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Epidermal inclusion cysts are slowly developing intradermal lesions which form after the implantation of epidermal tissue into the dermal tissue. Epidermal cysts occur infrequently in the foot, but can occur after traumatic episodes, including surgically induced trauma. Epidermal inclusion cysts have been described as a complication of minimally invasive foot and ankle surgery; however, they have been described infrequently as a complication of radiofrequency microtenotomy. To our knowledge, only one other case study exists discussing the development of a singular epidermal cyst after undergoing radiofrequency microtenotomy. Therefore, the purpose of the present case report was to discuss a case of the development of multiple epidermal inclusion cysts of the plantar heel after radiofrequency microtenotomy for treatment of plantar fasciitis. After undergoing radiofrequency coblation in November 2017, the patient developed multiple plantar heel cysts. She went on to have them surgically removed in February 2018 and again in June 2018. By the time of presentation to our office in October 2018, multiple cysts were still present to her heel despite 2 surgical excisions. Seventeen months after surgical excision in February 2019, the patient remained cyst-free.

Birt Hogg Dube syndrome is a rare disease characterized by autosomal dominant inherited multiple cysts in the lungs, renal tumors and skin fibrofolliculomas. It was first described in 1977 by Birt et al. In this case report, a patient who was diagnosed with symptoms and his first degree relative is presented. Diseases that should be considered in differential diagnosis are discussed. The diagnosis of this disease is usually made after recurrent pneumothorax. Since it is a genetic disease, the importance of follow-up and screening needs of patients and their relatives is emphasized.

Background: Cystic enlargement of ovaries may develop due a large number of causesand may need surgical intervention. Moreover, some ovarian cysts arise due to endocrinedisorders & do not require surgery. We report an unusual case of massive enlargement ofovaries with multiple cysts in a girl with severe hypothyroidism. Morphologic features ofcysts on ultrasonography and clinical features of hypothyroidism with elevated TSH levelfacilitates diagnosis of multiple ovarian cysts and hypothyroidism. Case presentation: A 23-year-old unmarried woman presented with abdominal enlargement,pain and moderate anemia. Abdominal ultra sonogram revealed huge enlargement of theovaries with multiple large cysts. She was admitted in a hospital, treated with blood transfusionand laparotomy was decided. She was referred to us in a private clinic. On further evaluation, she had features of hypothyroidism with high TSH level and abdomino-pelvic ultrasoundrevealed enlarged ovaries with multiple large thin-walled cysts and mild ascitis. Conservativemanagement with thyroxin replacement therapy was given and after 3 weeks of thyroxine(T4) therapy, follow-up abdominal ultrasound showed significant reduction in ovarian size.After 4 months of thyroxine therapy, ovarian size normalized, cysts disappeared completelyand there was significant improvement of patient’s condition and she became euthyroid. Conclusion: This case report highlights the rare association between hypothyroidism andmulticystic ovarian enlargement. It is necessary to keep in mind the possibility ofhypothyroidism in the differential diagnosis of adult patients with ovarian enlargement andmultiple cyst formation in order to prevent unnecessary ovarian surgery. Bangladesh J Obstet Gynaecol, 2018; Vol. 33(1) : 78-81

Multiple scrotal epidermoid cysts present a difficult challenge. Individual cyst excision for multiple cysts is painstaking, and there is a high risk of recurrence. If treated conservatively, multiple cysts may cause pain, become infected or cause problems with self-esteem due to the cosmetic appearance. We present a technique for excision of the anterior scrotal wall as a treatment for multiple scrotal epidermoid cysts. Level of evidence: Not applicable.

Background In neurocysticercosis, the larval form of the pork tapeworm Taenia solium appears to evolve through three phases—active, degenerative and sometimes calcification—before disappearance. The antihelmintic drug, albendazole, has been shown to hasten the resolution of active cysts in neurocysticercosis. Little is known about the time cysts take to progress through each phase, with or without treatment. Methods We reconfigured brain imaging data from patient level to cyst level for 117 patients in a randomized clinical trial of albendazole in which images were taken at baseline, 1, 6, 12 and 24 mo. Applying a multistate model, we modelled the hazard of a cyst evolving to subsequent cyst phases before the next imaging (vs no change). We examined the impact of albendazole treatment overall and by patient and cyst characteristics on the hazard. Results Albendazole accelerated the evolution from the active to degenerative phase (HR=2.7, 95% CI 1.3 to 6.5) and from the degenerative phase to disappearance (HR=1.9, 95% CI 1.1 to 3.9). Albendazole’s impact was stronger for patients who were male, did not have calcified cysts at baseline and who had multiple cysts in different locations. Conclusions This research provides a better understanding of where in the cyst trajectory albendazole has the greatest impact.

Solitary fibrous tumors (SFT) rarely arise in the pelvis. Here, we report two cases of SFT arising from the pelvic retroperitoneum. The first case involves a 64-year-old woman diagnosed with a 5-cm pelvic mass. Magnetic resonance imaging revealed a solid and cystic mass with marked enhancement, but limited water restriction. During surgery, intraligamental tumor arising near the round ligament was resected. Pathologically, the tumor comprised dilated vessels and spindle-shaped cells positive for STAT6 and CD34. The second case involves a 53-year-old woman diagnosed with a 4.5-cm pelvic mass through computed tomography. Magnetic resonance imaging demonstrated a solid mass with multiple cysts with strong enhancement and slight water restriction. During surgery, the tumor was found in the retroperitoneum. Pathologically, spindle-shaped tumor cells positive for STAT6 and CD34 had proliferated around the prominent hyalinized vessels. Although rare in the pelvis, SFT should be suspected when a mass with strong enhancement is found.

Spontaneous hyperstimulation syndrome (spOHSS) is a rare event in pregnancies following natural conception. Only a few cases are reported in the scientific literature and result associated with massive ovarian enlargement with multiple cysts, dehydration, and fluid accumulation in the "third space". We report a novel case of spOHSS in a naturally conceived singleton pregnancy. The spOHSS was characterized by massive ovarian enlargement with multiple cysts. No dehydration and no signs of ascites were observed. The pregnancy uneventful evolved up to term.

Highlights • MCN is very rarely multicentric. • Presence of ovarian-type stroma is required for the diagnosis of MCN. • This is a case of diffuse MCN in the setting of chronic pancreatitis. • It highlights the importance of multidisciplinary care for pancreatic cystic disease., Introduction Mucinous cystic neoplasms (MCN) are rare premalignant neoplasms of the pancreas that are typically found as single lesions in the pancreatic body and tail of women in the fifth and sixth decade of life, do not communicate with the pancreatic ductal system and are characterized by mucin-producing epithelium supported by ovarian-type stroma. Presentation of case We present here a case of diffuse pancreatic involvement by MCN in a 64-year-old woman with chronic pancreatitis. Pre-operative suspicion for MCN was low due to the multi-centric nature of the lesions and imaging/biochemical fluid analysis demonstrating connection with the pancreatic ductal architecture. The patient underwent total pancreatectomy with pathology showing multiple cysts lined by flat epithelium with focal ovarian-type stroma, consistent with low-grade MCN. Discussion The presence of ovarian stroma on histological analysis is one of the defining characteristics of MCNs per WHO guidelines, and is mandatory for its diagnosis. Only one case of diffuse MCN has been previously described in the literature; however, in this case the authors were not able to reach a definitive histological diagnosis based on WHO criteria. Conclusion To our knowledge, this is the first report of diffuse histology-proven MCN of the pancreas.

Autosomal dominant polycystic kidney disease (ADPKD) is the most common hereditary renal disease, which usually manifests in adulthood. It is characterized by the development of multiple cysts in the kidneys and many other extrarenal manifestations. We aimed to determine the factors that contribute to the progression of ADPKD to end-stage renal disease (ESRD). In a retrospective multicentric study, we reviewed the records of 569 patients with ADPKD, hospitalized at a nephrology department or followed up at the outpatient department of university and regional hospitals, covering the north and center of the country, during the period 1969–2016. The mean age of the study patients was 48.54 ± 13.68 years and 14% were young adults (40 years (P = 0.009), hematuria (P = 0.034), hemoglobin >14 g/dL (P = 0.0013), high uric acid level (P = 0.001), and leukocyturia (P = 0.02). Death occurred in 59 cases (10.3%), mostly caused by infections (44.1%). In our study, ADPKD was lately diagnosed in most cases. Family screening is important, which will enable early detection and management of the complications associated with ADPKD.

Cystic lung disease (CLD) is a group of lung disorders characterized by the presence of multiple cysts, defined as air-filled lucencies or low-attenuating areas, bordered by a thin wall (usually < 4 mm). It is very often mixed with giant bullaes which are common in patients with emphysema. Case report: A 76-year-old woman with a medical history of subocclusive disturbance was admitted to surgery department. Accidentally, during preoperative examination, chest X-ray revealed giant bullae in the right lung. CT scan confirmed it, but due to the wall thickness the changes have been classified into pulmonary cyst which have a completely different approach in treatment. Thus, patient underwent without surgery and was treated conservatively. Conclusion: The main difference between a giant bullae and a pulmonary cyst is in wall thickness, if it measures between 1 and 4 mm it is pulmonary cyst, unlike bullae whose wall is thinner than 1mm.

This case report describes a male patient born in 1953 presenting an occasional increase in serum amylase and lipase forty years ago. The monitoring of enzymes was accompanied by radiological investigations, which did not reveal pancreatic pathology. In his family, including 10 siblings, half were carriers of this isolated anomaly; multiple cysts in pancreas, kidneys, and liver were present in some family members, in addition to a pancreatic neoplasia in a sister who did not carry the enzymatic abnormality. Our patient developed colon adenocarcinoma at the age of 67. Here we examine the characteristics of non-pathological chronic pancreatic hyperenzymemia defined as such by the main Italian pioneer Professor Gullo.

Background Researchers have proved that simple renal cysts (SRCs) might be correlated with renal dysfunction, but it is still controversial. Thus, we conducted clinical research study with large sample size and long-term follow-up to clarify the relationship between SRCs and renal dysfunction. Methods A total of 571 SRCs patients in outpatients of nephrology department were included, we investigated the clinical characteristics of growth SRCs compared with non-growth SRCs, evaluated the incidence of renal dysfunction in SRCs and explored the risk factors of renal dysfunction in growth SRCs. Results The mean baseline age was 51.31 ± 14.37 years in the whole cohort, ranging from 19 to 79 years, and 57.6% of them were male. The median follow-up duration was 3 years, ranging from 1 to 10 years. In addition, the final maximum diameter increased 1 mm (2.74%) per year. Patients in growth SRCs group tented to have higher percentage of hypertension, hematuria, large cyst and multiple cysts compared with non-growth SRCs group. The prevalence of renal dysfunction was 15.6% after the follow-up, and the prevalence of renal dysfunction was about 10 times higher in growth SRCs group than non-growth SRCs group (23.3% vs. 2.4%). Renal dysfunction was significantly associated with age, female, total cholesterol, diastolic blood pressure, final maximum diameter and yearly change in maximum diameter in growth SRCs. Conclusions SRCs were closely related to the decline of renal function, we recommend close follow-up for growth SRCs.

Acinar cystic transformation (ACT) or acinar cell cystadenoma is a rare benign tumor of the pancreas. Their clinical presentation is nonspecific, thus hampering their detection and frequently leading to misdiagnosis. In this report, we present a case of ACT of the pancreas in a 54-year-old man that was vague abdominal symptoms. A magnetic resonance imaging was shown a well-defined cystic mass located in the head of the pancreas, measuring 57×47×23 mm. Our patient was treated by pancreaticoduodenectomy. In the macroscopic examination of the mass, a multicystic lesion was found in cream-colored pancreatic tissue. Histological and immunohistochemical studies examination revealed a cystic mass containing multiple cysts at varying sizes, lined by epithelial cells without atypia and positive staining of CK7, CK8/18, and CK19. A high index of clinical suspicion is required to diagnose this tumor. The surgical approach is to ensure accurate diagnosis and to avoid complications

A benign lymphoepithelial cyst (BLEC) is defined as a rare, benign lesion composed of single or multiple cysts found within salivary glands or the lateral cervical area. Increasing reports suggest an association between BLEC and human immunodeficiency virus (HIV), although its pathogenesis remains unclear. We report a 51-year-old male who presented with recurrent bilateral BLECs after initial parotidectomy of cyst. An HIV panel was then performed with a positive result. We review the surgical and medical managements of BLEC while also discussing further treatment recommendations. Clinicians should be aware that BLEC recurrence postparotidectomy may be the initial presenting symptom of HIV in a patient with no risk factors.

A total of three cases of congenital porcine polycystic kidneys were observed incidentally in Hampshire and Desi crossbred piglets during necropsy examination in the Department of Pathology, College of Veterinary Science, Assam Agricultural University (AAU), Khanapara, Guwahati. Grossly, the kidneys were swollen with thinning of the cortex. There were presence of multiple cysts containing serous fluid. Microscopically, the cystic cavities were emptied and surrounded by a serous membrane and fibrous connective tissues. Renal tubules and glomeruli around the cysts were atrophied. The end stage renal failure appears to be the cause of death in piglets. The cases were diagnosed as congenital polycystic kidneys.

We encountered 2 patients with symptomatic huge simple renal cysts. In case 1, 4,000 mL of cyst fluid was drained via a catheter, but intracystic bleeding occurred immediately afterwards. Transcatheter arterial embolization (TAE) was performed, after which the bleeding stopped, and cyst drainage was repeated successfully. After 2 years, the total cyst volume was reduced from 11,775 mL to 75.4 mL. In case 2, TAE was performed prophylactically before drainage. Subsequently, 9,400 mL of fluid was removed from multiple cysts. After 1 year, the total cyst volume was reduced from 9,215 mL to 633 mL without bleeding. Based on these 2 cases, prophylactic TAE before drainage may be useful in patients with huge renal cysts.

INTRODUCCION: El Esteatocistoma Multiple (EM), tambien denominado bocistomatosis o enfermedad poliquistica epidermica, es una patologia cutanea poco frecuente con alta carga genetica, que se caracteriza por la aparicion de multiples quistes, los mismos que son consecuencia de una alteracion de los conductos de las glandulas sebaceas. Estos quistes pueden llegar a medir desde 1-2 milimetros hasta varios centimetros de diametro. Es importante diferenciar el esteatocistoma multiple con otras patologias como quistes eruptivos vellosos, quistes epidermicos o lipomas para descartar sindromes cutaneos asociados a estas patologias. A nivel mundial no existen datos epidemiologicos del EM; se han reportado treinta casos en familias y varios casos esporadicos a nivel mundial. Generalmente se presenta entre la primera y segunda decada de vida, con una mayor prevalencia en hombres. CASO CLINICO: Paciente femenina, de 26 anos de edad, afrodescendiente, sin antecedentes personales o familiares de relevancia. Acudio a consulta externa de dermatologia por presentar desde hace aproximadamente siete anos, nodulos blanquecinos a nivel de axilas, cuello e hipogastrio, levemente pruriginosos, que aumentan en numero y tamano de manera progresiva. EVOLUCION: La paciente fue sometida a biopsia de lesion en region axilar derecha, con reporte de anatomia patologica compatible con esteatocistoma multiple, los cuales fueron extirpados quirurgicamente. CONCLUSIONES: El esteatocistoma es una patologia infrecuente, de la cual existen muy pocos estudios. Aunque se conoce su benignidad, es importante su diagnostico diferencial, por su posible asociacion a paquioniquia congenita, acne nodulo quistico, hipotricosis, hipertricosis, hidrosadenitis supurativa y poliposis gastrointestinal. Ademas se debe sospechar de esta enfermedad cuando exista un cuadro clinico con nodulos quisticos.ABSTRACTBACKGROUND: Multiple Steatocystoma (MS), also called bocistomatosis or epidermal polycystic disease, is rare skin pathology with high genetic load, which is characterized by the appearance of multiple cysts, which are the result of an alteration of the ducts of the sebaceous glands. These cysts can measure from 1 - 2 millimeters to several centimeters in diameter. It is important to differentiate multiple steatocystoma with other pathologies such as villous eruptive cysts, epidermal cysts or lipomas to rule out cutaneous syndromes associated with these pathologies. There are no clear data about the epidemiology of MS; thirty cases have been reported in families and several sporadic cases worldwide. It usually occurs between the first and second decade of life, with a higher prevalence in men. CASE REPORT: A 26-year-old, female patient of African descent; without personal or family history. She came to the consult of dermatology for presenting approximately since seven years, whitish nodules at the level of armpits, neck and hypogastrium, slightly pruritic, increasing in number and size progressively. EVOLUTION: The patient underwent a biopsy of the lesion in the right axillary region, with a pathology report compatible with multiple steatocystoma, which were surgically excised. CONCLUSIONS: Steatocystoma is an infrequent pathology, of which there are very few studies. Although it is benignity is known, it is important to realize the differential diagnosis, for possible association with pachyonychia congenita, acne nodule cystic, hypotrichosis, hypertrichosis, hidradenitis suppurativa and gastrointestinal polyposis. In addition, this disease should be suspected when there is a clinical picture with cystic nodules.

Highlights • Coexistence of hepatic cyst and liver sarcoma. • Recurrence of hepatic cysts. • Surgical approach has been mentioned as the treatment modality. • The roles of chemotherapy and radiotherapy are still controversial., Introduction Liver sarcoma is exceedingly rare and is a clinical challenge. Case report A 69-year-old female presented with right upper quadrant pain after a fall. Her CT scan showed multiple cysts. She was initially diagnosed as hepatic cysts with hemorrhage and underwent puncture and drainage of liver cysts. But the cysts relapsed quickly. Then she underwent fenestration of the hepatic cysts. The liver cysts reoccurred again accompanied by massive bleeding and obstructive jaundice. She underwent right trihepatectomy and her final pathological report showed liver sarcoma. However, the hepatic sarcoma reoccurred again. Its’ diagnosis and treatment process are extremely complex. In the end, she had a bad ending. Conclusion We believe that timely diagnosis and complete excision of liver sarcoma are very important.

Hydatid disease is a prevalent disease in India. The most common organs involved are the liver and the lungs. Most of the time, the lung cysts are single and large. Multiple cysts have been described in literature but they are generally bilateral. We present here a case of multiple hydatidosis which involved only one lung, but occupied all the segments of the lung. The cysts were numerous and interconnected giving the appearance of a maze. The images of the computed tomography (CT) scan reveal that there was very little identifiable lung tissue. But after surgery, the healthy lung tissue expanded and occupied the chest cavity.

Central mucoepidermoid carcinoma (MEC) poses a diagnostic challenge because of its rarity and histological overlap with glandular odontogenic cyst (GOC). In MEC of both salivary glands and jaws, MAML2 arrangement has been well known as the specific gene alteration. We report a case of central MEC arising from GOC diagnosed by MAML2 fusion gene. A 57-year-old male presented a multilocular cystic lesion in left molar region of the mandible. Histopathologically, multiple cysts lined by thin cuboidal or non-keratinized squamous epithelium with small duct-like structures, mucous cells and ciliated cells were present. It was diagnosed as GOC. The recurrent lesion after nine years showed the proliferation of many cystic and solid nests composed of epidermoid, mucous and intermediated cells. Nested PCR revealed CRTC3-MAML2 fusion gene in the recurrent lesion, but not in the primary one. Similarly, MAML-2 rearrangement by FISH analysis was positive in the recurrent lesion, while negative for the primary one, thus confirming the diagnosis of central MEC arising from GOC. Analysis of MAML2 rearrangement can be used as a supportive evidence to distinguish central MEC from GOC.

Primary multiple tumors are an independent emergence and development two or more neoplasms in one patient. Thus can be the struck not only different bodies of various systems, but pair bodies (mammary glands, lungs, etc.) also, and one body with multicentric defeat. Primary multiple tumors can be synchronous and metachronous. The increase in frequency of multiple neoplasms is noted in recent years.A clinical observation of a 62-year-old patient with synchronous-metachronous primary-multiple cancer of both kidney and prostate gland is presented. A feature of this observation is multiple lesions of both kidneys, as well as the presence of two different morphological forms of renal cell carcinoma in one kidney (papillary and clear cell). The difficulty in identifying and differentiating kidney tumors with a cystic structure was due to the presence of multiple cysts of both kidneys of different types according to Bosniak.

Breast cysts (galactocele) form in the mammary gland from ductal obstruction. Multiple pathologic entities may produce complex cystic breast lesions. Ultrasound is presently the first primary modality in breast evaluation after physical palpitation. We report a progressive case of multiple cysts in a 32-year-old woman, ranging from 28 mm to 20 mm. Though in-situ milk (sono-penic) appears sterile, the superficial presentation (externally) is that of a firm mass. Due to the known hazards of radioactive mammography, this case report proves the usefulness of sonar to image, map, measure, identify and diagnose breast pathology. In women with dense-heavy breast, ultrasound examination will play an important role in screening palpable and non-palpable masses.

We herein describe a pediatric case of bilateral morning glory anomaly whose retrobulbar cysts and renal disease were underdiagnosed, and finally, he was diagnosed with renal coloboma syndrome. We recommend patients with colobomatous optic nerve malformations undergo a complete workup to avoid missed diagnosis, which includes (i) general physical examination looking for heart defects, genitourinary, auricular, and midline facial defects among other abnormalities; (ii) simple nephrologic investigations such as routine urine test and/or renal ultrasound to check for renal hypoplasia; and (iii) neuroimaging check for cerebrovascular anomalies and midline cranial defects. Genetic testing can be a useful tool to guide the workup.

Different types and locations of choroid plexus cysts (CPCs) have been described, including oversized and bilateral. It appears that the type, size, and number of CPCs are correlated with various degrees of aneuploidy risk. This report deals with the natural history and significance of CPCs filling only one choroid plexus. Multiple CPCs filling the entire choroid plexus were detected in 9 of 4211 consecutive second-trimester sonographic examinations. Karyotyping via amniocentesis or neonatal blood analysis was performed in all cases. CPCs in a single choroid plexus were associated with transient ventriculomegaly in five of nine fetuses. Resolution of CPCs took place between 25 and 33 weeks of pregnancy, with most resolving after the 30th week. Karyotyping revealed normal results in all cases. Favorable prognosis of newly described multiple CPCs in a single choroid plexus should be mentioned during patient counseling.

Epidermal inclusion cyst (EIC) and syringoma are both benign lesions that are primarily asymptomatic and occur at various places on the body. Although both EIC and syringoma are common, their joint appearance has not been previously reported. These benign proliferations target different populations, and with differing clinical presentations. Syringomas tend to develop in young females as smaller multiple lesions, while EICs often present in older males as single or multiple variants that are typically larger in size. They also possess distinctive histopathological appearances that can used for their diagnosis. Furthermore, despite both having unclear etiologies, the involvement of the eccrine duct has been a proposed mechanism in the development of both lesions. Thus, further investigation of eccrine ducts in the pathology of these lesions can be the basis for assessing the association between EICs and syringomas. We report a unique case of a 16-year-old boy who presented to the clinic with multiple cysts (at least 20) on the scrotum, most of which consisted of both EIC and syringoma histologically. We are not aware of any previous reports of patients with multiple combined syringomas and EICs, and their potential association should be further explored.

Highlights • A case of the intramural cyst of the gallbladder is rarely encountered. • The cyst derived from the Luschka duct, a specific histological element of the gallbladder, has not received much attention. • The gallbladder’s mural cyst, which is derived from the Luschka duct, is different from Rokitansky-Aschoff sinus origin., Introduction and importance An intramural cyst is a rare lesion that develops in the wall of the gallbladder. Although the acquired cysts originate from the Rokitansky-Aschoff sinus (RAS), the congenital them, such as the duct of Luschka, are rare. Luschka's duct is a unique and specific tissue component that is histologically different from the inherent bile duct and without the communication to the lumen of the gallbladder. Case presentation A woman in her seventies underwent cholecystectomy for the treatment of repeated choledocholithiasis. Pathological examination of the resected specimen revealed multiple cysts in the subserosal tissue of the liver bed. The cysts were lined by cuboidal epithelium and surrounded by hypercellular fibrous tissue. Apart from the Luschka's ducts scattered around the cyst, no other components were observed. Immunohistochemically, the cystic epithelium was different from that of the gallbladder and phenotypically similar to that of the Luschka's duct. Discussion From histopathological and immunohistological findings, it was suggested that the cysts of the present case are not derived from RAS, which is the most common in the gallbladder, but from the Luschka’s duct. Conclusion We report an extremely rare case of intramural cysts that appear to have originated from the Luschka’s duct.