospective chart review was performed on consecutive patients who underwent EUS with FNA of pancreatic cysts at one tertiary referral center from 2000-08 and second referral center from 2009 2012. Patients with personal or family history of pancreatic adenocarcinoma, known acute or chronic pancreatitis, cysts!15mm, or imaging features suspicious for malignancy on EUS (cysts with solid component, mural nodules, thick cyst wall and dilated pancreatic duct) were excluded. All patients who had either carcinoembryonic antigen (CEA) or cytological examination of the cystic fluid performed were included in the study. The cytology was considered diagnostic if it showed malignancy (defined as malignant cells, atypical cells or cells suspicious/suggestive of malignancy) or definitive diagnosis of serous or mucinous cyst. The cytology was negative if the sample was not satisfactory, acellular, paucicellular or had benign epithelial cells. Malignancy was confirmed by surgical pathology or metastases on imaging. CEA O192 ng/ml was considered mucinous,! 5ng/ml serous and values in between indeterminate. Results: 125 patients with benign appearing pancreatic cysts were included in the study. Cyst sizes were: 42 patients (33.6%) with cyst size 15-19mm; 45 patients (36%) 20-29mm and 37 patients (29.6%) O19mm. Cyst size wasn’t available in 1 patient. Samples were sent for cytology in 111 (89%) of these patients: 3 (2.7%) patients had malignant cells, 2 (1.8%) were diagnostic of mucinous cyst and 106 (95.4%) were indeterminate. 2/3 patients with malignant cytology underwent surgery and the pathology was completely benign. The third patient did not undergo surgery. Follow-up imaging after 4 years showed stable size of cyst and no evidence of malignancy. 1/2 patients where cytology was diagnostic of mucinous cyst, CEA was O192 ng/ml, it was not sent in the other due to viscous and insufficient fluid. In cysts when CEA was measured, the diagnostic yield of CEA was 68%. Cytology did not add have incremental diagnostic value over CEA and added $150 250 to the total cost of the procedure. Conclusion: Cytological analysis of benign appearing cysts is unnecessary and adds cost to the procedure without any incremental benefit. It can also lead to unnecessary surgeries. Checking CEA only may be sufficient and the most costeffective approach.

Sarcocystis sinensis is the most prevalent thick-walled Sarcocystis species in beef on sale for consumers in Germany

Bovines are intermediate hosts of Sarcocystis cruzi, Sarcocystis hirsuta, and Sarcocystis hominis, which use canids, felids, or primates as definitive hosts, respectively. Cattle represent also intermediate hosts of Sarcocystis sinensis, but the definitive hosts of this parasite are not yet known. Sarcocystosis in cattle is frequently asymptomatic. The infection is characterized by the presence of thin-walled (S. cruzi) or thick-walled muscle cysts or sarcocysts (S. hominis, S. sinensis, and S. hirsuta). Recent reports suggest high prevalence of the zoonotic S. hominis in beef in Europe. We therefore aimed at differentiating Sarcocystis spp. in beef offered to consumers in Germany using molecular and microscopical methods, focusing on those species producing thick-walled sarcocysts. A total of 257 beef samples were obtained from different butcheries and supermarkets in Germany and processed by conventional and multiplex real-time PCR. In addition, 130 of these samples were processed by light microscopy and in 24.6% thick-walled cysts were detected. Transmission electron microscopical analysis of six of these samples revealed an ultrastructural cyst wall pattern compatible with S. sinensis in five samples and with S. hominis in one sample. PCR-amplified 18S ribosomal DNA (rDNA) fragments of 28 individual thick-walled cysts were sequenced, and sequence identities of ≥98% with S. sinensis (n = 22), S. hominis (n = 5) and S. hirsuta (n = 1) were observed. Moreover, nine Sarcocystis sp. 18S rDNA full length gene sequences were obtained, five of S. sinensis, three of S. hominis, and one of S. hirsuta. Out of all samples (n = 257), 174 (67.7%) tested positive by conventional PCR and 179 (69.6%) by multiplex real-time PCR for Sarcocystis spp. Regarding individual species, 134 (52%), 95 (37%), 17 (6.6%), and 16 (6.2%) were positive for S. cruzi, S. sinensis, S. hirsuta, and S. hominis, respectively. In conclusion, S. sinensis is the most prevalent thick-walled Sarcocystis species in beef offered for consumption in Germany. Further studies are needed to identify the final host of S. sinensis as well as the potential role of this protozoan as a differential diagnosis to the zoonotic species S. hominis.