Thick-walled Cysts Research Articles

Gray wolf (Canis lupus) is a natural definitive host for Neospora caninum

The gray wolf (Canis lupus) was found to be a new natural definitive host for Neospora caninum. Neospora-like oocysts were found microscopically in the feces of three of 73 wolves from Minnesota examined at necropsy. N. caninum-specific DNA was amplified from the oocysts of all three wolves. Oocysts from one wolf were infective for the gamma interferon gene knock out (KO) mice. Viable N. caninum (designated NcWolfUS1) was isolated in cell cultures seeded with tissue homogenate from the infected mouse. Typical thick walled tissue cysts were found in outbred mice inoculated with the parasite from the KO mouse. Tissue stages in mice stained positively with N. caninum-specific polyclonal antibodies. Our observation suggests that wolves may be an important link in the sylvatic cycle of N. caninum.

A Rare Presentation of Mass Abdomen

An elderly male who had undergone inguinal hernia surgery eight years back presented with an intra-abdominal mass. Clinically and radiologically it was diagnosed as mesenteric cyst. Laparotomy revealed a thick walled cyst embedded in the omentum, containing brownish necrotic material and few 'linen thread knots'. On the basis of the latter finding the mass was thought to be a walled off hematoma, a complication of previous hernia surgery. Such a complication of inguinal surgery has not been reported earlier.

Pulmonary langerhans cell histiocytosis in adults: high-resolution CT—pathology comparisons and evolutional changes at CT

To compare high-resolution (HR) CT and histopathological findings and to evaluate serial CT findings in pulmonary Langerhans cell histiocytosis (PLCH). We reviewed CT of lung lesions in 27 adults (M:F = 20:7, mean age, 41 ± 12.3 years) with PLCH. After evaluating lung abnormalities including nodules, micronodules, thick-walled, thin-walled, and bizarre-shaped cysts and reticulation, observers compared CT findings obtained at lung biopsy sites with histopathological findings. The final CT was compared with the initial CT to determine disease extent changes. The most frequently observed patterns of lung abnormalities were micronodules (n = 24, 89%), thick-walled (n = 22, 82%), and thin-walled (n = 22, 82%) cysts. Even thin-walled and bizarre cysts harboured active inflammatory Langerhans cell sheets and eosinophils in their walls. In thin-walled cysts, we noted pericystic inflammatory cell infiltrations along the alveolar walls, as well as pericystic emphysema. Thin-walled or bizarre cysts demonstrated a tendency to coalesce with surrounding cysts via their cystic wall destruction. Fourteen (52%) patients showed improvement and nine (33%) showed progressing disease. More than half of patients with pulmonary PLCH show improvement at follow-up CT. Even thin-walled cysts harbour active inflammatory cells on histopathology and exhibit improvement at follow-up CT.

Investigation of interleukin-1 alpha and interleukin-6 expression and interleukin-1 alpha gene polymorphism in keratocystic odontogenic tumors and ameloblastomas

In jawbones, ameloblastomas and odontogenic keratocysts share many clinical features in common such as aggressiveness, high recurrence rates and radical management options. Understanding the pathogenesis and biological aspects of these tumors would improve the success of diagnose and treatment procedures. The aim of this study was to exhibit the reasons of high recurrence rates and growth potentials of ameloblastomas and keratocystic odontogenic tumours by investigating the expression of IL-1α and IL-6 and IL-1α -889 gene polymorphism. IL-1α and IL-6 are shown as very effective tissue degrading factors in bone remodelling. This study included 25 cases of ameloblastomas, 41 cases of keratocystic odontogenic tumors (parakeratinized odontogenic keratocysts) and 8 cases of orthokeratinized odontogenic keratocysts. All histological slides were stained immunohistochemically to show the expression of IL-1α and IL-6. Restriction fragment length analysis was used to investigate the cytokine gene polymorphism. The higher expression rates of IL-1α and IL-6 were associated with tumor size in ameloblastomas and with cyst wall thickness in keratocystic odontogenic tumors. This finding suggested us that the cytokines IL-1α and IL-6 play a role on aggressive behaviour of ameloblastomas and keratocystic odontogenic tumors by making easy bone resorption. In addition, IL-1α (-889) T polymorphism was found consistent with increased IL-1α expression but not seem as a risk factor on the development of these tumors.

Echinostoma revolutum: metacercariae in Filopaludina snails from Nam Dinh Province, Vietnam, and adults from experimental hamsters.

We detected metacercariae of Echinostoma revolutum in Filopaludina sp. snails purchased from a local market in Nam Dinh Province for the first time in Vietnam. Adult flukes were harvested from experimentally infected hamsters at days 14 and 17 post-infection. The metacercariae were round, 170-190 µm (n=15) in diameter, with a cyst wall thickness of about 12 µm. A total of 37 collar spines were arranged around the head collar, and large excretory granules were seen in 2 canals of the excretory bladder. The 14-day old adult flukes were elongated, ventrally curved, and 5.0-7.2×0.8-1.3 mm (n=20). The head collar had a total of 37 collar spines arranged in 2 alternating rows, including 5 corner spines on each side. The cirrus sac contained a saccular seminal vesicle, a prostatic gland, and an unarmed cirrus. Two tandem testes were smooth or slightly lobed. Eggs were ovoid to elliptical, 110-118×70-75 µm. These morphological characters were similar to those of E. revolutum and E. jurini. We tentatively identified it as E. revolutum because the validity of E. jurini remains to be elucidated. The taxonomic relationship of E. revolutum and E. jurini is discussed.

Diffuse Large B-Cell Lymphoma Associated with Chronic Inflammation Manifested as a Soft Tissue Mass: Incidental Discovery on Histological Examination

We report an extraordinary case of diffuse large B-cell lymphoma arising in a cystic necrotic mass in a 35-year-old man who presented with a soft tissue mass at the site of previous surgery. A benign mass was surgically removed 17 years ago, after which a cystic lesion gradually developed at the same site. The resected mass appeared as a thick-walled cyst filled with brown necrotic and hemorrhagic material. On microscopic examination, the cyst wall was primarily necrotic tissue with some aggregates of large atypical lymphoid cells. These atypical cells were diffusely positive for CD20 and showed a high proliferation index, Epstein-Barr virus positivity, and clonal rearrangement of the immunoglobulin gene. His present condition was diagnosed as Epstein-Barr virus-associated diffuse large B-cell lymphoma arising from chronic inflammation. It is important to be aware of the clinical manifestations and histological features of this rare disease in light of diagnosis and treatment.

The predictive value of suspicious sonographic characteristics in atypical cyst-like breast lesions

Background and purpose Simple breast cysts are a common sonographic finding and do not require further diagnostic evaluation. In contrast, atypical breast cysts do harbour a risk of malignancy. The purpose of this study was to evaluate the predictive value of sonographic findings that are considered characteristic of malignant atypical cyst-like lesions. Patients and methods Six descriptive sonographic criteria of 202 atypical cysts in 176 women were compared with histopathological findings after surgical excision and their statistical association was evaluated. Results Of these six criteria thick cyst wall ( p < 0.0001), lobulation ( p = 0.0001) and hyperechogenicity ( p = 0.003) were found to be highly predictive of breast cancer. The presence of two or more sonographic criteria was associated with a 10.3 times greater risk of malignancy ( p < 0.0001). Conclusion The association between suspicious sonographic criteria and histology after surgery was evaluated. We propose surgical excision when two or more sonographic criteria are diagnosed in a single atypical breast cyst.

Cystic Echinococcosis Due to Echinococcus Equinus in a Horse from Southern Germany

In Europe, cystic echinococcosis is rare in horses and is mostly diagnosed at slaughter or postmortem examination. Equine cystic echinococcosis can be caused by various Echinococcus taxa, but only Echinococcus equinus (the "horse strain") is known to produce fertile cysts. In Europe, E. equinus appears to be endemic in Great Britain, Ireland, Spain, and Italy and has sporadically been reported in Belgium and Switzerland. The present report describes the first case of a molecularly confirmed E. equinus infection in a horse foaled and raised in Germany. The 19-year-old mare was presented for examination of inappetence, emaciation, and respiratory symptoms. X-ray radiographs of the thorax showed 2 well-circumscribed tumor-like masses, each approximately 10 cm in diameter in the caudal lung field. The horse was euthanized as its condition rapidly deteriorated. Necropsy revealed 2 thick-walled hydatid cysts, each 7-8 cm in diameter in the lung. The tri-layered cyst walls consisted of an outer adventitial layer, a laminated acellular intermediate layer, and an inner germinal membrane. Grossly, the cysts contained a clear, amber liquid with hydatid sand. Light microscopy of the hydatid sand revealed free protoscoleces, intact and ruptured brood capsules, calcareous corpuscles, and debris. Samples of protoscoleces underwent molecular characterization, and the diagnosis of E. equinus was confirmed by restriction fragment length polymorphism-polymerase chain reaction and sequence analysis of the complete mitochondrial nicotinamide adenine dinucleotide dehydrogenase subunit 1 gene.

Histiocytose langerhansienne pulmonaire de l’adulte

Pulmonary Langerhans-cell histiocytosis in adults is a rare condition of unknown etiology characterized by the accumulation of Langerhans cells organized in granulomas involving the distal bronchioles and destroying their walls. It occurs in young subjects who smoke, with frequency peaking between 20 and 40 years. High-resolution thoracic CT is essential for diagnosis; in typical forms it shows a combination of nodules, cavitary nodules, thick-walled cysts, and thin-walled cysts. Diagnostic certainty requires a surgical lung biopsy, by videothoracoscopy, but only if a specialist considers it indicated. It is difficult to predict the disease course for any given patient. A prospective multicenter cohort study currently underway should provide more information about the natural history of this disease. Management is empirical, for efficacy has not been proved for any treatment. Stopping smoking is especially important to prevent the added development of chronic obstructive pulmonary disease (COPD), cardiovascular complications, or the onset of bronchopulmonary cancer, the frequency of which appears elevated in these patients. Oral corticosteroids are used to treat disease progression, especially in the symptomatic mainly nodular forms, but their efficacy for respiratory function has not been shown. Vinblastine, the reference treatment for multisystem forms of Langerhans-cell histiocytosis, is not indicated for pulmonary involvement in adults. Better knowledge of the pathogenic mechanisms involved in this condition should eventually make it possible to develop innovative treatment strategies. The creation of the national reference center for Langerhans-cell histiocytosis has given new momentum to clinical and pathophysiologic research on this orphan disease.

Branchial remnant cysts of mature and juvenile horses

This clinical report describes 8 cases of branchial remnant cysts (BRC) in the horse. The horses presented with bimodal age distribution, with 5 cases in mature horses (age 8-21 years) and 3 in foals (age 1, 6 and 10 months). Mature cases presented for dysphagia or intermittent oesophageal obstruction (2/5), and retropharyngeal swelling (3/5), whereas respiratory stridor and visible mass were presenting complaints in the foals. Presence of a right-sided (5/8) or dorsally located (2/8) palpable retropharyngeal mass of 3-35 cm diameter was noted clinically; one left-sided mass was identified as an incidental finding at necropsy. Ultrasonography typically revealed a thick-walled cyst containing hypoechoic fluid with dependent hyperechoic masses consistent with blood clots. Radiographs and upper airway endoscopy were also consistent with a retropharyngeal mass. Fluid cytology revealed chronic haemorrhage in 6/8 cases, and squamous epithelial cells in one case. Histopathology in all cases demonstrated an epithelium-lined cyst with no smooth muscle or thyroid tissue. Two cases was subjected to euthanasia; one due to concurrent laryngeal anomalies and one due to financial constraints. The remaining 5 cases were treated via surgical excision. Post operatively, right laryngeal hemiplegia was observed in 4/5 cases. All previous reports of BRC in the horse have described juvenile individuals. Brachial remnant cyst should be considered a differential diagnosis for mature horses with masses of the throatlatch area and can be definitively diagnosed by the presence of squamous epithelium in aspirated fluid or by histopathology of the excised mass. Right recurrent laryngeal nerve damage is a common complication of surgery.

Muscular sarcocystosis in wild carnivores in Honshu, Japan

A total of 65 free-living carnivores collected on Honshu Island, Japan were examined for muscular Sarcocystis species infections. Among them, 12 Japanese raccoon dogs (Nyctereutes procyonoides viverrinus), one Japanese red fox (Vulpes vulpes japonica), three Japanese martens (Martes melampus melampus), and two Japanese badgers (Meles meles anakuma) were found to have sarcocysts in their muscles. No inflammatory reactions associated with sarcocysts were observed. Ultrastructurally, the sarcocysts detected in the Japanese raccoon dogs, Japanese red fox, and Japanese martens were similar to each other, with the sarcocyst wall being thin and exhibiting minute undulations. On the other hand, the sarcocysts detected in the Japanese badgers had a thick cyst wall with numerous finger-like protrusions which contained microtubules. The species of Sarcocystis in Japanese carnivores remain to be determined. This is the first published report on muscular sarcocystosis in Japanese carnivores.

The intricacies of dinoflagellate pellicle cysts: The example of Alexandrium minutum cysts from a bloom-recurrent area (Bay of Baiona, NW Spain)

Abstract The terms “temporary”, “pellicle”, and “ecdysal” cyst have been employed arbitrarily in the literature of the dinoflagellate life cycle to describe a non-motile and single-layered-wall stage with no mandatory dormancy period, of asexual or sexual origin. These three terms have been used more or less synonymously, but more specific definitions, taking into account morphological and physiological aspects and their roles in dinoflagellate population dynamics, are still needed. To clarify the current terminology, we examine and discuss the usages and foundations of those terms. The background for this discussion is provided by a comparison of the morphology and germination times of three different types of Alexandrium minutum cysts collected during a seasonal bloom in the Bay of Baiona (NW Spain). The double-walled cysts were similar to the resting cysts reported for this species, but other, thin-walled and thecate cysts were also observed. These latter cyst types needed between 1 and 17 days to germinate and were therefore considered as short-term cysts, in contrast to the 1.5-month dormancy period of resting (hypnozygotic) cysts. Our results showed that the temporal distribution of these short-term cysts during the bloom period followed a pattern very similar to that of vegetative cells. However, resting cysts were only detected at the end of the bloom. In the context of our present knowledge regarding the dormancy and quiescence of dinoflagellate cysts, “temporary” is a very misleading and uncertain term and must be rejected. The term “ecdysal” has been used in reference to thin-walled cysts when ecdysis has been proven; however, ecdysis is not unique to this type of cysts as thick-walled zygotic cysts can be formed thorough ecdysis of a thecate planozygote. In conclusion, based on our current understanding of cysts, the term “pellicle” more appropriately describes single-layered-wall stages.

Development and Ultrastructure of Cystoisospora canis Nemeséri, 1959 (syn. Isospora canis) Monozoic Cysts in Two Noncanine Cell Lines

Cystoisospora canis is a coccidial parasite of the intestinal tract that can cause severe disease in dogs. Clinical signs include watery diarrhea, vomiting, fever, and weight loss. Extraintestinal stages of Cystoisospora spp. have been demonstrated in the mesenteric lymph nodes of paratenic hosts. Information on the biology of extraintestinal stages of canine Cystoisospora species is limited. The current study examined the development of C. canis in 2 noncanine cell lines and the ultrastructure of the monozoic cysts that formed. Monolayers of bovine turbinate cells and African green monkey kidney cells were grown on coverslips and inoculated with excysted C. canis sporozoites. Coverslips were collected on various days and fixed and stained for light microscopy (LM) or transmission electron microscopy (TEM). A single, centrally located, slightly crescent-shaped sporozoite surrounded by a thick cyst wall within a parasitophorous vacuole was observed with the use of LM and TEM. No division and no multinucleated stages were observed with either LM or TEM. With TEM, typical organelles of sporozoites were observed, such as rhoptries, dense granules, a crystalloid body, polysaccharide granules, and a conoid. The structure and ultrastructure of C. canis monozoic cysts produced in vitro are similar to extraintestinal cysts of other Cystoisospora species in experimentally infected animals and those of Cystoisospora belli observed in immunocompromised humans. This is the first study that fully demonstrates in vitro the development of what structurally resemble extraintestinal cysts of a Cystoisospora spp.

Pancreatic Cystic Neoplasm: The Role of Cyst Morphology, Cyst Fluid Analysis, and Expectant Management

Among pancreatic cysts, mucinous cystadenoma, and intraductal papillary mucinous neoplasms have the potential for malignant transformation. Differentiation between benign and potentially malignant/malignant (PMM) cysts remains difficult. The purpose of this study was to: (1) identify the diagnostic value of endoscopic ultrasound findings, serum, and cyst fluid tumor markers (CA19-9 and CEA), (2) determine the rate of subsequent surgical resection in patients initially managed conservatively, and (3) determine the role of cyst fluid viscosity "string sign" in differentiating pancreatic cysts. Patients with cytologic or pathologic diagnosis for pancreatic cystic neoplasms were analyzed. The study included 79 patients. Cyst fluid CEA had a median of 1.0 ng/mL in benign cysts and 471.1 ng/mL in PMM cysts (P < .0001). Cyst fluid CA 19-9 was not statistically significant (P = .22). Neither serum CA 19-9 nor CEA was useful (P = .68 and P = .31). Increased cyst fluid viscosity was associated with PMM cysts (P < .0001). Median string sign was 0 mm in benign cysts and 3.5 mm in PMM cysts. The presence of thick walls (5 of 5, 100%) or intracystic growth (6 of 6, 100%) were associated with PMM cysts. Of the 50 patients with PMM cysts, 19 were treated conservatively. In those patients followed for more than 6 months, 2 of 12 (16.7%) had surgical resection after a median of 29.5 months for worrisome changes on imaging. The presence of a thick cyst wall or intracystic growth, elevated cyst fluid CEA, and a long "string sign" were associated with PMM cysts. 16.7% of patients with a PMM cyst managed conservatively ultimately required surgical resection.

Abnormal Fluorodeoxyglucose PET in Pulmonary Langerhans Cell Histiocytosis

Pulmonary Langerhans cell histiocytosis (PLCH) is an inflammatory lung disease strongly associated with cigarette smoking and an increased risk of malignant neoplasms. Although the chest CT scan characteristics of PLCH are well recognized, the PET scan characteristics of adults with PLCH are unknown. We identified 11 patients with PLCH who underwent PET scanning over a 6-year period from July 2001 to June 2007. The presenting clinicoradiologic features including PET scan and chest CT scan findings were analyzed. Five of 11 patients had positive PET scan findings. Of the five PET scan-positive patients, 4 (80%) were women, 4 (80%) were current smokers, and the median age was 45 years (age range, 31 to 52 years). PET scan-positive findings were more likely to be present if the scan was performed early in the clinical course. Three PET scan-positive patients (60%) had multiorgan involvement. PET scan-positive patients had predominantly nodular inflammatory lung disease (> 100 nodules) with most nodules measuring < 8 mm, whereas all PET scan-negative patients had predominantly cystic lung disease with fewer nodules (< 25 nodules). Notable abnormal PET scan findings included foci of increased uptake in nodular lung lesions, thick-walled cysts, bone, and liver lesions. The mean maximum standardized uptake value of the PET scan-positive lesions ranged from 2.0 to 18.2. PLCH may be associated with abnormal thoracic and extrathoracic PET scan results. Patients with nodular disease seen on chest CT scans appear more likely to have abnormal PET scan findings. Our results suggest that PET scan imaging cannot reliably distinguish between the benign inflammatory nodular lesions of PLCH and malignant lesions.

Endometriosis of the Posterior Cul-De-Sac: Clinical Presentation and Findings at Transvaginal Ultrasound

The purpose of our study was to evaluate the clinical findings and transvaginal ultrasound features of posterior cul-de-sac endometriosis. A retrospective search of cases over a 13-year period was performed and yielded 25 patients with posterior cul-de-sac endometriosis. The diagnosis of posterior cul-de-sac endometriosis was confirmed by histology (n = 13), conventional barium enema (n = 13), colonoscopy (n = 8), CT (n = 8), MRI (n = 17), diagnostic laparoscopy (n = 14), and laparotomy (n = 13). All patients underwent transvaginal and abdominal ultrasound including power Doppler examination. Two radiologists working in consensus analyzed the clinical data and reviewed the imaging studies. All 25 patients presented with lower abdominal pain that was cyclic in six patients. Eleven patients were unintended childless. Rectal discomfort was mentioned by 17 patients, two of whom also reported rectal blood loss. At physical examination, eight patients had a palpable mass in the posterior cul-de-sac. Transvaginal ultrasound detected one or more hypoechoic masses in the posterior cul-de-sac in all 25 patients. All masses were solid, noncompressible, and localized on the serosal surface of the rectosigmoid with sparing of mucosa and submucosa. The lesions had a rounded or ovoid shape and a mean sagittal diameter of 37 mm with vascularity. The masses had a spiculated or tethering contour in 19 patients. Abdominal ultrasound detected thick-walled adnexal cysts in 11 patients, hydronephrosis in eight, and involvement of the ileocecal region in five. Patients with endometriosis of the posterior cul-de-sac frequently present with atypical noncyclic symptoms. The transvaginal ultrasound features characteristic of posterior cul-de-sac endometriosis are a solid, often spiculated, noncompressible mass near the posterior cul-de-sac that is localized at the serosal surface of the rectosigmoid, spares the mucosa and submucosa, and is vascular.

Do cyst wall thickness and cyst size have any effect on the intra-operative inadvertent rupture of echinococcal hydatid cyst of central nervous system?

Our primary aim was to investigate whether there is any association between thickness of the hydatid cyst's wall and size and whether it has any effect on intact removal of the cyst, independent of the surgeons' technique. Sixteen cases of echinococcal hydatid cyst of the central nervous system, operated on between 1991 and 2007 by various surgeons, were examined. Cyst diameter was directly measured on the specimen or calculated on radiological scans. Histological preparations were made identically by cutting 5-microm-thick longitudinal sections from paraffin blocks of formalin-fixed tissue and stained with HE. Wall thickness was measured using a micrometer by the same pathologist blinded to the measurements of cyst diameter. Cyst diameter and wall thickness correlated negatively (the larger the cyst the thinner the cyst wall); however this was not statistically significant. Neither the cyst size nor the wall thickness proved to be statistically significant as a factor having an effect on intact removal of the cyst. In conclusion, the cyst size and wall thickness do not have any effect on the intact removal of hydatid cyst. It seems that the use of appropriate surgical techniques play the most effective role in outcome of hydatid cyst surgery.

Progressive diffuse pulmonary Langerhans cell histiocytosis improved by cladribine chemotherapy

Langerhans cell histiocytosis (LCH) is a group of disorders characterised by monoclonal proliferation of histiocytic cells (Langerhans cells) producing tumour-like masses in multiple organs including the bone, skin, lymph nodes...

EUS-guided ethanol lavage with paclitaxel injection for septated cystic tumors of the pancreas

Background and study aims: EUS-guided intervention has been recently tried for treatment of cystic tumors. Factor which might influence the treatment response are presence of septation and mural nodule, and cyst wall thickness. This study aimed to evaluate the effectiveness of EUS-guided ethanol lavage with paclitaxel injection (EUS-EP) for treating septated cystic tumors of the pancreas.

Isolation and Characterization of Some Pathogenic Agents Causing Wobbling Syndrome in Cultured Oreochromis niloticus

It is the first study all over Egypt which is dealing with fish swimming abnormalities influenced by mixed pathogens. A total of 160 Oreochromis niloticus were collected from some private fish farms at Sharkia governorate during the period from January to December 2008. Fish through isolation and characterization of some pathogenic agents were classified according to these groups: - A-Normal group: Free from any pathogenic agent. B-Bacterial infected group: Four bacterial isolates recovered from gas bladder affection of O.niloticus were Flavobacterium columnare, Pseudomonas fluorescens, Vibrio harveyi, and Staph aureus. Fish infected with bacteria showed up-right position or swim on its lateral sides. C-Mycotic infected group: Gas bladder infected with Ichthyophonus hoferi showed thick walled multinucleated cysts present near blood vessels confirmed by isolation in MEM containing 10% foetal bovine serum. D-Parasitic infected group: Gas bladder infected with Goussia cichlidarum showing white nodules variable in size contain fragile walled oocysts, have four sporocysts with two sporozoites, identified by the morphometry. E-Wobbling group: Etiological agents of the wobbling syndrome were coccidian parasite G. cichlidarum, I. hoferi and a strain of F. columnare. In-vitro sensitivity test of isolated bacterial strains to different chemotherapeutic agents was conducted to determine the effective antibiotics against isolated bacteria. No treatment is known to I. hoferi infected fish. Treatment of O. niloticus group infected with parasitic G. cichlidarum by Mirazid has been tried with great success. The present study has succeeded in isolation, identification and characterization of some significant pathogenic agents dealing with parasitic, bacterial, and mycotic groups which act as the causative agents of wobbling disease and shed light on ignored diagnosis of wobbling disease in Egypt cultured tilapia.