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Background: Our aim was to train and test a deep learning-based algorithm for automatically segmenting kidneys and renal cysts in patients with autosomal dominant polycystic kidney disease (ADPKD). Methods: We retrospectively selected all ADPKD patients who underwent renal MRI with coronal T2-weighted imaging at our institution from 2008 to 2022. The 20 most recent examinations constituted the test dataset, to mimic pseudoprospective enrolment. The remaining ones constituted the training dataset to which eight normal renal MRIs were added. Kidneys and cysts ground truth segmentations were performed on coronal T2-weighted images by a junior radiologist supervised by an experienced radiologist. Kidneys and cysts of the 20 test MRIs were segmented by the algorithm and three independent human raters. Segmentations were compared using overlap metrics. The total kidney volume (TKV), total cystic volume (TCV), and cystic index (TCV divided by TKV) were compared using Bland–Altman analysis. Results: We included 164 ADPKD patients. Dice similarity coefficients ranged from 85.9% to 87.4% between the algorithms and the raters' segmentations and from 84.2% to 86.2% across raters' segmentations. For TCV assessment, the biases ± standard deviations (SD) were 3–19 ± 137–151 mL between the algorithm and the raters, and 22–45 ± 49–57 mL across raters. The algorithm underestimated TKV and TCV in two outliers with TCV > 2800 mL. For cystic index assessment, the biases ± SD were 2.5–6.9% ± 6.7–8.3% between the algorithm and the raters, and 2.1–9.4 ± 7.4–11.6% across raters. Conclusion: The algorithm's performance fell within the range of inter-rater variability, but large TKV and TCV were underestimated. Relevance statement: Accurate automated segmentation of the renal cysts will enable the large-scale evaluation of the prognostic value of TCV and cystic index in ADPKD patients. If these biomarkers are prognostic, then automated segmentation will facilitate their use in daily routine. Key Points: Cystic volume is an emerging biomarker in ADPKD. The algorithm's performance in segmenting kidneys and cysts fell within interrater variability. The segmentation of very large cysts, under-represented in the training dataset, needs improvement. [ABSTRACT FROM AUTHOR]

Objective: The extent of resection of pediatric low-grade glioma mostly improves progression-free survival. In chiasmatic hypothalamic glioma (CHG), complete resections are limited due to the relevantly high risk of associated neurological and endocrinological deficits. Still, surgery might have its role in the framework of a multidisciplinary team (MDT) approach. We report our retrospective experience from two centers on surgical options and their impact on long-term outcomes. Methods: Medical records of surgically treated pediatric CHG patients between 2004 and 2022 were analyzed. Patient characteristics, surgical interventions, histology, and non-surgical therapy were retrieved together with outcome measures such as visual acuity, endocrine function, and survival. Results: A total of 63 patients (33 female, NF-1, n = 8) were included. Age at first diagnosis was 4.6 years (range 0.2–16.9) and cohort follow-up was 108 ± 72 months. Twenty patients were surgically treated with a biopsy and 43 patients with debulking at a median age of 6.5 years (range 0.16–16.9). Patients received a median of 2 tumor surgeries (range 1–5). Cyst drainage was accomplished in 15 patients, and 27 patients had ventriculoperitoneal shunt implantation. Non-surgical therapy was given in 69.8%. At the end of follow-up, 74.6% of patients had stable disease. The cohort had a median Karnofsky score of 90 (range 0–100). Four patients died. Hormone substitution was necessary in 30.2%, and visual acuity was impaired in 66% of patients. Conclusion: Pediatric CHG is a chronic disease due to overall high survival with multiple progressions. Surgical therapy remains a key treatment option offering biopsy, limited tumor-debulking, cyst fenestration, and hydrocephalus management in the framework of MDT decision-making. Team experience contributes to reducing possible deficits in this challenging cohort. [ABSTRACT FROM AUTHOR]

Labrune syndrome is a rare white matter disease characterized by angiomatous leukoencephalopathy, diffuse intracranial calcifications and supratentorial and infratentorial parenchymal cysts. The clinical worsening is often related to cyst expansion, and surgery may be advocated for symptomatic management in about one third of cases. However, no consensus exists on the surgical timing, the most effective procedure, and the long-term results. Electronic databases PubMed/MEDLINE and Google Scholar were searched for studies published up to April 2022 using the search string (Labrune syndrome OR leukoencephalopathy with calcifications and cysts OR brain calcifications OR brain cysts) AND (therapy OR surgery). We found 28 studies in the literature, and we added a new case from our institution, comprising 37 patients. All the patients in this series underwent surgical intervention. We reviewed all the pertinent literature to discuss clinical-radiological features and etiopathogenesis, specifically addressing the surgical options, clinical results, and prognosis. Leukoencephalopathy with cerebral calcifications and cysts is a rare neurodegenerative disorder for which effective medical treatment is lacking. Surgery remains the only therapeutic option to control the disease to reduce the mass effect of growing cystic lesions. Almost half of the patients who underwent surgery required further approaches, with great concern for the associated disabilities. Several procedures have been described, with no evidence regarding which procedure is the most effective. Individual-based surgical planning must be advocated, tailoring the approach to limit side effects. Mini-invasive neuroendoscopic approaches may be considered to achieve satisfactory results. [ABSTRACT FROM AUTHOR]

Objectives To investigate optical coherence microscopy (OCM) imaging features and the application value of these high-resolution images for identifying endocervical canal lesions (ECLs), which is a clinical dilemma in cervical cancer screening programs. Methods In total, 520 OCM images were obtained by scanning the cervical canal lesions with an ultra-high-resolution OCM system (204 specimens from 73 patients). The OCM morphologic characteristics of ECLs were observed and summarized, and then 3 researchers performed a diagnostic test of OCM images of cervical canal lesions. The accuracy, sensitivity, specificity, positive predictive value, negative predictive value, 95% confidence interval of each parameter, and interinvestigator agreement (κ) were calculated. Results Normal endocervix, cysts, squamous metaplasia, high-grade squamous intraepithelial lesions involving glands, and invasive carcinoma had distinct OCM characteristics, which correlated well with corresponding H&E histologic sections. The accuracy, sensitivity, and specificity of the 3 researchers were 90.6%, 89.3% (95% CI, 86.5%-91.7%) and 91.6% (95% CI, 89.2%-93.5%), respectively. The positive predictive value was 90.1% (95% CI, 87.3%-92.4%), and the negative predictive value was 90.9% (95% CI, 88.5%-92.9%), with almost perfect agreement (κ = 0.874). Conclusions The application of the OCM system in cervical canal lesions is feasible and could help improve detection of occult ECLs in cervical cancer screening programs. This study lays the foundation for further research on OCM in cervical canal lesions in vivo, which also has a potential impact on projecting pathologic evaluation beyond what is currently possible, perhaps globally. [ABSTRACT FROM AUTHOR]

Phallocryptus spinosus (Milne-Edwards, 1840) and Branchinectella media (Schmankewitsch, 1873) are two anostracan species co-occurring in several saline lakes of the eastern steppic zone of Algeria. Both species produce resting eggs to persist in their temporary and unstable habitats, constituting a resting eggs bank. B. media has a wide and scattered distribution area, and it is known to prefer cold temperatures (16 °C max). Resting egg banks and hatching patterns of both species have been assessed in seven saline lakes. Results showed that densities of P. spinosus resting eggs were always higher than those of B. media, whatever the lake (F = 4.66, p = 0.0005). They range between 93,000 ± 75 and 1,495,000 ± 366.5 resting eggs m−2 for P. spinosus, and between 670 ± 30 and 365,000 ± 268 resting eggs m−2 for B. media. Hatching percentages of eggs incubated at temperatures of 16 °C and 22 °C, and salinities of 0 and 5 psu, showed that 16 °C and 5 psu was the most suitable combination for B. media, since 38.88 ± 1.93% of eggs hatched under these conditions. For P. spinosus, 81.11 ± 1.92% of eggs hatched at 22 °C and 5 psu. Resting eggs diameters measurements of both species as well as scanning electron micrographs of B. media are provided. [ABSTRACT FROM AUTHOR]

Background: Autosomal dominant polycystic kidney disease (ADPKD) is the most prevalent hereditary kidney disease, characterized by enlarged kidneys with numerous cysts, high blood pressure, and a variety of extrarenal complications. This disease is a significant cause of renal failure and requires accurate differentiation from other cystic kidney diseases, especially when family history does not clearly indicate ADPKD. This is crucial due to differences in prognosis, treatment, and familial implications. Advanced molecular genetics and imaging techniques are employed to diagnose and assess the prognosis of patients and their families. Case presentation: The case study revolves around three patients from the same family—two sisters and one daughter—referred to a nephrology department for ADPKD management. The initial proband, a 42-year-old woman, experienced abdominal discomfort leading to an ultrasound that suggested ADPKD. However, MRI findings indicated standard-sized kidneys with bilateral parapelvic cysts, and no genetic markers for ADPKD were found. Her sister, presenting with controlled hypertension and similar ultrasound findings, also had her initial ADPKD diagnosis refuted by MRI and genetic testing, which revealed no significant mutations. The daughter, however, exhibited a different scenario with enlarged kidneys and multiple cysts characteristic of early-stage ADPKD. Genetic testing confirmed a deleterious PKD1 mutation, suggesting a de novo mutation, as her father showed no signs of the disease. Conclusion: This study highlights the complexity and necessity of thorough diagnostic processes in suspected ADPKD cases to prevent misdiagnosis. The initial symptoms and imaging might misleadingly suggest ADPKD, as seen in the cases of the two older patients. Still, further detailed imaging and genetic analyses revealed no ADPKD, preventing inappropriate treatment and stress. In contrast, the younger patient's distinctive clinical and genetic profile confirmed ADPKD, illustrating the variability within even closely related individuals. Such detailed assessments are crucial in guiding correct treatment decisions and providing accurate familial counseling, emphasizing the importance of considering a broader spectrum of renal cystic disorders before confirming a diagnosis of ADPKD. [ABSTRACT FROM AUTHOR]

The dinoflagellate genus Bysmatrum is an unusual member of the Peridiniales and cannot be attributed to any known family. Bysmatrum differs from typical peridinialean genera in that the second and third anterior intercalary plates are separated and both antapical plates are asymmetrical. Currently, Bysmatrum encompasses six epibenthic or tide-pool species, but information on their genetic diversity and biogeography remains limited. In the present study, we obtained five strains of Bysmatrum from the South China Sea by isolating single cells and three strains from Ingril, a French Mediterranean lagoon by incubating sediments. Strains from Ingril Lagoon displayed the plate formula Po, cp, X, 4′, 3a, 7′′, 6C, 4S, 5′′′, 2′′′′. They also exhibited an elongated nucleus in the hypocone and a type B eyespot. Smooth and spherical cysts were produced in culture. Small and/or partially large subunit ribosomal DNA sequences were obtained for all eight strains. Molecular phylogeny was inferred using these concatenated sequences through maximum likelihood and Bayesian inference methods. Bysmatrum granulosum and B. subsalsum were identified from Thailand and China for the first time, each of them comprising of two ribotypes. Bysmatrum ingrilense sp. nov. was monophyletic and closest to B. subsalsum ribotype B. Pinnatoxin and related toxins were examined in two strains of Bysmatrum ingrilense by LC-MS/MS, but none were detected. Our results highlight that the diversity of Bysmatrum might be underestimated. [ABSTRACT FROM AUTHOR]

Floodplains have a high diversity of aquatic environments, including temporary lakes that constantly suffer from drought events. To survive in these conditions, several groups of organisms, among them ciliate protists, have developed strategies to avoid dehydration, such as resistance cysts. Sediment samples were collected from the central region of the lake during a drought event. The sediments were dried in an oven and stored. For the experiment, the sediment was rehydrated with water and kept in an incubation chamber. Samples from 6 microcosms were taken every seven days for 9 weeks. The frequency of each ciliate species hatching from resting structures was calculated using the constancy index, with morphospecies classified as constant, accessory, or rare. A total of 82 ciliates morphospecies were recorded, of which four were constant, three accessory, and 75 rare. The Oxytrichidae and Euplotidae families showed the highest morphospecies richness, among which only 16 morphospecies were already recorded in the literature as producing cysts. Although no significant temporal difference was observed for the difference in the hatching of morphospecies over time. The morphospecies increment curve showed an increasing trend during the experiment. Finally, based on predicted climate change projections, temporary environments may experience longer and more frequent periods of drought, thus ciliate morphospecies that are able to remain in a form of resistance for a long period will outperform those that are more sensitive or lack this type of functional trait. [ABSTRACT FROM AUTHOR]

Abstract Background Our aim was to train and test a deep learning-based algorithm for automatically segmenting kidneys and renal cysts in patients with autosomal dominant polycystic kidney disease (ADPKD). Methods We retrospectively selected all ADPKD patients who underwent renal MRI with coronal T2-weighted imaging at our institution from 2008 to 2022. The 20 most recent examinations constituted the test dataset, to mimic pseudoprospective enrolment. The remaining ones constituted the training dataset to which eight normal renal MRIs were added. Kidneys and cysts ground truth segmentations were performed on coronal T2-weighted images by a junior radiologist supervised by an experienced radiologist. Kidneys and cysts of the 20 test MRIs were segmented by the algorithm and three independent human raters. Segmentations were compared using overlap metrics. The total kidney volume (TKV), total cystic volume (TCV), and cystic index (TCV divided by TKV) were compared using Bland–Altman analysis. Results We included 164 ADPKD patients. Dice similarity coefficients ranged from 85.9% to 87.4% between the algorithms and the raters’ segmentations and from 84.2% to 86.2% across raters’ segmentations. For TCV assessment, the biases ± standard deviations (SD) were 3–19 ± 137–151 mL between the algorithm and the raters, and 22–45 ± 49–57 mL across raters. The algorithm underestimated TKV and TCV in two outliers with TCV > 2800 mL. For cystic index assessment, the biases ± SD were 2.5–6.9% ± 6.7–8.3% between the algorithm and the raters, and 2.1–9.4 ± 7.4–11.6% across raters. Conclusion The algorithm’s performance fell within the range of inter-rater variability, but large TKV and TCV were underestimated. Relevance statement Accurate automated segmentation of the renal cysts will enable the large-scale evaluation of the prognostic value of TCV and cystic index in ADPKD patients. If these biomarkers are prognostic, then automated segmentation will facilitate their use in daily routine. Key Points Cystic volume is an emerging biomarker in ADPKD. The algorithm’s performance in segmenting kidneys and cysts fell within interrater variability. The segmentation of very large cysts, under-represented in the training dataset, needs improvement. Graphical Abstract

Abstract Background Autosomal dominant polycystic kidney disease (ADPKD) is the most prevalent hereditary kidney disease, characterized by enlarged kidneys with numerous cysts, high blood pressure, and a variety of extrarenal complications. This disease is a significant cause of renal failure and requires accurate differentiation from other cystic kidney diseases, especially when family history does not clearly indicate ADPKD. This is crucial due to differences in prognosis, treatment, and familial implications. Advanced molecular genetics and imaging techniques are employed to diagnose and assess the prognosis of patients and their families. Case presentation The case study revolves around three patients from the same family—two sisters and one daughter—referred to a nephrology department for ADPKD management. The initial proband, a 42-year-old woman, experienced abdominal discomfort leading to an ultrasound that suggested ADPKD. However, MRI findings indicated standard-sized kidneys with bilateral parapelvic cysts, and no genetic markers for ADPKD were found. Her sister, presenting with controlled hypertension and similar ultrasound findings, also had her initial ADPKD diagnosis refuted by MRI and genetic testing, which revealed no significant mutations. The daughter, however, exhibited a different scenario with enlarged kidneys and multiple cysts characteristic of early-stage ADPKD. Genetic testing confirmed a deleterious PKD1 mutation, suggesting a de novo mutation, as her father showed no signs of the disease. Conclusion This study highlights the complexity and necessity of thorough diagnostic processes in suspected ADPKD cases to prevent misdiagnosis. The initial symptoms and imaging might misleadingly suggest ADPKD, as seen in the cases of the two older patients. Still, further detailed imaging and genetic analyses revealed no ADPKD, preventing inappropriate treatment and stress. In contrast, the younger patient's distinctive clinical and genetic profile confirmed ADPKD, illustrating the variability within even closely related individuals. Such detailed assessments are crucial in guiding correct treatment decisions and providing accurate familial counseling, emphasizing the importance of considering a broader spectrum of renal cystic disorders before confirming a diagnosis of ADPKD.

Intradiploic epidermoid cysts are rare, benign tumors, accounting for less than 1% of all intracranial tumors. Due to their scarcity, we are reporting a case of an intradiploic epidermoid cyst and reviewing several similar cases in the literature to provide a better description of this tumor and analyze its clinical and radiological features. We conducted a search on the PubMed database for studies published between January 2010 and February 2023, including studies of nontraumatic and noniatrogenic calvarial cysts. We found a total of 34 studies and 41 patients, with an average patient age of 42.5 years. Common symptoms included painless masses, headaches, and seizures. The occipital, frontal, and parietal regions were the most common locations for these tumors. Some patients experienced complications such as otitis media, infection, or extension into the orbit and brain. Surgical resection was performed in all cases except for 2 patients with contraindications to surgery. Histological examination confirmed the diagnosis of an intradiploic epidermoid cyst. These cysts are rare skull lesions and can potentially cause neurological deficits due to their mass effect. If incompletely resected, they may also undergo malignant transformation. No single institution has accumulated enough cases to describe this rare tumor accurately. Therefore, through this review, we aim to highlight this tumor's epidemiological, clinical, and radiological features.

Background & Aims: Ovarian cancers are increasing in incidence, and an accurate ultrasonographic diagnosis, along with a complete physical examination and history taking, is essential for prompt diagnosis and early reporting. In this study, we aimed to evaluate the efficacy of ultrasonography (USG) in identifying ovarian lesions using histopathology as the gold standard. Materials & Methods: This was a retrospective study conducted by evaluating the reports of patients in the menopausal age group who had undergone total hysterectomy or oophorectomy. Histopathological diagnoses were retrieved from the Department of Pathology, and ultrasonographic (USG) reports were obtained from the patients' medical records. Results: This study included the histopathological and ultrasonographic reports of 239 women, of which 95.4% of cases were benign, while borderline lesions and malignant lesions constituted 3.3% and 1.3%, respectively. USG showed sensitivities of 93.55%, 66.7%, and 33% in identifying benign, borderline, and malignant lesions, respectively. Specificities of 91.67%, 91.84%, and 99.46% were noted in classifying ovarian lesions as benign, borderline, and malignant, respectively. Conclusion: Ultrasonography (USG) remains an important imaging tool for the early diagnosis of ovarian lesions, and a standardized reporting protocol should be implemented in every institution to increase the accuracy of USG and to reduce the inter-observer variability commonly encountered in ultrasound.

Abstract Background Dilatation of common bile duct (CBD) is mostly pathological and mainly occurs secondary to mechanical causes. We aimed to explore the prevalence of CBD dilatation in Intraductal Papillary Mucinous Neoplasms of the pancreas (IPMN) among patients referred to EUS. Methods A retrospective study of all patients who had an EUS diagnosis of IPMN from 2011 to 2019 at Galilee Medical Center were extracted. Control group including patients with other types of pancreatic cysts. Results Overall, 2400 patients were included in the study, of them 158 patients were diagnosed with pancreatic cysts, 117 patients (74%) diagnosed with IPMN (group A), and 41 patients (26%) diagnosed with other pancreatic cysts (group B). Univariate analysis showed significant association of IPMN (OR 3.8, 95% CI 1.3–11.5), resected gallbladder (GB) (OR 7.75, 95% CI 3.19–18.84), and age (OR 1, 95% CI 1.01–1.08) with CBD dilatation. Classifying IPMN to sub-groups using adjusted multivariate logistic regression analysis, only main duct-IPMN (MD-IPMN) significantly correlated with CBD dilatation compared to branch duct (BD)-IPMN and mixed type-IPMN (OR 19.6, 95% CI 4.57–83.33, OR 16.3, 95% CI 3.02–88.08). Conclusion MD-IPMN was significantly correlated with dilated CBD. Assessment of the pancreas is warranted in encountered cases of dilated CBD without obvious mechanical cause.

In most reported cases, pancreatic pseudocysts are the most commonly reported cases and mostly occur in adults. Idiopathic non-pancreatic pseudocyst is rarely reported among children. We are reporting a rare case of retroperitoneal pseudocyst in a 6-year-old male with a 4-week history of abdominal swelling. He had asymmetrical abdominal distention on the right lumber and iliac regions with a smooth surface measuring 12 × 22 cm in its largest dimension. CT scan showed a mesenteric cyst, ipsilateral hydronephrosis, and intrahepatic duct dilatations. Intraoperatively, a retroperitoneal cystic mass was completely excised histologically confirmed pseudocyst. The patient was discharged home after fully recovery after 4 days of surgery. Surgical interventions remain to be the stay management of retroperitoneal pseudocysts with an earlier full recovery. Open surgical technique remains to be a preferred approach, especially for the large and complex retroperitoneal cysts. [ABSTRACT FROM AUTHOR]

Tumor markers such as carbohydrate antigen 19-9 (CA19-9) are generally useful in ruling out malignancy of hepatic cysts. The patient was a 72-year-old man who had a ruptured liver cyst in the right liver, which had been noted since he was 67 years old at another hospital. The initial laboratory tests demonstrated elevated CA19-9 (193 784.3 U/mL). We made the diagnosis with a simple ruptured liver cyst from magnetic resonance imaging and cytological examination of ascites, and laparoscopic fenestration with drainage of the abdominal fluid was performed. Pathological diagnosis of the resected wall cyst was non-parasitic simple hepatic cyst with acute inflammation and hemorrhage. The patient's serum levels of CA19-9 were 164.0 U/mL on postoperative day 23. The follow-up abdominal computed tomography scan performed 2 months later did not any finding of tumor. [ABSTRACT FROM AUTHOR]

Protoperidinium claudicans is a planktonic, heterotrophic, bioluminescent dinoflagellate species commonly found in neritic waters. It has long been considered to display phenotypic variation in its second anterior intercalary plate, which could vary between quadra, penta and hexa. The equivalent spinose, cordate cyst goes under the name of Votadinium spinosum. Here we perform incubation experiments with cysts from France, Canada, China and Japan, which demonstrate that P. claudicans forms a species complex, with at least two ribotypes with a penta configuration (P. claudicans) and one with a quadra configuration (P. carriae sp. nov.). A fossil-based cyst, V. multispinosum sp. nov., is described as the equivalent of P. carriae. Molecular phylogenetics using large subunit ribosomal DNA supports these observations. The cyst–theca relationships for Votadinium psilodora and another, undescribed, cordate, spineless Votadinium species are also reported from China. Macromolecular analyses of the cyst wall of V. multispinosum reveal it is comprised of a protein-rich carbohydrate compound. We show that this compound is not uncommon in dinoflagellate and ciliate cysts and that it is unlikely to preserve very well upon sedimentation and burial. [ABSTRACT FROM AUTHOR]

Purpose: To perform a comparative analysis of surgically resected mucinous cystic neoplasm (MCN) of pancreas and branch-duct type intraductal papillary mucinous neoplasms (BD-IPMN) considering clinico-radiological high-risk predictors for malignant tumors using the current management guidelines. Materials and methods: 224 patients who underwent surgical resection and had histopathologically confirmed MCNs (benign 73; malignant 17) or BD-IPMNs (benign 110; malignant 24) and had pre-operative CT or MRI were retrospectively reviewed. Tumors classified as either high-grade dysplasia or invasive carcinoma were considered malignant, whereas those with low-grade dysplasia were considered benign. Imaging features were analyzed by two radiologists based on selected high-risk stigmata or worrisome features proposed by prevalent guidelines except tumors with main pancreatic duct dilatation (> 5 mm) were excluded. Results: MCNs and BD-IPMNs showed significant differences in aspects like tumor size, location, the presence and size of enhancing mural nodules, the presence of wall or septal thickening, and multiplicity. Multivariate analyses revealed tumor size (OR, 1.336; 95% CI, 1.124–1.660, p = 0.002) and the presence of enhancing mural nodules (OR, 67.383; 95% CI, 4.490-1011.299, p = 0.002) as significant predictors of malignant MCNs. The optimal tumor size differentiating benign from malignant tumor was 8.95 cm, with a 70.6% sensitivity, 89% specificity, PPV of 27.6%, and NPV of 96.9%, demonstrating superior specificity than the guideline-suggested threshold of 4.0 cm. For malignant BD-IPMNs, the presence of enhancing mural nodules (OR, 15.804; 95% CI, 4.439–56.274, p < 0.001) and CA 19 − 9 elevation (OR, 19.089; 95%CI, 2.868-127.068, p = 0.002) as malignant predictors, with a size of enhancing mural nodule threshold of 5.5 mm providing the best malignancy differentiation. Conclusion: While current guidelines may be appropriate for managing BD-IPMNs, our results showed a notably larger optimal threshold size for malignant MCNs than that suggested by current guidelines. This warrants reconsidering existing guideline thresholds for initial risk stratification and management of MCNs. [ABSTRACT FROM AUTHOR]

"Cysts of the ligamentum flavum (cysts‐LF)" is the term for non‐neoplastic cystic lesion involving LF. The aim of the present study was to elucidate the histopathological characteristics and pathogenesis of "cysts‐LF". Herein, we defined cysts‐LF as spinal cysts containing degenerative LF components. From archival cases, we investigated 18 symptomatic cysts‐LF surgically removed from 18 patients (13 males and five females; median age 68.5 years [range, 42–86 years]). The elastic fibers of LF components in the wall were separated and/or torn, and cyst walls were accompanied by chondroid metaplasia (17 cases), myxoid changes (13 cases), ossification (11 cases), amyloid deposits (14 cases), hemosiderosis (six cases), granular/smudgy calcification (four cases), synovial cell linings (three cases), and severe inflammatory infiltrates (one case). These histologic features of our cysts‐LF were shared by previously reported "cysts‐LF." Fourteen cysts‐LF demonstrated vascular stenosis/occlusion, and eight showed thick hyalinized vessels, suggesting local circulatory insufficiency. Eight cases (44%) exhibited lipomembranous fat necrosis, accompanied by hyalinized vascular changes (p = 0.003). Ischemic conditions were observed in nearly half of the present cysts‐LF, and may be one of the main contributing factors for the formation of cysts‐LF, via degeneration and cystic changes in the LF. [ABSTRACT FROM AUTHOR]

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An astonishing range of morphologies and life strategies has arisen across the vast diversity of protists, allowing them to thrive in most environments. In model protists, like Tetrahymena, Dictyostelium, or Trypanosoma, life cycles involving multiple life stages with different morphologies have been well characterized. In contrast, knowledge of the life cycles of free‐living protists, which primarily consist of uncultivated environmental lineages, remains largely fragmentary. Various life stages and lineage‐specific cellular innovations have been observed in the field for uncultivated protists, but such innovations generally lack functional characterization and have unknown physiological and ecological roles. In the actual state of knowledge, evidence of sexual processes is confirmed for 20% of free‐living protist lineages. Nevertheless, at the onset of eukaryotic diversification, common molecular trends emerged to promote genetic recombination, establishing sex as an inherent feature of protists. Here, we review protist life cycles from the viewpoint of life cycle transitions and genetics across major eukaryotic lineages. We focus on the scarcely observed sexual cycle of free‐living protists, summarizing evidence for its existence and describing key genes governing its progression, as well as, current methods for studying the genetics of sexual cycles in both cultivable and uncultivated protist groups. [ABSTRACT FROM AUTHOR]

Cryptosporidium and Giardia are infectious parasitic forms widely distributed in aquatic ecosystems and resistant to disinfection of drinking water. Their presence was investigated in the lower areas of the city's four rivers through a four-stage methodology. Between December 2017 and April 2018, three monitoring campaigns were conducted, with results ranging between not detected to 500 oocysts/L for Cryptosporidium, and between not detected and 300 for Giardia. Cryptosporidium was more abundant, especially in the Machángara River. In the same period, the bacteriological quality of the rivers was also reviewed using Total Streptococci and Fecal Enterococci expressed in colony-forming units (CFU)/100 mL as indicators. The results showed a progressive increase in pollution as the course of the rivers progressed. The sensitivity of bacterial indicators to changes in quality is also observed, which is why their use in specific studies is recommended. It is concluded that untreated domestic wastewater discharges may be the main source of contamination by bacteria and parasites and that there is a relationship between their concentration and the seasonal period. In dry weather, the concentration is higher for both microorganisms. This study fills a gap in knowledge in the region, due to the absence of data on parasitic indicators with great impacts on public health. [ABSTRACT FROM AUTHOR]

Background: Dilatation of common bile duct (CBD) is mostly pathological and mainly occurs secondary to mechanical causes. We aimed to explore the prevalence of CBD dilatation in Intraductal Papillary Mucinous Neoplasms of the pancreas (IPMN) among patients referred to EUS. Methods: A retrospective study of all patients who had an EUS diagnosis of IPMN from 2011 to 2019 at Galilee Medical Center were extracted. Control group including patients with other types of pancreatic cysts. Results: Overall, 2400 patients were included in the study, of them 158 patients were diagnosed with pancreatic cysts, 117 patients (74%) diagnosed with IPMN (group A), and 41 patients (26%) diagnosed with other pancreatic cysts (group B). Univariate analysis showed significant association of IPMN (OR 3.8, 95% CI 1.3–11.5), resected gallbladder (GB) (OR 7.75, 95% CI 3.19–18.84), and age (OR 1, 95% CI 1.01–1.08) with CBD dilatation. Classifying IPMN to sub-groups using adjusted multivariate logistic regression analysis, only main duct-IPMN (MD-IPMN) significantly correlated with CBD dilatation compared to branch duct (BD)-IPMN and mixed type-IPMN (OR 19.6, 95% CI 4.57–83.33, OR 16.3, 95% CI 3.02–88.08). Conclusion: MD-IPMN was significantly correlated with dilated CBD. Assessment of the pancreas is warranted in encountered cases of dilated CBD without obvious mechanical cause. [ABSTRACT FROM AUTHOR]

Unerupted teeth in dogs are fairly common and may develop an odontogenic cyst that causes destruction of the surrounding bone and affect adjacent teeth. We analyzed histological reports of cysts associated with unerupted teeth in a large population of dogs. Medical records and histopathological results of cysts associated with unerupted teeth were evaluated from all dogs treated at a private referral veterinary dental clinic over a 10-year period (2012-2022). A total of 192 dogs with 279 cysts associated with one or more unerupted teeth were included in the study. Brachycephalic breeds were overrepresented. The most affected were Tibetan Spaniels with 58 dogs (30%) and Boxers with 48 dogs (25%). The most common affected tooth was the mandibular first premolar tooth with 238 (84%) cysts. Of the total of 279 cysts, 208 (75%) were histopathologically examined. None of the cysts examined contained malignant changes. Based on these 208 cysts, the probability of finding a cyst with malignant changes in a population of dogs is 0-1.4% (confidence interval 95%). [ABSTRACT FROM AUTHOR]

Objectives: Spinal arachnoid cysts (SAC) are rare lesions. There are many uncertainties regarding details about Intradural and Extradural SAC. We present a series of 12 cases of SAC along with a comprehensive review of the literature. In this review, we discussed the differences between Intradural and Extradural SAC pertaining to demography, pathogenesis, surgical procedures and outcomes. Methods: We retrospectively collected the data of 12 patients of SAC treated at our Institute from 2012 to 2023. The age, gender, clinical, radiological, surgical data and outcome were noted. An extensive review of the literature was done to analyse and note the differences between Intradural and extradural SAC and their surgical management. Results: In our series of 12 patients, 7 had Extradural SAC(58.3%), 3 had Intradural SAC(25%) and 2 had Intramedullary SAC(16.7%). . Of the 12 patients, 4 were males and 8 were females (1:2). Age range was 9 to 64 years and the mean age was 34.42 ± 17.71 years. There were four paediatric patients in the series. The most common symptoms reported at presentation are weakness of limbs(81.9%),back pain(36.4%), sensory symptoms(36.4%), radicular pain (18.2%), and bladder disturbances(9.1%). Out of the 12 patients, surgery was done in 11 patients and one patient was managed conservatively. Conclusions: From the review of the literature, intradural SAC was twice as common as extradural SAC. Ventrally located SACs are more common in Intradural locations as compared to Extradural. The intradural SACs were more commonly located in the thoracic and cervical regions when compared to extradural SACs which were located commonly in the thoracolumbar, thoracic and lumbar regions. Extradural SACs were mostly Primary and the mainstay of treatment is complete or partial excision of the cyst with identification and ligation of the communicating pedicle. Selective laminectomy, partial excision of the cyst and wide fenestration to sustain CSF flow is the recommended treatment in Intradural SAC. [ABSTRACT FROM AUTHOR]

Introduction: Patients with mucosal cysts in the maxillary sinus require special consideration in patients who require implant therapy for the restoration when undergoing implant therapy for the restoration of the posterior maxillary dentition. Treatment strategies for these clinical situations remain controversial in the literature. Thus, this study seeks to describe a safe and effective therapeutic strategy for sinus augmentation in patients with pre‐existing maxillary antral cysts. Methods: A total of 15 patients and 18 sinuses were consecutively enrolled in this cohort study and underwent maxillary antral cyst treatment by needle aspiration and simultaneous maxillary sinus augmentation (MSA). During surgical procedures, threeimplants (Zimmer Biomet, Indiana, USA) were positioned in 11 sinuses and two implants (Zimmer Biomet, Indiana, USA) were positioned in 5 sinuses. Results: Overall implant success and survival rates were 100% and 97.8%, respectively at 1 year and 5‐year follow‐ups. Crestal bone resorption averaged 0.3 ± 0.2 mm 5‐year post‐loading, showing bone stability. Implant survival rate at 5‐year follow‐up expressed predictability of the technique comparable to historical data when MSA was performed alone. Crestal bone resorption averaged 0.3 ± 0.2 mm 5 years post‐loading and shows bone stability utilizing mucosal cyst aspiration with concomitant MSA procedures. Quality of life evaluation at 1‐week post‐op showed similar results to published historical data. In 81% (13 sinuses), the CBCT examination at 5‐year follow‐up showed no cyst reformation, in 19% (3 sinuses) cyst reformation was visible, but smaller in size when compared to the pre‐op CBCT evaluation, and all the patients were asymptomatic. Conclusions: Maxillary sinus mucosal cyst aspiration with concomitant MSA, may be a viable option to treat maxillary sinus cyst. [ABSTRACT FROM AUTHOR]

Purpose: To evaluate success rates of computed tomography (CT)-guided lumbar facet synovial cyst (LFC) rupture. Materials and methods: We retrospectively reviewed all LFC ruptures performed by a single musculoskeletal radiologist with > 10 years of experience, using posterior facet approach and/or direct puncture by ipsilateral/contralateral interlaminar, or transforaminal approach. All patients also received a corticosteroid injection. Rupture rates were calculated, and clinical success rate was determined through medical record review. Pre-procedure magnetic resonance imaging (MRI) images and CT procedure images were also reviewed for LFC and facet joint imaging features that may predict rupture. Results: There were 37 patients, 17 (46%) female and 20 (54%) male, ages 62 ± 12 (range 39–87) years. Thirty-four (92%) of LFC were successfully ruptured, 17 (50%) by facet approach and 17 (50%) by direct cyst puncture. At least one direct puncture approach was possible in 35 (95%) patients. No MRI or CT LFC or facet joint features predicted cyst rupture. Thirty-one (91%) of patients reported immediate pain relief, and 19 (53%) did not have further intervention for LFC-related pain. Sixteen (84%) of these patients remained pain-free for an average follow-up time period of 28 months. Fourteen (39%) of patients required surgical intervention. There were no complications. Conclusion: Our systematic approach to CT-guided LFC rupture is safe and has high technical and clinical success rates similar to prior studies. Since there are no definitive imaging features that determine rupture success, this procedure can almost always be attempted as a first-line treatment for LFC. [ABSTRACT FROM AUTHOR]

Pancreatic pseudocysts are surrounded by a non-epithelialized wall confined to the pancreas and localized to the pancreatic tissue or adjacent pancreatic cavity. In contrast, pancreatic cystic tumors occur less frequently than solid lesions and are often detected incidentally on imaging. Regarding the qualitative diagnosis of pancreatic pseudocysts, it is important to differentiate them from neoplastic cysts. We report the case of a 74-year-old woman with a giant hemorrhagic pancreatic pseudocyst and a suspected cystic pancreatic tumor, wherein distal pancreatectomy and splenectomy with lymph node dissection were performed. The patient was discharged 11 days postsurgery, with a good postoperative course. There are no reports of giant pancreatic pseudocysts larger than 10 cm with hematoma contents. The presumptive diagnosis of pseudocysts based on imaging alone may be difficult. Surgical resection is considered when it is difficult to distinguish a giant pancreatic pseudocyst from a cystic neoplasm. [ABSTRACT FROM AUTHOR]

Despite the fact that the first red tide reported on the coasts of the Iberian Peninsula was due to Lingulodinium polyedra, knowledge about their frequency and, particularly, about the environmental conditions contributing to bloom initiation is still scarce. For this reason, L. polyedra bloom episodes were observed and studied in three Galician rias during the summer season based on the 1993–2008 record database period; additionally, samples were collected in summer 2008. Proliferations of L. polyedra occurred in the rias of Ares and Barqueiro in June and August, respectively, while in the Ria of Coruña, they persisted from the end of June to early September. Red tides developed when the surface temperature reached 17 °C, with "seasonal thermal window" conditions, and when salinities were ≥30, i.e., an "optimal salinity window"; when these parameters were lower than these thresholds, cyst germination decreased. A cyst transport mechanism from sediments to the surface must also exist; this mechanism was found to be natural (tidal currents) in the ria of Barqueiro or anthropogenic (dredging) in the rias of Ares and Coruña. Surface temperatures during summer were usually favorable for cyst germination (85 to 100%) during the 1993–2008 period; however, water temperatures below 10 m depth only rarely reached the 17 °C threshold (2 to 18%). During this 16-year period, dredging activities could explain 71% (Coruña) and 44% (Ares) of the recorded bloom events. When a bloom episode developed in early summer, favorable conditions did not lead to a new red tide, probably due to the lag period required by cysts for germination. Moreover, blooms did not develop when high densities of diatoms (>1,000,000 cells·L−1) remained in the water column as a result of summer upwelling pulses occurring in specific years. The temperature–sediment disturbance pattern found in this study provides a useful tool for the prevention of eventual risks resulting from red tides of this dinoflagellate. [ABSTRACT FROM AUTHOR]

Key Clinical Message: When treating a painless or asymptomatic mass in the submental or floor of the mouth, sublingual epidermoid cyst should be considered. Despite its irregularity, preventing malignant transformation is essential for a successful outcome. Dermoid and epidermoid cysts are rarely found in the head and neck region. They account for less than 0.01% of all oral cavity cysts. This is a rare case of a sublingual epidermoid cyst of the oral cavity in a 25‐year‐old male. The patient presented with a painless sublingual swelling for a duration of 1 month. The clinical examination revealed a non‐tender swelling in the sublingual region extending to the submental triangle. Magnetic resonance imaging confirmed a 6.2 × 7.7 × 3.2 cm cystic lesion in the sublingual space. Fine needle aspiration cytology confirmed dermoid cyst contents. Intra‐oral surgical excision under general anesthesia was performed successfully. Histopathological analysis revealed that the cyst wall was lined by stratified squamous epithelium. The presence of a prominent granular layer and keratin flakes confirmed the diagnosis of an epidermoid cyst. Postoperative recovery was good, and no recurrence was observed during follow‐up. This case emphasizes the infrequent and unusual presentation of a case of a giant plunging sublingual epidermoid cyst and promotes awareness and potential studies in the enhancement of patient care in this area. [ABSTRACT FROM AUTHOR]

Objective: Calcification is a hallmark characteristic of oligodendroglioma (ODG) that may be used as a diagnostic factor, but its prognostic implications remain unclear. This study aimed to investigate the features of calcified ODGs and to evaluate the differences in survival between patients with calcified and noncalcified ODGs. Methods: We retrospectively reviewed the records of 305 consecutive patients who were diagnosed with IDH-mutant, 1p/19q codeleted ODG at our institution from July 2009 to August 2020. Patients with intratumoral calcification were identified. The clinical, radiologic, and molecular features of the patients in the calcified group and noncalcified group were recorded. Univariate and multivariate analyses were performed to identify prognostic factors. Results: Of the 305 patients, 112 (36.7%) were confirmed to have intratumoral calcification. Compared to ODGs without calcification, ODGs with calcifications had a larger tumor diameter; lower degree of resection; higher tumor grade; higher MGMT methylation level; higher Ki-67 index; and higher rates of midline crossing, enhancement, cyst, and 1q/19p copolysomy, and patients with calcification were more likely to receive chemoradiotherapy. ODGs with T2 hypointense calcification had a higher Hounsfield unit (HU) value on CT scans, and a lower degree of resection. Patients with T2 hypointense calcification ODGs had a shorter survival than those with non-hypointense calcification ODGs. ODGs with calcification and cysts showed a higher Ki-67 index, tumor grade, and enhanced rate, and the patients had an unfavorable overall survival (OS). Calcification was found to be a negative prognostic factor for both progression-free survival (PFS) and OS by univariate analysis, which was confirmed by the Cox proportional hazard model. Conclusions: Calcification is a useful negative prognostic factor for PFS and OS in patients with ODGs and could therefore be helpful in guiding personalized treatment and predicting patient prognosis. Clinical relevance statement: Calcification can serve as an independent prognostic factor for patients with oligodendroglioma and shows a vital role in guiding individualized treatment. Key Points: • Intratumoral calcification is an independent negative prognostic risk factor for progression-free survival and overall survival in oligodendroglioma patients. • Calcifications in oligodendroglioma can be divided into hypointense and non-hypointense subtypes based on T2-weighted imaging, and patients with T2-hypointense calcification oligodendrogliomas have worse prognosis. • Calcification concurrent with cysts indicates a more aggressive phenotype of oligodendrogliomas and a significantly reduced survival rate. [ABSTRACT FROM AUTHOR]

Background: Cystic echinococcosis (CE) cysts may persist for decades because of immune modulation mechanisms. Here, we characterize the cysts and the blood immune responses in patients with CE. Methods: We enrolled 61 patients with CE and 19 control subjects. We received tissue samples from seven patients with CE and a control subject requiring liver cystectomy. The immunohistochemistry evaluation of the immune cell subtypes and cytokines in the pericysts and surrounding liver and the antigen B (AgB)-specific response analysis of whole blood were performed. Results: In CE, the pericyst and the surrounding liver parenchyma showed aggregates of CD3+ T lymphocytes, mainly CD4+. B lymphocyte aggregates were present in the liver tissue. Monocytes/granulocytes were rarely observed. Th2 cytokine expression was scarce, whereas IFN-γ expression was present in the CE tissues. The control subject did not show an inflammatory infiltrate. The IL-4-specific response to AgB was increased in the patients with CE compared to the control, and this result was confirmed in a larger cohort (p = 0.003), whereas the IFN-γ-response was similar between the two groups (p = 0.5570). Conclusion: In patients with CE, CD4+ lymphocytes infiltrate the pericyst and the surrounding liver tissue with a low IL-4/IL-13 expression level and a moderate IFN-γ expression level; moreover, an IL-4 parasite-specific response is detected in the periphery. These results support adventitia involvement in CE immunopathogenesis. [ABSTRACT FROM AUTHOR]

Benign multicystic peritoneal mesothelioma (BMPM) is a rare condition, in which patients have multiple cystic lesions of the peritoneum. BMPM can mimic mucinous carcinomatosis and can thus create a diagnostic dilemma. We present the case of a 76-year-old woman who was referred for management of ascending colon adenocarcinoma and was noted to have several nonspecific cystic lesions in the abdomen and pelvis on preoperative computed tomography and diagnostic laparoscopy. Frozen section analysis suggested the lesions contained 'mucin'. Due to concern for metastases, right colectomy was aborted. Final histologic analysis of the laparoscopic biopsies revealed mesothelial cysts, consistent with BMPM, unrelated to her colon adenocarcinoma. Laparoscopic right colectomy was performed 2 weeks later. BMPM can create diagnostic and therapeutic uncertainty in patients with known visceral malignancies when discovered incidentally. Frozen section analysis may not be accurate in differentiating the two, and final histologic confirmation should be sought prior to definitive treatment. [ABSTRACT FROM AUTHOR]

A medical condition called hematosalpinx causes an accumulation of blood within the fallopian tube. It is usually seen in patients with ectopic pregnancy. Inflammatory disease of the pelvis, tubal cancer, pelvic trauma, and endometriosis are further causes. Here, we report a unique case of hematosalpinx with associated tubal torsion in a 13-year-old female lacking any previously reported contributing causes. She is celibate and presented with abdominal pain and fever. Beta-hcg was not present, and her menstrual cycle was regular. Pelvic ultrasound sonography revealed a large cyst and was suggestive of a right paraovarian cyst. An exploratory laparotomy was performed and a giant hematosalpinx was observed in an otherwise normal ovary. In conclusion, although very rare in adolescence, hematosalpinx must be considered in the differential diagnosis. This unusual instance highlights new concerns regarding the pathogenesis of hematosalpinx. [ABSTRACT FROM AUTHOR]

Colonic duplication constitutes a rare congenital anomaly, characterized by the presence of hollow cystic or tubular structures exhibiting an epithelial-lined intestinal wall. Diagnostic challenges persist due to its low incidence and manifestation of nonspecific symptoms such as abdominal pain or constipation, resulting in a reluctance to pursue surgical resection. As associated malignancies in colonic duplication are rare, the inherent malignant potential of these anomalies remains undetermined. Additionally, despite reported instances of associated malignancies in colonic duplication, there is an absence of reports in the literature detailing tubular adenoma within these cases. The histologic features of the presented case are particularly noteworthy, situated at the precancerous stage, intimating potential progression towards adenocarcinoma within colonic duplication.

The authors report a case of pathologically proven intracardiac bronchogenic cyst embedded within the interatrial septum of a 30-year-old woman presenting with chest pain and first-degree AV block. Multimodality imaging played an essential role in the discovery, investigation, and diagnosis of this extremely rare entity.

Objectives: To determine the relative frequency, demographic and pathologic profiles of patients diagnosed with cysts of the jaws. Materials and Methods: Biopsy records of the participating institutions from 2000 to 2020 were reviewed for lesions diagnosed in the cyst category. Demographic data, the location of the cysts and pathologic diagnoses were collected. Data were analyzed by appropriate statistics using IBM SPSS software version 28.0. Results: From 148,353 accessioned cases, 25,628 cases (17.28%) were diagnosed in the cyst category. Mean age of the patients ± SD = 42.62 ± 19.36 years. Paediatric patients (aged ≤ 16 years) accounted for 9.63%, while geriatric patients (aged ≥ 65) comprised 14.22% of all the patients. The male‐to‐female ratio was 1.27:1. The majority of the lesions were encountered in the mandible. The most prevalent cyst was radicular cyst followed by dentigerous cyst and odontogenic keratocyst. In the paediatric group, dentigerous cyst was the most prevalent, whereas in the geriatric group, radicular cyst was the most common. Conclusions: In general, the results of this study are in accordance with previous studies. This study provides an invaluable database for clinicians when formulating clinical differential diagnoses as well as for pathologists in rendering the final diagnosis. [ABSTRACT FROM AUTHOR]

Most cases of secondary spontaneous pneumothorax in patients with active pulmonary tuberculosis are caused by rupturing of the visceral pleura caused by Mycobacterium tuberculosis. The check-valve airway mechanism in the lungs is generally involved in the formation of pulmonary cysts, which often cause spontaneous pneumothorax. Herein, we describe a rare case of repeated spontaneous pneumothorax suspected to have been caused by pulmonary cyst formation as a result of a tuberculoma. The patient was a man with a family history of pulmonary tuberculosis. Pulmonary cysts were gradually enlarged on the peripheral side of a lung mass in the upper lobe of the patient's right lung, who experienced two spontaneous pneumothoraxes in the area. Exploratory surgery was performed to diagnose the lung mass and treat the pneumothorax, resulting in a final diagnosis of pulmonary tuberculoma. A check-valve mechanism caused by the pulmonary tuberculoma was suspected based on the patient's clinical course. [ABSTRACT FROM AUTHOR]

Peritoneal inclusion cysts (PICs) are a rare and benign condition of uncertain pathogenesis. The fluid-filled, mesothelial-lined cysts manifest within the abdominopelvic cavity. This case report details an unusual occurrence of a 97 mm PIC- presenting as an umbilical hernia- in a 26-year-old male patient with no prior surgical history. Following pre-operative cross-sectional imaging, this was managed through open excision without complication. A systematic review of the literature highlighted 30 previous cases [26F, 4M] with a mean age of 34 years (std ±15.4) and a median diameter of 93 mm [IQR, 109 mm]. A total of 53% (n = 16) of cases had a history of previous abdominal surgery. Surgical excision is safe and laparoscopic modality should be considered (<1% recurrence). Accepting the limited evidence base, image guided drainage should be avoided (50% recurrence, n = 2). [ABSTRACT FROM AUTHOR]

Background: Surveillance of pancreatic cysts are necessary due to risk of malignant transformation. However, reported progression rates to advanced neoplasia are variable and the high frequency of surveillance scans may pose a considerable burden on healthcare resources. Purpose: To validate the effectiveness of the Fukuoka Guidelines surveillance regime and determine if a longer surveillance interval can be established. Material and Methods: All magnetic resonance imaging (MRI) studies of the pancreas performed at our institution between January 2014 and December 2016 with at least one pancreatic cystic lesion and follow-up MRI or computed tomography (CT) over at least two years were reviewed for size, worrisome feature (WF), and high-risk stigmata (HRS) at diagnosis and follow-up imaging (up to year 6). Reference standards for advanced neoplasia were based on endoscopic ultrasound, fine needle aspiration cytology, or the presence of ≥2 WF or ≥1 HRS on imaging. Comparison of MRI features of progression and outcomes of diagnostic endpoints between lesions <20 mm and ≥20 mm was performed. Results: A total of 270 patients were included (201 cysts <20 mm, 69 cysts ≥20 mm). Compared with cysts <20 mm, cysts ≥20 mm were more likely to be associated with WF or HRS (40.6% vs. 12.4%; P ≤0.00001), demonstrate increase in size of ≥5 mm in two years (20.3% vs. 10.9%; P = 0.049), and develop advanced neoplasia (24.6% vs. 0.5%; P <0.00001). Conclusion: Pancreatic cysts <20 mm have a low risk of developing WF and HRS and surveillance interval may be lengthened. [ABSTRACT FROM AUTHOR]

Cowper's syringocele is a cystic dilation of the bulbourethral duct or gland. This rare pathology has historically been diagnosed in the pediatric population, with recent literature reporting an increased incidence in adults. Attempts have been made to classify Cowper's syringoceles by their appearance on imaging and endoscopy, however a simpler classification of unobstructed versus obstructed may be of more utility in directing management. Herein, we present a novel case of a Cowper's syringocele developed in adulthood that supports the suspicion for underdiagnosis, as well as one proposed mechanism of acquired etiology of Cowper's syringoceles involving incomplete or intermittent obstruction secondary to the application of external force of the leading to asymptomatic cystic dilation. [ABSTRACT FROM AUTHOR]

Racemose neurocysticercosis (RNC) is a malignant form of Taenia solium infection. It carries high mortality due to widespread intraparenchymal invasion, mass effect, and cyst rupture. Cerebellar RNC is unusual and constitutes a surgical challenge. Scarce applications of ultrasound (US) -guided resection have been reported for RNC of the posterior fossa. We report the case of a 66-year-old woman who presented with ataxia and dysmetria. Her past medical history was relevant for seizures and hydrocephalus secondary to neurocysticercosis. Because of the increasing cyst invasion and threatening mass effect in the posterior fossa, the patient underwent US-guided resection of lesions. Postoperative computed tomography (CT) demonstrated complete excision of cysts, and a 2-year follow-up magnetic resonance imaging (MRI) showed no recurrence. On neurological examination, the patient had persistent ataxia without new-onset neurological deficits. The present case study illustrates the feasibility and cost-effective approach of US-guided resection to provide enhanced operative visualization and achieve complete cyst resection. [ABSTRACT FROM AUTHOR]

Purpose: This study aims to evaluate and identify magnetic resonance (MR) findings of mural nodules to detect squamous cell carcinoma arising from ovarian mature cystic teratoma (SCC-MCT). Methods: This retrospective study examined 135 patients (SCC-MCTs, n = 12; and benign MCTs, n = 123) with confirmed diagnoses across five different institutions between January 2010 and June 2022. Preoperative MR images for each patient were independently assessed by two experienced radiologists and analyzed following previously reported findings (PRFs): age, tumor size, presence of mural nodules, size of mural nodule, and the angle between mural nodule and cyst wall (acute or obtuse). Furthermore, this study evaluated four mural nodule features—diffusion restriction, fat intensity, Palm tree appearance, and calcification—and the presence of transmural extension. Results: There were significant differences between the SCC-MCT and benign MCT groups in terms of all PRFs and all mural nodule findings (p < 0.01). Among the PRFs, "tumor size" demonstrated the highest diagnostic performance, with a sensitivity of 83.3% and a specificity of 88.6%. A combination of the aforementioned four mural nodule findings showed a sensitivity and specificity of 83.3% and 97.6%, respectively, for the diagnosis of SCC-MCT. Regarding diagnosis based on a combination of four mural nodule findings, the specificity was significantly higher than the diagnosis based on tumor size (p = 0.021). Based on these mural nodule findings, three SCC-MCT patients without transmural invasion could be diagnosed. Conclusion: Mural nodule MR findings had a higher diagnostic performance than PRFs for SCC-MCT and can potentially allow early detection of SCC-MCTs. [ABSTRACT FROM AUTHOR]

The prevalence of intra-osseous jaw lesions differs in various populations; it remains a major concern for dentists and oral surgeons. Jawbones can be afflicted by a varied group of lesions and can present in diverse clinical patterns, hence adequate knowledge of the clinical and demographic characteristics of these lesions is necessary for the early detection and management. Hence, this study was designed to analyze the prevalence of intra-osseous jaw lesions in the pediatric population. The histopathology reports of all oral jaw lesions from the pediatric population, aged 0-14 years, between 1991 to 2023 period were retrospectively analyzed from the archives of the Department of our Institute and the data were analyzed through descriptive statistics. Our investigation underscores a predominance of intraosseous jaw lesions among males (53%) compared to females (47%), with the most commonly affected age group falling within the range of 6 to 11 years. The posterior mandible emerged as the primary location of these lesions, followed closely by the posterior maxilla. The histopathological examination further elucidates the landscape of these lesions, with radicular cysts comprising the majority (36%), trailed by dentigerous cysts (23%), odontogenic tumors (20%), and various other entities such as reactive/inflammatory (9%), fibro-osseous (7%), and neoplastic lesions (4%). In light of these findings, dental practitioners and specialists must have a complete understanding of the clinical and demographic characteristics associated with intraosseous jaw lesions in pediatric patients. Early recognition and accurate diagnosis are paramount for effective management and optimal patient outcomes. [ABSTRACT FROM AUTHOR]

Pathologies of the vagina are important causes of symptoms related to the genital tract in women. They can be missed on transabdominal ultrasonography (USG), which is the baseline modality used for evaluation of gynaecological complaints. Transperineal USG and MRI are the imaging modalities of choice for evaluation of the vagina. Diseases of the vagina can be grouped depending upon the age group in which they occur. In children and young adults, congenital anomalies like longitudinal or transverse vaginal septum, imperforate hymen, vaginal aplasia or atresia, and rectovaginal fistula can be seen. Malignant tumours can rarely occur in children, rhabdomyosarcoma being the most common one. Common diseases affecting adults include benign lesions like epidermoid, Gartner duct, and Bartholin cysts, and urogenital fistulas involving the vagina. Endometriosis and other benign tumours of vagina including leiomyoma, fibroepithelial polyp, and angiomyxoma are occasionally seen. Malignant tumours can be primary, the most common one being squamous cell carcinoma, or secondary, due to direct extension from cancers involving the adjacent organs. Characteristic morphological changes occur in the vagina after radiotherapy, which can be identified on imaging. Knowledge about the imaging appearances of these diseases is crucial in guiding appropriate management. [ABSTRACT FROM AUTHOR]

Cystic echinococcosis (CE) is a parasitic disease caused by the larval stages of Echinococcus and is considered a neglected disease of public health worldwide. CE primarily affects the liver and demonstrates distinctive radiological findings in computed tomography (CT) and ultrasonography (US). Surgery is considered the mainstay of CE treatment. The patient was a 17-year-old man admitted to the Emergency Department of Shahid Faghihi Hospital affiliated with Shiraz University of Medical Sciences with dull right upper quadrant abdominal pain, loss of appetite, abdominal distention, and fullness. An abdominal CT scan revealed a giant hepatic cyst measuring about 24x20x15 cm in the right hepatic lobe (RHL) with a pressure effect on the right kidney, pancreas, and bowel loops. Semi-chevron incision was done and the patient underwent partial precystectomy with capitonnage and omentoplasty. The surgical outcome was uneventful and the patient was discharged on the eighth day after the surgery with the oral Albendazole. Reviewing the literature, our case was the 5th rank according to the size of the recorded published cases. The most common countries where the largest liver hydatid cysts were reported were Greece and Turkey. The most common surgery was the open surgery and the most common incisions were Kocher and then Chevron incisions. When dealing with a huge liver cyst, a high index of suspicion for echinococcal etiology becomes important in endemic areas such as Iran. The choice of treatment for giant hepatic cysts substantially seems to be radical surgery by surgical ablation in general to mitigate the mortality and morbidity rate, because they are at risk of rupture, anaphylaxis, and so forth. (The abstract is too long for a case report [260 words], it should be around 100 words. The part I highlighted can be deleted.) [ABSTRACT FROM AUTHOR]

Previous reports describing laparoscopic deroofing as a management modality for a hepatic cyst with biliary communication remain limited. We present the case of a 76-year-old woman who was monitored for 4 years for a giant hepatic cyst in the right lobe of the liver. She presented to our department with a chief complaint of abdominal distension. Moreover, imaging revealed a 24-cm giant hepatic cyst. During laparoscopic deroofing, minimal bile leakage from the intra-cyst wall was observed, which was laparoscopically closed with sutures. No bile leakage or cyst recurrence was observed 18 months postoperative. This highlights that laparoscopic surgery may be used in managing hepatic cysts with biliary communication. Intraoperative findings may reveal biliary communication, which requires careful observation of the cyst wall after deroofing. [ABSTRACT FROM AUTHOR]

Anatomical variations of the biliary tree pose diagnostic and treatment challenges. While most are harmless and often discovered incidentally during procedures, some can lead to clinical issues and biliary complications, making knowledge of these variants crucial to prevent surgical mishaps. Here, we present an unusual and clinically significant case. A 61-year-old man is admitted to the hospital with epigastric pain and diagnosis of pancreatitis of biliary origin and intermediate risk of choledocholithiasis. Magnetic resonance cholangiopancreatography (MRCP) reported hepatolithiasis and choledocholithiasis, whereas endoscopic retrograde cholangiopancreatography showed cystic drain of the right hepatic duct. One month later the patient presented again to the emergency room with increasing abdominal pain and a computed tomography that demonstrated the presence of hepatic abscess and acute cholecystitis. The patient underwent percutaneous drain abscess and a subtotal laparoscopic cholecystectomy. Biliary anatomical variants present challenges on the diagnostic investigations, interventional and surgical procedures, understanding the possible complications is essential. [ABSTRACT FROM AUTHOR]

This study describes dehydration of agar containing cysts as a novel and inexpensive method for long-term storage of Acanthamoeba spp. collections at room temperature. Five hundred microliters of axenically cultured Acanthamoeba spp. trophozoites (106 cells/mL) in PYG media or 150 µl of amoeba suspension (106 cells or cysts/mL) from monoxenic plate culture was spread onto the surface of non-nutritive agar (NNA, 2–3-mm thick) without or with a layer of heat-inactivated Escherichia coli, respectively. The plates were sealed and incubated at 30 °C. After the encystment, the Parafilm® was removed, and the plates were kept at the same temperature until the NNA was completely dehydrated. The dehydrated cyst-containing NNA was cut in rectangles and stored in airtight tubes at room temperature for up to 3 years. Cyst viability was assessed by inoculating them in fresh NNA with a layer of E. coli and in PYG followed by incubation at 30 °C. One hundred percent of samples from all specimens (19) stored over the 3 years allowed new cultures to be re-established; however, two strains showed reduced viability, at 66.7% and 62.5%, after 2 years of room temperature storage. One hundred percent of the cyst samples produced axenically and maintained in dry NNA allowed the re-establishment of axenic cultures through direct incubation in PYG, with excystment occurring within 24 or 48 h. For the first time, we report the dehydration of cyst-containing agar as an economical and effective method for the long-term storage of Acanthamoeba spp. collections at room temperature. It enables the creation of large collections using reduced space and economical transport of Acanthamoeba strains, in addition to allowing better organization of the collection. [ABSTRACT FROM AUTHOR]