Borderline Serous Papillary Tumor Arising in a Paraovarian Cyst: A Case Report and an Extensive Review of the Literature

Background: Paraovarian cysts are benign cysts that develop near the ovaries and fallopian tubes in the pelvic region. They can cause mass effects requiring excision. In rare cases, tumors may develop inside these cysts. These tumors may be benign, malignant, or borderline. Case Report: A 26-year-old lady presented for excision of a paraovarian cyst. Pre-operative imaging showed the presence of few undulating folds at the periphery of the cyst. The patient underwent laparoscopic pelvic cystectomy without intra-operative drainage. Pathological examination of the specimen revealed a borderline serous papillary tumor protruding from the cyst wall. Conclusion: The occurrence of a borderline tumor, also known as a tumor of low malignant potential, in a pre-existing paraovarian cyst is very rare and has only been reported few times in the literature. A thorough review of these cases showed that the most common imaging finding that raises suspicion for a borderline tumor within a paraovarian cyst is the presence of small intracystic projections within the unilocular adnexal cyst. However, since evaluating the presence of an intracystic tumor is not always possible, performing a fertility-preserving laparoscopic cystectomy without cyst content spillage, is recommended. If properly excised, the prognosis of this tumor is good, and recurrence is rare.

Giant complex non-parasitic splenic cyst in a young boy: is laparoscopic spleen-preserving surgery safe?

Non-parasitic splenic cysts are an uncommon finding in pediatric patients. We report on a 14-year-old male presenting with a giant abdominal mass. Imaging documented a giant splenic cyst, and preoperative blood tests revealed high levels of CA125. Minimally invasive unroofing of the cyst was performed. Notably, the cyst content was hematic, but histopathological studies described a mesothelial cyst lining. To date, no recurrence has been noted. Laparoscopic spleen-preserving surgery appears to be a valid and safe treatment option in children with complex non-parasitic splenic cyst to preserve the splenic parenchyma.

Microbiome of Infected Cysts, Feces and Saliva in Patients with Autosomal Dominant Polycystic Kidney Disease: Case Reports

Background: Cyst infection is a frequent and serious complication of autosomal dominant polycystic kidney disease (ADPKD). It is often difficult to treat and can be fatal, but much is still unknown about this type of infection. Hematogenous spread via bacterial translocation in the intestine is considered to be the main cause, so intestinal flora may be involved. However, the exact role of the intestinal flora in cyst infection in ADPKD is unknown.Case presentation: We report a 66-year-old woman and a 56-year-old man with ADPKD who had severe hepatic cyst infection. We analyzed the microbiome of infected cyst content, feces, and saliva in these two patients. The microbiome of patient 1 showed various bacteria in an infected cyst, whereas that of patient 2 showed only one bacterium. In both patients, the composition of the microbiome of the cyst content was quite different from those of feces and saliva, and the main bacteria in the infected cyst content represented a small proportion of those in feces and saliva.Conclusions: Cyst infection in ADPKD can be caused by a single bacterium or multiple bacteria, and cyst content culture or blood culture may identify only some of the causative bacteria. The association between bacteria in cysts and those in feces or saliva remains uncertain, and further research on this topic is needed.

Bleomycin sclerotherapy following doxycycline lavage in the treatment of ranulas: A retrospective analysis and review of the literature

Objective A ranula is a mucus-filled salivary pseudocyst that forms in the floor of the mouth, commonly arising from the sublingual or submandibular salivary glands following obstruction or trauma. Complete excision of the injured gland and removal of the cyst content is the first-choice therapy, but has the potential for complications related to injury to nearby structures. As such, minimally invasive approaches such as percutaneous sclerotherapy have been investigated. We aim to contribute to the literature by assessing the efficacy and safety of our technique through our experience with 18 patients over the last decade. Methods This retrospective study evaluated 18 patients with intraoral and plunging ranulas treated by percutaneous bleomycin ablation. The primary endpoint was the treatment result. Secondary endpoints included bleomycin dosage and complications. Results The study evaluated 12 males and six females with a median age of 23.5 years (range 13–39 years). At a final follow-up of at least 2 months (6.5±5.5 months), four patients demonstrated complete response (22%) and 14 patients demonstrated residual presence, recurrence, or regrowth of the lesion (78%). There were no statistically significant associations between outcomes and history of prior treatment, number of treatments, and size or type of ranula. No complications were noted. Conclusions Our findings indicate that bleomycin, while safe for use in various head and neck malformations, is of limited utility in ranula therapy when the offending gland is not addressed primarily.

Percutaneous aspiration–injection–reaspiration (PAIR) for the treatment of abdominal cysts: Initial report in sheep and goat

Percutaneous aspiration–injection–reaspiration (PAIR), also called sclerotherapy, is a minimally invasive, inexpensive and safe technique for the treatment of abdominal cysts in humans. A study was planned to evaluate the feasibility of this procedure in the management of abdominal cysts in sheep and goat. Adult ewes (n = 5) and one doe (n = 1) found to have abdominal cysts (one cyst/animal) on repeated survey ultrasonography (USG) were included in the study. The animals were restrained in standing position. A hypodermic needle (G-18) securely attached to a 10-mL Dispovan syringe was carefully passed under ultrasound guidance into the abdominal cyst in all these animals. Depending on the size of the cyst, 1.0–5.5 mL fluid was aspirated, and 0.5–2.0 mL of 20% hypertonic saline solution infused. The needle was thereafter kept in situ for 10 min. The maximum possible volume of the cyst content was reaspirated and the needle withdrawn. On day 7, sclerotherapy was repeated in five animals showing no appreciable reduction in cyst size by USG. USG was repeated on days 30 and 90. All the cysts except one responded to PAIR during this period. From this study it can be concluded that sclerotherapy using hypertonic saline (20%) is a minimally invasive, inexpensive, effective and safe interventional ultrasonographic technique for the treatment of abdominal cysts in sheep and goats. However, the procedure needs further evaluation after using different sclerotic agents of varying concentrations and duration of their retention in the cysts in a sufficient number of animals with cysts.

A Rare Case of Malignant Transformation of Keratinous Cyst in Gluteal Region

Keratinous cyst (Epidermoid cysts) is more common and frequently encountered. It is one of the commonest benign lesion. Malignant transformation of keratinous (epidermoid) cyst is very rare. Epidermal cyst is noted as non-malignant condition. Few cases have shown malignant transformation of keratinous cyst into Squamous Cell Carcinoma (SCC). Here, authors report a rare case of 49-year-old male who presented with long standing keratinous cyst in gluteal region which turned out as SCC 35 years after intial presentation of the leison, and here authors have discussed the clinicopathological features of this rare entity. Hence, any swelling which is long standing, showing sudden increase in size, progressing symptoms, more than 2 cm in diameter, cyst content seen as heterogenous pattern on imaging should be highly suspicious of malignancy.

Splenic Pseudocyst by Aeromonas Salmonicida in Adolescent an Isolated Occurrence: A Case Report

Introduction: Aeromonas Salmonicida is a rare type of the causative agent for splenic pseudocyst. We are reporting a case of splenic pseudocyst treated with deroofing of the cyst wall. An adolescent presented to us with a history of abdominal pain, fever, and loose stool for 3 days and was investigated. Computed tomography showed huge cystic mass arising from the inferior pole of the spleen. The adolescent underwent laparotomy, drainage of splenic cyst, and deroofing of cyst wall. The culture of Aeromonas Salmonicida was growth in the cyst content. To the best of our knowledge, this is the first case of such nature.

Craniopharyngioma and Rathke’s cleft cysts

Both craniopharyngiomas and Rathke’s cysts are rare pituitary lesions of dysembryogenic origin. Their radiological differentiation may be sometimes difficult due to their occasionally similar imaging characteristics. The surgical management of these lesions, especially of craniopharyngiomas, may be very challenging. Gross total removal of a craniopharyngioma is associated with longer recurrence-free survival but could be associated with higher rate of surgery-related morbidities and pituitary insufficiency. Craniopharyngiomas are considered in the majority of cases to be a ‘chronic disease’. A principle difference in the operative management of these two lesions is that in craniopharyngiomas, resection of their thicker capsule is mandatory in order to achieve complete removal, whereas it is nearly impossible and not recommended to attempt such cyst wall removal in Rathke’s cysts. Emptying of the cyst content is usually sufficient to provide cure in the majority of these patients. Recurrences in Rathke’s cyst are only rarely observed in contrast to craniopharyngiomas.

Placental Chorionic Cyst Fluid Has Prothrombotic Properties and Differs From Amniotic Fluid

Introduction Chorionic cysts of the chorion laeve, fetal chorionic plate, septum, and free membranes have been associated with placental hypoxia, but they have no clear clinical significance. Although immunohistochemistry has identified fibronectin and collagen IV in cyst fluid, the contents have yet to be fully characterized. Methods Placental chorionic cysts (N = 10) were sampled by fluid extraction and hemotoxylin and eosin-stained sections. Amniotic fluid samples (N = 8) were obtained from pregnant women who had cytogenetic evaluation. The content of the cysts was tested for thrombogenicity using thromboelastography. The cyst content was tested by Luminex multiplex and ELISA assays and for known prothrombotic and proinflammatory factors. Results We identified cysts, especially those in the chorionic plate, adjacent to intervillous thrombi with apparent cyst rupture. Thromboelastography revealed a significantly shorter R time compared to whole blood control samples. Concentration of creatinine, α-fetoprotein, and surfactant D in the cyst fluid differed significantly from amniotic fluid. Cyst fluids had a significantly higher expression of all prothrombotic and some proinflammatory factors. Discussion Our data provide the first evidence that chorionic cyst fluid is prothrombotic and different from amniotic fluid. The association of ruptured cysts with adjacent thrombi and the prothrombotic properties of cyst fluid suggest a causal relationship; however, further studies are needed.