Gastric Bronchogenic Cyst Histologically Diagnosed After Laparoscopic Excision: Report of a Case

Abdominal computed tomography of a 71-year-old man revealed a 3-cm mass in gastric cardia. Although the mass was widely attached to the gastric wall, no clear contrast enhancement was observed. Abdominal magnetic resonance imaging revealed the mass to have homogenous high intensity on T2W1 images and isointensity on T1W1 images. On diffusion-weighted imaging, no high intensity was observed. However, the mass had a smooth surface and was widely attached to the gastric wall, consistent with computed tomography findings. A gastric submucosal tumor was suspected. Laparoscopic tumor resection was performed. Histopathologic diagnosis of the mass was a bronchogenic cyst derived from the respiratory primordium originating in the foregut of the primitive intestine. Such cysts are mostly found in the mediastinum or thoracic cavity; their occurrence on the gastric wall is extremely rare. Despite this, we think that bronchogenic cysts should be considered in the differential diagnosis of abdominal unilocular cystic diseases.     

Ciliated foregut cyst of the gallbladder: report of a case

We report the rare case of a gallbladder cyst arising from the foregut remnants. A 36-year-old woman was referred to our hospital after screening ultrasonography (US) detected a tumor in the gallbladder. On admission, she was well and her blood analyses were all normal. US showed a cystic mass with internal high-echoic lesions, and computed tomography (CT) demonstrated a protruding tumor with slight enhancement in the gallbladder. Angiography provided no additional information; however, sequential CT-arteriography (CTA) clearly demonstrated that this tumor was a cystic lesion. Surgical exploration was performed, first because of the difficulty in establishing a definite diagnosis, and also because the patient wanted the tumor removed. The resected specimen contained a unilocular cystic tumor that looked like a submucosal tumor. Histologically, the wall of the cyst was lined by ciliated stratified columnar epithelium with interspersed goblet cells and underlying smooth muscle fibers. The mass was finally diagnosed as a congenital ciliated foregut cyst of the gallbladder. Cysts of the gallbladder are uncommon and the majority are acquired. To our knowledge, this represents only the fourth report of a ciliated foregut cyst of the gallbladder in the literature. Although rare, an awareness of this entity could allow a preoperative diagnosis to be made, whereby surgical exploration may be avoided. CT-A is a very useful diagnostic tool, especially when the nature of the tumor presents a difficult differential diagnosis.     

Bronchogenic cyst.

Two recent patients with bronchogenic cysts, presenting in an atypical manner, stimulated our review of this subject. Twenty patients with bronchogenic cysts have been treated at the Boston Floating Hospital over the past 20 yr. Of these patients, 19 out of 20 were symptomatic, the most common symptom being fever (6 out of 20). Half of our patients had no respiratory symptoms but only one was found to have an asymptomatic mass on chest x-ray. The majority of theses cysts were found within the pulmonary parenchyma, the right lung being affected three times more commonly than the left. These facts are at odds with the reports in the literature. Three were found in the neck. Bronchogenic cysts are generally thought to be small, solitary, and limited in area. However, a significant number in our series (8 out of 20) were large, multiple or multicystic, and involved segments, lobes, multiple lobes, and, on one occasion, an entire lung. The correct pre-operative diagnosis was made in only 30% of the cases. The fact that the diagnosis was often missed led to long delays in treatment resulting in recurrent infectious complications and repeated hospitalizations. The most common cause of error in diagnosis was failure to follow a pneumonia to complete resolution. Despite the frequent delays in diagnosis, surgical treatment was curative in all patients.     

Adult Wilms'' tumor mimicking hemorrhagic renal cyst

A 36-year-old man presented with macroscopic hematuria associated with right flank pain. Examination of the patient revealed a cystic mass in the right kidney. Because the mass had increased in size, enucleation of the mass was performed. Histopathological findings revealed nephroblastoma, therefore, radical nephrectomy was performed. We believe the pathogenesis of the cystic formation to be a process in which a tumor that had developed in the pericalyceal region spontaneously ruptured, exuding urine into the perinephric space, forming a cystic mass. The patient is alive with no evidence of disease 24 months after the operation.     

Lymphoepithelial cysts of the pancreas: Case report and review of the literature

The aim of this report was to describe the clinical and pathologic features of lymphoepithelial cysts of the pancreas, establish the differential diagnosis of other pancreatic cysts, and review the literature.A 53-year-old man was incidentally diagnosed with a pancreatic lesion after an abdominal CT scan. This study showed a solid mass in the tail of the pancreas not enhanced by helical CT. Endoscopic ultrasound examination revealed a low-density tissue mass on the surface of the pancreas, less echogenic than the surrounding parenchyma. Distal pancreatectomy and splenectomy were performed with a suspected diagnosis of mucinous cystic tumor. The patient has had an uneventful postoperative period, and the pathologic finding was a lymphoepithelial cyst of the pancreas. Lymphoepithelial cyst of the pancreas is an unusual and benign entity that must be taken into consideration when evaluating a cystic lesion of the pancreas because a different therapeutic approach may be required.     

Mucus-secreting presacral cyst

A mucus-secreting presarcal cyst was found in a 49-year-old woman who complained of dysuria. A routine rectal digital examination revealed a retrorectal mass. Diagnostic imaging demonstrated a large presacral cystic tumor. The cyst was removed through a transsacral approach. Histologically, the cyst membrane consisted of squamous and columnar mucus-secreting epithelium, and was diagnosed as a mucus-secreting presacral cyst.     

A case of completely isolated advanced enteric duplication cyst cancer performed partial pancreatectomy

IntroductionEnteric duplication cysts are rare and, in addition, isolated enteric duplication cysts are lower morbidity prevalence rate. These cysts lack a connection to the gastrointestinal tract or the adjacent mesenteric vasculature and have only been reported in 10 case reports. In these reports, only two reports were cases with malignant transformation. Our case was a report for the advanced cancer of the isolated enteric duplication cyst.Case presentationThe patient was a 43 year-old woman with slightly abdominal pain and mass formation. The abdominal contrast-enhanced computed tomography showed 130 × 100 × 90 mm huge cystic mass existed in right upper peritoneal cavity. The cystic mass had thickened wall and many enhanced nodules. As these imaging findings suggested a tumor originated from pancreas and the preoperative diagnose was suspect of mucinous cystic neoplasm. In operative findings, the tumor originated from pancreatic head and did not attach to gastrointestinal tract. Final pathology indicated the cyst was an isolated advanced enteric duplication cyst cancer and not originated from pancreas.ConclusionWe experienced an extremely rare case of completely isolated advanced enteric duplication cyst cancer. Unique to this case, the preoperative diagnosis was suspect of mucinous cystic neoplasm arising from pancreas head and partial pancreatectomy was performed. However, in the pathological findings, this cyst diagnosed advanced enteric duplication cyst cancer.     

Unusually rapid development of a lateral neck mass: Diagnosis and treatment of a branchial cleft cyst. A case report

IntroductionBranchial cleft cysts are benign lesions caused by anomalous development of the branchial cleft. Cases that arise in the lateral neck region are often misdiagnosed, resulting initially in inappropriate management.Case presentationWe describe a 32-year-old woman with a swelling on the right side of her neck and no pain during palpation or neck motion.DiscussionThe patient was evaluated using fine-needle aspiration cytology (FNAC), ultrasound, and magnetic resonance imaging (MRI) scans. The MRI showed a right-sided cervical mass with hyperintense content, well-defined margins, and no evidence of infiltration into surrounding structures, while FNAC found a yellow, pus-like fluid, keratinised anuclear cells, squamous epithelium, and a matrix of amorphous debris.ConclusionBased on the images and the patient’s symptoms, a surgical intervention was performed.     

Testicular epidermoid cyst in Klinefelter''s syndrome

A 38-year-old Japanese man was referred to our outpatient clinic for treatment of infertility. Semen analysis showed azoospermia. Chromosome analysis revealed a 47XXY karyotype, and non-mosaic Klinefelter's syndrome (KFS) was diagnosed. Upon physical examination, the patient's right testicular volume was 30 mL and the left testicular volume was 3 mL. Laboratory tests showed normal levels of lactate dehydrogenase, alpha-fetoprotein, and human chorionic gonadotropin beta-subunit. The plasma luteinizing hormone and follicle-stimulating hormone levels were increased to 15.7 mIU/mL and 45.9 mIU/mL, respectively. The plasma testosterone was decreased to 0.25 ng/mL. Magnetic resonance imaging showed a right testicular mass of low-signal intensity on the T1-weighted image and of high-signal intensity on the T2-weighted image. Therefore, the final diagnosis was KFS with a right testicular tumor. Thus, a right high orchiectomy was performed. Histological examination revealed an epidermoid cyst of the right testis. Epidermoid cysts in cases of KFS are rare. To our knowledge, only seven cases, including ours, have been reported in the literature.     

Epidermoid cyst originating from an intrapancreatic accessory spleen

We report a rare case of an epidermoid cyst originating from an intrapancreatic accessory spleen, in a 40-year-old Japanese man with no clinical symptoms. A cystic tumor in the pancreatic tail was detected incidentally by abdominal ultrasonography. The patient was referred to the KKR Tachikawa Hospital for further examination of the tumor. Preoperative imaging findings suggested that the tumor was an epidermoid cyst originating from an intrapancreatic accessory spleen. On both pre-and post-contrast computed tomography and magnetic resonance images, the solid compartment of the tumor had the same X-ray attenuation and intensity as the spleen. Upon surgical excision, the mass consisted of solid and cystic components that were macroscopically evident on the preoperative images. Microscopic analysis revealed that the solid component was an accessory spleen in the pancreatic tail, whereas the cystic component was lined with stratified epithelium representative of an epidermoid cyst. This is the thirteenth report (in English) of an epidermoid cyst originating from an intrapancreatic accessory spleen, and the first case to be diagnosed prior to surgery.     

Time-course ultrasonographic observation of a mesenteric pseudocyst of the sigmoid colon: Report of a case

A 35-year-old woman was referred to our hospital for investigation of lower abdominal pain and a feeling of fullness. At her first consultation, a transvaginal ultrasonography (US) revealed a homogeneous cystic mass in the lower abdomen. Over a period of 8 months the US findings of the content of this mass changed from fine and faint internal echoes to moderate amounts of irregularly contoured internal echoes. At laparotomy, the cystic mass, which measured 3.0 × 3.0 × 3.5 cm, appeared to arise in the sigmoid mesocolon and tightly adhered to the appendix. The cyst was unilocular and contained a slightly yellow gelatinous fluid. Microscopically, its wall was fibrous and lacked an epithelial lining, suggesting that it was a so-called pseudocyst arising from the sigmoid mesocolon. To our knowledge, this is the first case report documenting the time-course ultrasonographic observations of a mesenteric pseudocyst. Our findings suggest that the time-elapsed ultrasonographic changes might have been dependent on the interval between the onset of cystic formation and the US examination.     

An isolated intestinal duplication cyst masquerading as a mucinous cystic neoplasm of the pancreas: A case report and review of the literature

IntroductionEnteric duplication cysts presenting in adulthood are rare. Isolated enteric duplication cysts, which lack a connection to the GI tract or the adjacent mesenteric vasculature, have only been cited in six previous case reports.Case presentationA 48-year-old female presented with a four-year history of intermittent nausea, vomiting and abdominal pain. Computed tomography (CT) scan of the abdomen revealed a 7 cm multi-lobular, calcified, cystic lesion intimately involved with the pancreas. Endoscopic ultrasound (EUS)-guided fine-needle aspiration (FNA) was non-diagnostic; however, the cyst fluid Carcinoembryonic Antigen (CEA) level was significantly elevated leading to a presumed diagnosis of a mucinous cystic neoplasm (MCN) of the pancreas. Intraoperatively, the cystic mass was identified and notably did not have any true attachments to the neighboring pancreas, gastrointestinal tract or vasculature. Final pathology demonstrated an isolated small bowel duplication cyst.DiscussionIn this case a patient presented with a clinical picture consistent with an MCN of the pancreas. However, intraoperatively and on final pathology the mass was found to be an isolated enteric duplication cyst. This represents only the seventh such case report in an adult.ConclusionAlthough rare, isolated enteric duplication cysts can be considered in a patient presenting with chronic abdominal pain and an abdominal mass on imaging. In this case we demonstrate that an isolated enteric duplication cyst can clinically mimic an MCN of the pancreas.     

Retrorectal Epidermoid Cyst – a Rare Entity: the Effectiveness of a Transperineal Posterior Approach

Background: Presacral cysts are rare presacral tumours. The ideal treatment is a matter of debate.

Methods: We report the case of a 39-year-old woman referred to our institution for a presacral mass, casually diagnosed during a pelvic ultrasound examination. Ano-rectal examination and MRI revealed the presence of a mass (53 χ 52 χ 54 mm) in the retrorectal space, located between the right pyriform muscle and the lateral rectal wall, without signs of invasion of the surrounding structures. We performed the intervention with a transperineal approach in the jack-knife position.

Results: Operating time was 20 minutes. During the postoperative period no complication was observed. The patient was discharged in good general condition. No complication occurred during 48 months follow-up. Conclusion: We chose this approach, because, although alternative approaches are described in the literature, they are based on a small number of patients, even if showing encouraging results. We found the posterior procedure safe, feasible and effective.     

Craniocerebral epidermoid and dermoid tumours: a review of 32 cases

Summary We reviewed 22 epidermoid and 10 dermoid tumours of the skull and brain from patients operated on consecutively at Henry Ford Hospital between 1975 and 1991.There were 19 intradural (16 epidermoid, 3 dermoid) and 13 extradural (6 epidermoid, 7 dermoid) lesions. The average age at presentation was 35 years for patients with epidermoids and 15 years for those with dermoids. Common clinical presentations for patients with intradural lesions included headache, visual deficits, and seizures, whereas patients with extradural lesions harbored asymptomatic scalp masses. All patients with intradural lesions were investigated with computed tomography (CT) and cerebral angiography, and 8 patients underwent magnetic resonance imaging (MRI).Total resection was possible in 12 (92%) of 13 extradural tumours, all with excellent outcomes. Eight (42%) of the intradural tumours were completely resected.Overall, with the intradural tumours we had good to excellent results in 17 patients (90%), poor results in 1 (5%), and 1 death (5%). Re-operation was needed in 5 intradural recurrences (26%) with deterioration in only one patient's neurologic status postoperatively.From a review of ours and others' data, we conclude that 1) these tumours have an insidious onset despite significant size and mass effect as demonstrated by imaging studies; 2) CT, angiography, and particularly MRI help to define the extent of subarachnoid tumour spread and involvement of neurovascular structures, thus permitting better surgical planning; 3) a significant number of intradural tumours are difficult to excise because of their adherence to neurovascular structures, and thus are related to higher morbidity and mortality; and 4) because of extremely slow growth, complete tumour resection should not be the goal at the risk of injury to neurovascular structures.     

Mesenteric cyst: an unusual presentation

A 5-year-old boy presented with the history of a small lower abdominal swelling since childhood which increased in size and became painful following a fall. Examination revealed a mobile, globular, cystic intraabdominal mass in the lower abdomen. Ultrasonography of the abdomen suggested a 7.5 × 5.5 cm cystic lesion, separate from the bladder, containing an echogenic mobile mass. Intra venous urography excluded any abnormality of the kidneys, ureters and bladder. Exploratory laparotomy revealed a sigmoid mesenteric cyst protruding out of one of the mesenteric leaves and attached to it by a narrow stalk. The excised cyst was found to be thin walled and unilocular. It was internally lined with fibrinous exhudate and contained serous fluid and a solid spherical blood clot. The child had an uneventful postoperative recovery. Histopathology of the cyst wall showed maturing granulation and fibrous tissue with hemosiderin laden macrophages and lymphoid aggregates consistent with the diagnosis of a lymphagioma with chronic inflammatory changes and evidence of past hemorrhage.     

Prevalence of renal cysts in a Middle-Eastern population: an evaluation of characteristics and risk factors

OBJECTIVE

To assess the prevalence of renal cysts in a large Middle‐Eastern population presenting for a health‐screening programme, evaluating cyst characteristics and risk factors for their development.

PATIENTS AND METHODS

The reported prevalence of renal cysts detected by ultrasonography (US) in the general population is 5.0–20.8%, and their development has been linked to several factors. The electronic charts of 8551 patients (from eight nations, predominantly Egypt and Yemen) presenting for the ‘check‐up’ programme at the author’s institution during 2005 were retrospectively reviewed. The presence and characteristics of renal cysts on abdominal US were noted, as were any associated renal pathologies. Various risk factors were evaluated for renal cyst development, i.e. age, gender, hypertension, diabetes mellitus and serum creatinine levels, and hyperlipidaemia and a history of bilharziasis were also assessed.

RESULTS

The prevalence of renal cysts was 4.2%, ranging from 0.6% for patients in their third decade, to a third of those aged >80 years. Cysts were detected in 4.8% of men and 2.8% of women (P < 0.001). The mean serum creatinine level was 1.02 mg/dL in those with cysts and 0.88 mg/dL in those without (P < 0.001). On univariate analysis, hypertension, diabetes and hyperlipidaemia had a significant influence on the occurrence of renal cysts, but not in the multivariate model. Of the 361 patients with renal cysts, 58 (16.1%) had bilateral and 26 (7.2%) had multiple unilateral cysts, with a mean (range) size of 26 (4–104) mm. The vast majority of cysts were classified as Bosniak I simple cysts; seven were Bosniak II and there was one Bosniak IV cyst. Associated renal pathologies included renal stones in 39 patients, hydronephrosis in nine, increased parenchymal echogenicity in 18, small atrophic kidneys in three, haematuria (not associated with other imaging abnormalities) in six, and a renal mass in one patient.

CONCLUSIONS

The prevalence of renal cysts detected by US in a health‐screened population from the Middle East was 4.2%. Increasing age, male gender and a higher serum creatinine level were significant independent risk factors for cyst development. There was also a relatively high prevalence of associated renal pathologies (increased parenchymal echogenicity and stones).     

Mediastinal cyst with rim calcification

A 58-year-old man who had been undergoing treatment for chronic pericarditis for 15 months was found to have a calcified mediastinal mass shadow on a chest X-ray and was referred to us for further study and treatment. Chest computed tomography and magnetic resonance imaging showed an anterior mediastinal multilocular tumor with rim calcification. Tumor markers were within normal limits. The patient was preoperatively diagnosed as having a calcified mediastinal cyst, and median sternotomy was performed to remove the cystic tumor and the surrounding thymic tissues. Histological examination revealed that the cyst wall consisted of dense fibrous tissue and calcification without epithelial cell lining on the inner surface. Thymic tissue was present around the cyst wall. Although we suspected a thymic cyst from the intraoperative findings, the final diagnosis was made as mediastinal cyst with rim calcification. We herein present a rare case of mediastinal cyst with rim calcification.     

Primary Hydatid Cyst of the Pancreas

Background: Hydatid cyst of the pancreas is rare, accounting for less than 1% of the various sites of hydatid disease, even in countries where echinococcosis is endemic. We report a case of pancreatic hydatid cyst to increase awareness for this important condition.

Case report: We describe a 33-year-old male with abdominal discomfort of one-year duration. On abdominal examination, there was mild tenderness with fullness in the right upper quadrant. Laboratory investigations revealed no abnormalities. Abdominal ultrasonography showed a cystic mass over the head of the pancreas. Abdominal CT scan confirmed the presence of a solitary cyst in the pancreatic head, with no enhancement on contrast CT. Indirect hemagglutination test for hydatid disease was negative. A pre-operative diagnosis of cystic neoplasm of the pancreas was made and laparo-tomy was done; on exploration there was a cystic mass arising from the head of the pancreas. A pericystectomy was carried out and the diagnosis of hydatid cyst of the pancreas was confirmed by histopathology. The postoperative period was uneventful and no recurrence was seen after 2 years of follow-up.

Conclusion: Pancreatic hydatidosis, though very rare, should be considered in the differential diagnosis of pancreatic cystic lesions in the appropriate epidaemiological setting.     

Tumor-Like Meniscal Cyst

A 50-year-old woman presented with a 5-year history of mild pain in her right knee, which had increased over the last 2 years. A palpable mass over the anterolateral aspect of the knee was obvious and the last 3 months she was experiencing locking episodes with consequent knee effusion. The differential diagnosis was driven between meniscal cyst, pigmented villonodular synovitis, synovial sarcoma, synovial chondromatosis, and aneurysm. After a diagnostic arthroscopy, the lesion was excised by a limited lateral arthrotomy. The pathologic findings revealed a synovial cyst. Intra-articular synovial cysts are uncommon, nonsymptomatic, and mostly incidental findings on magnetic resonance imaging (MRI) and arthroscopy. This lateral meniscus synovial cyst (2.5 × 2.5 cm) was enlarged within the intracondylar notch and produced disabling knee symptoms. The peculiarity of this lesion was the tumor-like appearance: its large size, the progress of symptoms, and the multilobulated, nonhomogenous signal on the MRI scan. One year postoperatively, the patient is asymptomatic and the MRI obtained at 6 months revealed no remnant of the fully excised cyst.     

Retrorectal epidermoid cyst in an elderly woman: Report of a case

An epidermoid cyst is a common occurrence in the skin. Such a cyst occurring in the retrorectal space, however, is extremely rare. We herein present a case of retrorectal epidermal cyst in a 67-year-old Japanese woman. She reported no symptoms and a perirectal mass behind the lower rectum was accidentally detected by computed tomography (CT). Contrast CT and magnetic resonance imaging revealed a cystic mass (76 x 70 x 63 mm) with a slightly enhanced thin wall which was attached to the lower rectum. The patient underwent surgery via a posterior approach. The mass was exposed after an excision of subcutaneous fat and was firmly adhered to the anal sphincter muscle. The cystic mass was completely removed without a proctectomy. Histologically, the cyst was diagnosed to be an epidermoid cyst. The postoperative course was uneventful, and the patient was discharged on postoperative day 9. A diagnosis of retrorectal cystic tumor is difficult, and a complete resection is necessary for the treatment of such tumors.