Search

This review will provide an overview of hepatobiliary mucinous cystic neoplasms and their mimics such as complex appearing benign cysts, intraductal papillary neoplasm of bile ducts, choledochal cysts, infectious cysts, and other cystic neoplasms. Preoperative imaging, particularly abdominal MRI with MRCP, plays a key role in differentiating these entities which differ widely in management. Familiarity with the differentiating imaging features of mucinous cystic neoplasms and their mimics allows radiologists to provide management-guiding reports. [ABSTRACT FROM AUTHOR]

Introduction: Surgical management differs for different cystic lesions of liver. Various clinical, biochemical and radiological features are specific to a particular cystic liver lesion pathology and it's associated complications. Preoperative diagnosis helps to select appropriate surgical approach and tailoring appropriate management. Aim: To evaluate the clinical, biochemical, radiological predictive factors to differentiate between hydatid diseases, simple cyst of liver and biliary cystadenoma. Also to evaluate appropriate management for hydatid disease with cystobiliary communication. Materials and Methods: A retrospective study was conducted at Institute of Surgical Gastroenterology, Madras Medical College, Chennai, Tamil Nadu, India. Data were collected from 65 patients including 44 patients of hydatid disease, 13 patients of simple cyst, and 8 patients of biliary cystadenoma using a maintained database from January 2014 to December 2019 with a follow up period up to December 2020 (mean follow up of 47.06±24.37 months). Various parameters like presence of cholangitis, deranged liver function test, number of cystic lesion, presence of calcification, presence of septation with or without enhancement were assessed. Data were statistically analysed using Analysis of Variance (ANOVA) and Chi-square test. Results: There were 44 (67.69%) females and 21 (32.31%) males in this study with mean age of 50.44±12.23 years. Though multiseptation was associated with 27 (61.36%) of hydatid cysts and 1 (7.69%) of atypical simple cyst, it was more specifically present in biliary cystadenoma 8 (100%). Presence of daughter cyst (n=24, 54.55%) in hydatid disease and multilobulated appearance (n=5, 62.5%) in biliary cystadenoma were strong predictors of diagnosis. Radical surgery was associated with significantly less postoperative bile leak than conservative surgery in patients of hydatid disease with cystobiliary communication. Conclusion: Predictive factors can help to make preoperative diagnosis correctly. Radical surgery reduces postoperative bile leak in patients of hydatid disease with cystobiliary communication. [ABSTRACT FROM AUTHOR]

Introduction: Surgical management differs for different cystic lesions of liver. Various clinical, biochemical and radiological features are specific to a particular cystic liver lesion pathology and it’s associated complications. Preoperative diagnosis helps to select appropriate surgical approach and tailoring appropriate management. Aim: To evaluate the clinical, biochemical, radiological predictive factors to differentiate between hydatid diseases, simple cyst of liver and biliary cystadenoma. Also to evaluate appropriate management for hydatid disease with cystobiliary communication. Materials and Methods: A retrospective study was conducted at Institute of Surgical Gastroenterology, Madras Medical College, Chennai, Tamil Nadu, India. Data were collected from 65 patients including 44 patients of hydatid disease, 13 patients of simple cyst, and 8 patients of biliary cystadenoma using a maintained database from January 2014 to December 2019 with a follow-up period up to December 2020 (mean follow-up of 47.06±24.37 months). Various parameters like presence of cholangitis, deranged liver function test, number of cystic lesion, presence of calcification, presence of septation with or without enhancement were assessed. Data were statistically analysed using Analysis of Variance (ANOVA) and Chi-square test. Results: There were 44 (67.69%) females and 21 (32.31%) males in this study with mean age of 50.44±12.23 years. Though multiseptation was associated with 27 (61.36%) of hydatid cysts and 1 (7.69%) of atypical simple cyst, it was more specifically present in biliary cystadenoma 8 (100%). Presence of daughter cyst (n=24, 54.55%) in hydatid disease and multilobulated appearance (n=5, 62.5%) in biliary cystadenoma were strong predictors of diagnosis. Radical surgery was associated with significantly less postoperative bile leak than conservative surgery in patients of hydatid disease with cystobiliary communication. Conclusion: Predictive factors can help to make preoperative diagnosis correctly. Radical surgery reduces postoperative bile leak in patients of hydatid disease with cystobiliary communication.

While cystic hepatic lesions are frequently encountered in clinical practice, differentiation amongst the various entities can prove difficult if the histologic pitfalls and diagnostic caveats are unknown. Many patients present with vague clinical symptoms and overlapping imaging findings. Herein we discuss the most commonly encountered cystic hepatic lesions including abscesses (pyogenic and amebic), echinococcal cyst, simple hepatic cyst, ciliated hepatic foregut cyst, intrahepatic pseudocyst, mucinous cystic neoplasm, hemangioma, angiosarcoma, multilocular cystic hepatocellular carcinoma, cystic metastatic lesions, hematoma, and biloma. [ABSTRACT FROM AUTHOR]

The purpose of this study was to determine if CT and MRI features can accurately differentiate mucinous cystic neoplasms (MCNs) from simple liver cysts and to compare accuracy of CT and MRI in detecting these features. Eighty-four surgically treated lesions with pre-operative CT or MRI were evaluated by two abdominal radiologists for upstream biliary dilatation, perfusional change, internal hemorrhage, thin septations, thick septations/nodularity, lobar location, and number of coexistent liver cysts. Odds ratios, sensitivities, specificities, and positive and negative predictive values were calculated for association of each feature with MCNs. Of 84 liver lesions, 13 (15%) were MCNs, all in women, and 71 (85%) were simple cysts, in 59 women and 12 men. Thick septations/nodularity, upstream biliary dilation, thin septations, internal hemorrhage, perfusional change, and fewer than 3 coexistent liver cysts were more frequent in MCNs than in simple cysts. The combination of thick septations/nodularity and at least one additional associated feature showed high specificity for MCNs (94–98%). MRI detected significant associations of biliary dilation, thin septations, and hemorrhage/debris with MCNs which CT did not. Surgically treated MCNs of the liver with preoperative imaging occurred at our institution only in women. Thick septations or nodularity, biliary dilation, thin septations, internal hemorrhage or debris, perfusional change, and fewer than 3 coexistent liver cysts are features that help differentiate MCNs from simple cysts. MRI has advantages over CT in detecting these features. • Mucinous cystic neoplasms of the liver and bile ducts are rare. • Imaging can differentiate mucinous cystic neoplasms from simple liver cysts. • MRI has advantages over CT in detecting differentiating features. [ABSTRACT FROM AUTHOR]

Incidental adnexal masses are commonly encountered at ultrasound, computed tomography, and magnetic resonance imaging. Since many of these lesions are surgically resected and ultimately found to be benign, patients may be exposed to personal and economic costs related to unnecessary oophorectomy. Thus, accurate non-invasive risk stratification of adnexal masses is essential for optimal management and outcomes. Multiple consensus guidelines in radiology have been published to assist in characterization of these masses as benign, indeterminate, or likely malignant. In the last two years, several new and updated stratification systems for assessment of incidental adnexal masses have been published. The purpose of this article is to offer a concise review of four recent publications: ACR 2020 update on the management of incidental adnexal findings on CT and MRI, SRU 2019 consensus update on simple adnexal cysts, O-RADS ultrasound risk stratification system (2020), and O-RADS MRI risk stratification system (2020). [ABSTRACT FROM AUTHOR]

Aim: A retroaortic left renal vein (RLRV) passes between the abdominal aorta and the vertebra, and drains into the inferior vena cava. This causes compression of the left renal vein between the abdominal aorta and the vertebra, and increased pressure in the left renal vein. In this study, we aimed to evaluate whether increased pressure in the left renal vein is associated with simple renal cysts in patients with RSRV in abdominal computed tomography (CT). Material and Method: This study was performed retrospectively by scanning the abdominal CT images between 2015-2019. A total of 198 patients with RLRV were included in the study. It was statistically evaluated whether there was a significant difference between the right and left kidney in terms of number and size of cysts. Results: The mean age of the patients was 52.6±16.5 (19-90). There was no significant difference between the two kidneys in terms of number of cysts (P=0.737). There was a significant difference between the two kidneys in terms of cyst size (P=0.012). Cysts in the left kidney with RLRV were significantly larger. Conclusion: In our study, while we could not find a significant difference between the two kidneys in terms of cyst numbers, we found that the size of the cysts in the left kidney with RLRV was significantly larger. This suggests that RLRV may not have an effect on formation of renal cyst, but may affect the size of the formed cysts. [ABSTRACT FROM AUTHOR]

Copyright of Pamukkale Medical Journal is the property of Pamukkale Journal of Medicine and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Purpose: The contribution of DWI and FLAIR to the differential diagnosis of type 1, 2, and 3 hydatid cysts and simple liver cysts was investigated according to the Gharbi classification. This study is the first report using FLAIR sequence for the differential diagnosis of liver hydatid cysts in this regard. Methods: A total of 82 hydatid cysts and 40 simple cysts were scanned with DWI (in b600-b1000 values) and FLAIR sequence. In 64 patients included in the study, a total of 122 cystic lesions were diagnosed histopathologically or during follow-up. FLAIR and DWI signal characteristics were evaluated, and ADC values were calculated. Results: The mean ADC value of hydatid cysts on DWI (b600) was 3.07 ± 0.41 × 10−3 s/mm2, while it was 3.91 ± 0.51 × 10−3 s/mm2 for simple cysts and the difference was statistically significant (p

Background: Clival cystic lesions are not frequently seen in neurosurgery. Cystic lesion in the clivus can be part of a neoplastic process such as chordoma, chondrosarcoma, plasmacytoma, or metastasis. Rare types of pure cystic clival lesions include simple bone cysts and arachnoid cysts, which are asymptomatic most of the time and do not cause symptoms until they reach a large size. Case Description: This is a case report of a healthy 53-year-old male patient with a clival cystic lesion. The patient underwent surgical drainage and wall resection of the clival lesion with no postoperative complications. Intraoperative finding raised the possibility of the diagnosis of an arachnoid cyst. However, the pathology findings indicated a simple bone cyst. Conclusion: Simple bone cyst and arachnoid cyst in the clivus are rare, they should be considered in the diagnosis of clival cystic lesions. [ABSTRACT FROM AUTHOR]

Objectives: To assess 3 cm size threshold for follow-up of simple cysts in postmenopausal women. Materials and methods: Radiology information system was retrospectively queried for "US pelvis complete" over 8 years in women > 50 years, with keywords ovarian cyst, adnexal cyst, ovarian mass, cystic mass, cystic neoplasm, ovarian neoplasm, and ovarian mass. Premenopausal women were excluded. Cysts, were classified as ≤ 1 cm, 1–3 cm, 3–5 cm, and ≥ 7 cm. Largest cysts on each ovary was recorded. EMR and imaging archives were reviewed for assessing size, stability duration, and surgical records. Descriptive statistics and confidence interval were performed. Results: 4388 patients met the initial search criteria. 919 cysts in 896 women (age: 50–91 years, mean: 61.5 years) were identified. We found 162 cysts ≤ 1 cm, 352 1–3 cm, 296 3–7 cm , and 51 ≥ 7 cm cysts. 127 patients with 1–3 cm cysts had no follow-up. Final analysis of 225 1–3 cm cysts included 203 ovarian and 22 paraovarian cysts (average size = 1.95 cm (1.1–3.0 cm)). 103 ovarian cysts had less than 2 years, and 100 cysts had more than 2 years follow-up. All except one ovarian cyst were stable for the entire duration of their follow-up (Mean duration of follow-up 5.4 years) (0.3%, 95% CI 0.0–0.05). 40 cysts resolved. One simple cyst increased in size (followed over 3.25 years) without suspicious imaging features and benign on surgery. Conclusion: 1–3 cm cysts represented the most common size range (> 40%) in postmenopausal women, majority of which are stable over follow-up with benign outcome. 3 cm size threshold is appropriate for simple cyst follow-up in postmenopausal women. [ABSTRACT FROM AUTHOR]

Aims: To evaluate the computed tomographic scan features of benign and malignant adnexal masses. Methods: Retrospective descriptive study of CT scan features of adnexal masses were evaluated at Department of Radiology of Nobel Medical College from April to September 2020. Initial ultrasound or clinical diagnoses of adnexal masses were referred for the CT scan. Incidental adnexal findings on abdominal-pelvic CT scan performed for other diagnosis were also included. Descriptive parameters were calculated. Results: Total 46 cases were studied where mean age was 41.3 years with range 10-74 years. Most common age group with adnexal masses were in between 30 and 50 years (56.6%); 86% had benign features and rest were associated with either ascites (66%) or peritoneal deposits (13%). Complex cysts (60%) was the most common consistency with simple cyst (26%) followed by solid (6%). Amongst the benign neoplastic lesions most of them were dermoid cysts (35%). Conclusions: CT scan can be used as a supplementary diagnostic tool for cystic and solid component characterization of adnexal masses and help in evaluation of the nature and extent of disease. [ABSTRACT FROM AUTHOR]

Introduction: To decide treatment of hepatic cysts diagnosis between simple hepatic cyst (SHC) and cystic mucinous neoplasm (CMN). Radiological features are not patognomonic. Some studies have suggested the utility of intracystic tumor markers., Methods: Retrospective analysis of our prospective database including patients treated due to symptomatic SHC from 2003 to 2021. The aim of the study was to evaluate the results of treatment of symptomatic SHC and the usefulness of the determination of intracystic "carcinoembryonic antigen" (CEA) and "carbohydrate antigen" CA 19.9., Results: 50 patients diagnosed and treated for symptomatic SHC were included. In 15 patients the first treatment was percutaneous drainage. In 35 patients the first treatment was laparoscopic fenestration. Four patients were diagnosed of premalignant or malignant liver cystic lesions (MCN, IPMN, lymphoma B); three of them required surgery after initial fenestration and pathological diagnosis. Median CEA and CA 19-9 were 196 μg/L and 227.321 U/mL respectively. Patients with malignant or premalignant pathology did not have higher levels of intracystic tumor markers. Positive predictive value was 0% for both markers, and negative predictive value was 89% and 91% respectively., Conclusion: Values of intracystic tumor markers CEA and CA 19-9 do not allow distinguishing simple cysts from cystic liver neoplasms. The most effective treatment for symptomatic simple liver cysts is surgical fenestration. The pathological analysis of the wall of the cysts enables the correct diagnosis, allowing to indicate a surgical reintervention in cases of hepatic cyst neoplasia., (Copyright © 2023. Published by Elsevier España, S.L.U.)

Background: Increased ultrasonography (US) use has been correlated with an increased incidence of pediatric renal cysts. For simple and stage II cysts, the malignancy risk is low in adulthood, no follow up is recommended; but there is no consensus on childhood management. Given that pediatric renal cysts may be manifestations of hereditary cystic diseases, a different approach and follow up should be taken for these patients. Herein we present the clinical characteristics and follow‐up data of pediatric patients with simple and stage II renal cysts. Methods: This cross‐sectional study involved 57 children (mean age, 12.44 ± 3.65 years) with simple (n = 35) and stage II cysts (n = 22) who were diagnosed and followed at the present institution for ≥2 years. Results: The median follow‐up period was 2.84 years for simple and 3.10 years for stage II cysts. None of the patients developed complications. No change in cyst diameter was detected in 65.7% of simple or in 45.5% of stage II cysts, whereas 13 simple cysts (37.1%) and eight stage II cysts (36.4%) increased in diameter. The diameter change per year was significantly higher in the stage II cysts than in the simple cysts (P = 0.017). Overall, 13 patients (22%) had an estimated glomerular filtration rate <90 mL/min/1.73 m2, and two patients had hypertension. Conclusion: Although the malignancy risk of simple and stage II kidney cysts is low for this age group, potential complications such as renal dysfunction, hypertension and hereditary cystic disease should be closely monitored. [ABSTRACT FROM AUTHOR]

The prevalence of simple renal cysts increases with age. Simple renal cyst aspiration and sclerotherapy with percutaneous nephrostomy catheter is frequently used in urological practice. This method can be applied under local anesthesia and various complications of this method have been reported. In this paper, we report an unusual complication of this method; the distal part of the nephrostomy catheter had separated after renal cyst aspiration and laparoscopic procedure was used to remove the end part of the catheter which remained within the cyst wall in the pararenal area.

Esophageal duplication cyst is a rare congenital anomaly resulting from a foregut budding error during the fourth to sixth week of embryonic development. Cervical esophageal duplication cysts are very rare and may cause respiratory distress in infancy. A full-term newborn girl who was born by normal delivery was transferred to our hospital because of swelling of the right anterior neck since birth. Cervical ultrasonography showed a 40 × 24 × 33 mm simple cyst on the right neck. Tracheal intubation was required at 2 weeks of age because of worsening external compression of the trachea. Fine-needle aspiration cytology revealed the existence of ciliated epithelium. At 1 month of age, exploration was performed through a transverse neck incision. The cyst had a layer of muscle connected to the lateral wall of the esophagus. Histopathological diagnosis was a cervical esophageal duplication cyst. We describe the clinical features of infantile cervical esophageal duplication cysts based on our experience of this rare disease in a neonate, along with a review of 19 cases previously reported in literature. [ABSTRACT FROM AUTHOR]

Schwannoma is a benign soft tissue tumor of neural origin arising from the Schwann cells of the neural sheath. It has rarely been reported in renal or perirenal region. The preoperative diagnosis has mostly been confused with renal cell carcinoma in this location in most previous reports. We report a case that presented with a large "simple cystic" mass at the renal hilum. The preoperative differential diagnosis included hilar renal cortical cyst, renal sinus cyst, ureteropelvic junction obstruction (UPJO), or even a hydatid cyst. The final diagnosis was clinched only on histopathological examination.