A case of bilateral intrathyroidal branchial cleft cyst in a newborn

We describe an extremely rare case of bilateral intrathyroidal branchial cleft cysts. A 2-day-old male neonate presented with intermittent tachypnea, dyspnea, and a palpable neck mass. Cervical ultrasonography and computerized tomography scan demonstrated a right-sided 3 × 3-cm cystic mass and a left sided 4.5 × 4-cm cystic mass, thought to be originating in the thyroid gland. The right-sided cyst decreased in size after OK-432 sclerotherapy. The left-sided cyst showed little response to 2 attempts of OK-432 sclerotherapy. Surgical removal of the left-sided cyst was done because of intermittent airway problems. The cystic mass was thought to be an intrathyroidal lesion. Microscopically, the cyst was lined by nonkeratinized squamous epithelium and respiratory epithelium. Lymphocyte infiltration was found in the subepithelial layer. The patient is currently doing well 12 months later with no evidence of recurrence.     

Pulmonary sequestration presenting as retroperitoneal cyst: case report

A 21-year-old woman presented with flank pain, and an abdominal and pelvic CT scan demonstrated a left 7.4-cm simple cyst superior to the left kidney. She underwent laparoscopic cyst decortication complicated by a diaphragmatic injury and pneumothorax. The final pathology report described a retroperitoneal pulmonary sequestration (RPS). Urologists need to consider RPS in the differential diagnosis of a retroperitoneal cyst because of the associated morbidity of hemorrhage during surgical excision. With the widespread use abdominal imaging techniques, more cases of RPS are likely to be identified and referred for laparoscopic management.     

Renal cell carcinoma in a multilocular renal cyst: a case report of a 27-year-old female and review of the literature.

A case of renal cell carcinoma in a multilocular renal cyst is reported. Excretory urography showed a mass, and ultrasound revealed multiple renal cysts in the middle part of the left kidney. This finding could also be visualized by computer tomography, a solid structure could not be detected. During operation a 6-cm multiloculated cyst was enucleated from the left kidney. A frozen section of the cystic lesion did not indicate a malignancy; however, further histopathological examination revealed a renal cell carcinoma, especially in the septal parts of the tumor.     

Laparoscopic management of a giant adrenal cyst: case report

A 22-cm left adrenal cyst in a 30-year-old woman was laparoscopically drained and then excised. The main symptom was dull left-upper-quadrant pain. Operative time was 95 minutes, and the hospital stay was 1 day. The patient returned to normal activity 7 days after surgery. Histology revealed a benign adrenal cyst. At the 3-month follow-up, ultrasonography showed the absence of any cystic recurrence, and adrenal endocrine function was normal. The advantages and disadvantages of this modality for the management of adrenal gland cysts are discussed.     

Giant hemorrhagic adrenal pseudocyst in a primiparous pregnancy: report of a case

Adrenal cysts are rare and are usually discovered incidentally during diagnostic imaging, surgery, or autopsy. Most cystic lesions of the adrenal gland are nonfunctioning and become symptomatic when complicated by rupture, hemorrhage, or infection. A 40-year-old woman presented with a history of gradual-onset pain in her left flank region at 20 weeks' gestation. Ultrasound showed a 20-cm cystic mass in her left abdominal cavity. Pertinent laboratory tests were within normal limits. The patient underwent exploratory laparotomy, which revealed a 20 × 15-cm left adrenal cyst; thus, we performed left adrenalectomy with complete excision of the cyst. Histological examination confirmed a hemorrhagic adrenal pseudocyst. The patient had an uneventful postoperative course, and subsequent routine obstetric ultrasound examinations showed normal fetal activity and development until the pregnancy terminated with a stillbirth caused by pre-eclampsia at 34 weeks' gestation. To the best of our knowledge, this is only the 12th reported case of adrenal pseudocyst discovered during pregnancy. We analyze the clinicopathologic findings and discuss the possible association of pregnancy, with special reference to etiopathogenesis, presentation, diagnosis, and treatment.     

Laparoscopic splenectomy for recurrent splenic cyst after laparoscopic marsupialization

We describe laparoscopic splenectomy for recurrent splenic cyst after laparoscopic marsupialization. The patient was a 24-year-old woman with a 20-cm palpable mass in the left upper quadrant. She had undergone laparoscopic marsupialization for splenic cyst 62 months previously. Abdominal ultrasonography and computed tomography revealed a huge cystic lesion of the spleen, and magnetic resonance imaging demonstrated multiple cystic lesions occupying almost the entire spleen. We performed laparoscopic splenectomy for the recurrent splenic cyst. The operation took 170 minutes. Histologic examination of the resected spleen revealed a hemangioma with cyst formation. The cyst wall consisted of fibrous tissue, covered by stratified cuboid or squamous epithelium. The patient had no abdominal symptoms during 13 months of follow-up. Postoperative follow-up examination by ultrasound or computed tomography is required after surgical treatment for splenic cyst to exclude the possibility of recurrence after preservation of the spleen.     

Juvenile cystic adenomyoma in a 19-year-old woman: a case report with a proposal for new diagnostic criteria

We report a case of a cystic adenomyoma in a 19-year-old nullipara who presented with severe dysmenorrhea and pelvic pain. Preoperative magnetic resonance imaging showed a 3-cm well-circumscribed mass with a 2.1-cm cystic cavity in the myometrium of the left fundus. The tumor, including the cyst, was excised via laparoscopy with a part of the normal myometrium using a modified myomectomy method. On histologic examination, the cystic cavity was lined by endometrial tissue composed of endometrial epithelium and stroma. After 12 months of postoperative follow-up, the patient had significant improvement of dysmenorrhea.     

Intrahepatic bile duct dilatation with a liver cyst and hemangioma: Report of a case

We report a case of intrahepatic bile duct dilatation with a liver cyst and hemangioma. A 58-year-old woman was referred for investigation of a cystic lesion and peripheral intrahepatic bile duct dilatation in the left lateral segment of the liver. Abdominal computed tomography (CT) and magnetic resonance imaging (MRI) showed dilatation of the intrahepatic bile ducts in the left lateral segment, near a 4.5-cm cystic lesion. Early enhancement into the delayed phase was seen in the dorsal part of the cystic lesion. Celiac angiogram showed a belt-shaped hypervascular area, but no encasement or irregularity of the artery. To exclude malignancy, we performed a left lobectomy. Microscopically, the cyst was lined with a single layer of flattened epithelial cells and a spongy tumor was diagnosed as cavernous hemangioma, which compressed the bile duct. The histopathological diagnosis was biliary stenosis associated with cavernous hemangioma of the liver. Invasive surgery may be avoided by awareness of this unusual benign pathology.     

Mündung eines Megaureters mit aplastischer Niere in eine Samenblasenzyste

Unilateral cyst of the seminal vesicle, ipsilateral ectopic ureter, and ipsilateral renal aplasia are the components of a rare congenital abnormality affecting the male urogenital tract. The clinical picture is characterized by a retrovesical cystic tumor, which may cause nonspecific symptoms. Differential diagnosis includes cysts of the müllerian duct, the urogenital sinus/ejaculatory duct, and the prostate.We report a case of a left seminal vesicle cyst associated with aplasia of the left kidney in a 14-year-old boy. Preoperatively, an ipsilateral renal agenesis was suspected, but a renal aplasia with an ectopic urinary megaureter into the seminal vesicle was found intraoperatively. An 8-cm cystic left seminal vesicle and an ipsilateral renal aplasia was successfully removed by operative laparoscopy.The advantages of the laparoscopic approach over open surgery include excellent exposure of the deep pelvic structures, a short hospitalization, and a rapid recovery for the patient. We searched the literature to review the clinical presentation, diagnostic procedures, differential diagnosis, and therapeutic treatment options for this anomaly.     

Replacement of the vena cava with aortic graft for living donor liver transplantation in budd-Chiari syndrome associated with hydatid cyst surgery: a case report

A 12-year-old girl, operated because of a hydatid cyst of the liver, with Budd-Chiari syndrome was evaluated for postoperative development of ascites and paraumbilical varicose veins. A vena caval stent was placed for the relief of inferior vena caval obstruction. The patient was admitted because of progressive deterioration in ascites and liver functions. Imaging techniques showed degeneration adjacent to the right hepatic vein in liver segments 7 to 8, a partially calcified 5-cm hydatid cyst, and a thrombosis in the inferior vena cava was that addressed with a 10-cm metal stent. A living donor segments 2 to 3 liver transplantation was obtained from the patient's mother. After completion of the donor operation without complications, the vena caval stent was removed following the recipient hepatectomy. Suprarenal flow continued after resection of the fibrotic vena cava and placement of a cadaveric cryopreserved aortic graft for the vena cava, anastomosed between the suprarenal and subdiaphragmatic segments of the vena cava. An end-to-side anastomosis was performed between the left hepatic vein of the donor liver and the aortic graft. There was no complication and the patient was discharged on postoperative day 19. Follow-up Doppler ultrasonography showed the aortic vena caval graft to be open, along with the hepatic/portal vein and hepatic artery. This case demonstrated that operations for liver hydatid cyst surgeries can iatrogenically induce Budd-Chiari syndrome; a cryopreserved aortic graft can be an alternative to ensure the continuity of the vena cava in living donor liver transplantation.     

Transoral robotic resection of a lingual thyroglossal duct cyst

Thyroglossal duct cysts (TGDCs) are epithelial rests of the thyroid gland left during embryologic descent from the tongue base. Thyroglossal duct cysts confined to the tongue base alone are even more unusual. We present a case of a 45-year-old woman who presented with complaints of sore throat, globus, and throat clearing for 10?years. On examination she was found to have a 2?×?1.5-cm cystic-appearing mass, left of midline in the vallecula. The patient had a transoral robotic resection of this vallecular cyst, which was subsequently found to be a lingual TGDC. We believe this is the first reported case of a TGDC that was successfully excised using a transoral robotic approach.     

Epidermoid cyst in the kidney

We report an extremely rare case of an epidermoid cyst in the kidney of a 74-year-old man who had presented with painless hematuria. Radiologic examination revealed a cyst in the kidney that was thought to be neoplastic. The patient underwent surgery to remove the cyst, and we received the nephrectomy specimen. A 6-cm cyst with no solid areas was seen. On histologic examination, this was an epidermoid cyst. We reviewed the published data and discuss the possible theories of origin of this rare condition.     

Laparoscopic splenectomy for a large multilocular splenic cyst with elevated CA19-9: Report of a case

INTRODUCTIONBecause splenic cysts are rare, a definitive treatment regime for these cysts remains unclear. We report a case of a large multilocular splenic cyst with elevated carbohydrate antigen 19-9 (CA19-9) levels, which was successfully treated with laparoscopic splenectomy.PRESENTATION OF CASEA 22-year-old female was admitted to our hospital with severe left upper abdominal pain. Serum CA19-9 level was mildly elevated (65 U/ml). Computed tomography revealed a 25-cm long spleen with multilocular cystic lesions, for which an emergency laparoscopic splenectomy was performed. Histological findings revealed that the lesion was a benign true cyst, and immunostaining analyses showed that the epithelium was CA19-9-positive.DISCUSSIONAlthough some spleen-preserving approaches have been reportedly used, splenic cyst recurrence usually occurs in true cyst cases, wherein the cyst is incompletely removed. Most reported cases of splenic cysts producing CA19-9 are true cysts.CONCLUSIONThe treatment approach should be decided on the basis of the type, shape, location, and even CA19-9 levels of the splenic cyst.     

Pulmonary mucinous cystadenocarcinoma: report of a case and review of the literature

A case of primary mucinous cystadenocarcinoma of the lung is presented. The patient was a 42-year-old woman with a 5-cm left lung mass. Left lower lobectomy was performed and analysis of a frozen section revealed mucinous cystadenocarcinoma. The tumor was a fibrous, walled cyst containing abundant mucinous material. Sparse groups of malignant cells were microscopically observed in pools of mucin; thus, the tumor resembled mucinous cystadenocarcinoma that occurs in the ovary, appendix, or pancreas. The tumor we found is a very rare intrapulmonary neoplasm that is differentiated from a metastatic lesion and mucinous bronchoalveolar carcinoma by its very different clinical course and prognosis.     

Colohepatic fistula due to hydatid disease

Communication of a hepatic hydatid cyst to the colon appears to be extremely rare. We report a 54-year-old male who underwent surgery for a huge hydatid cyst. Four days after the cyst was aspirated and many daughter cysts were removed, gross fecal contamination occurred as a result of a 0.5-cm defect in the right transverse colon. The defect was repaired and the colon temporarily exteriorized. Recovery was uneventful.     

Emergency laparoscopic unroofing of a ruptured hepatic cyst.

The use of laparoscopic techniques in the emergency treatment of liver cyst complications has not been reported in the literature. Laparoscopic surgery is a well-established treatment modality for giant hepatic cyst in the elective setting. We report a case of laparoscopic unroofing of a 15-cm ruptured hepatic cyst, which had recurred after previous percutaneous alcohol instillation therapy. Laparoscopic ultrasound was used to delineate the extent of the cyst while a Harmonic scalpel was used for dissection. The patient made an uneventful recovery and was discharged 4 days after the operation.     

Giant intraosseous cyst-like lesions in rheumatoid arthritis report of a case

The term "intraosseous synovial cyst" is used to designate both the epiphyseal cyst-like lesions seen in patients with rheumatoid arthritis (RA) and mucoid cysts, which occur in a different setting. We report the case of a patient in whom a 4-cm cyst-like lesion developed in the left tibia 18 years after onset of RA and 6 years after osmic acid synovectomy of the left knee. Positive contrast arthrography and magnetic resonance imaging visualized a communication between the lesion and the joint space. Preexisting bone and joint lesions and increased intraarticular pressure play a major role in the genesis of cyst-like lesions in RA. In our patient, the osmic acid synovectomy may have contributed to the development of the lesion. "Synovial cyst" is a misnomer for these giant lesions, which are geodes rather than cysts. Despite their low incidence, these lesions deserve attention because they raise diagnostic and therapeutic problems.     

Secretory Carcinoma of the Breast with a Cystically Dilated Intraductal Component: Report of a Case

A case of secretory carcinoma of the breast in a 61-year-old woman is described. She came to our hospital complaining of a bloody nipple discharge. The physical examination revealed a 2.8 × 2.1-cm, firm, irregular lump with bloody nipple discharge in her left breast. Mammography demonstrated an irregular mass and ultrasonography showed an irregular hypoechoic mass accompanied with a cyst. Ductgraphy was done. It showed a dilated mammary duct leading to the cyst which was partially occupied with carcinoma. A cytologic smear of the nipple discharge and fine-needle aspiration cytology revealed similar findings, and both findings were malignant. A modified radical mastectomy was performed. A pathological examination revealed secretory carcinoma of the breast which had spread inward and outward from the cyst. In addition, the nipple discharge flowed from the cyst through the dilated mammary duct. The patient is presently alive and well 2 years after the operation. Secretory carcinoma is an extremely rare tumor of the breast and 48 cases have been reported in Japan. The present case is the first known case of secretory carcinoma demonstrating a bloody nipple discharge to come from a cyst which has been invaded by carcinoma. Received: December 7, 2000 / Accepted: January 8, 2002 Reprint requests to: J. Izumi, Department of Surgery, Kyouritsu Hospital, 16-5 Chuoh-cho, Kawanishi 666-0016, Japan     

Laparoscopic resection of an epidermoid cyst originating from an intrapancreatic accessory spleen: Report of a case

A 67-year-old man underwent an investigation of epigastric pain and weight loss. Preoperative imaging findings suggested the presence of a tumor, which developed as an epidermoid cyst and originated from an intrapancreatic accessory spleen; however, the possibility of malignancy could not be ruled out. We therefore performed a laparoscopic-assisted distal pancreatectomy with a splenectomy for both diagnostic and treatment purposes. Five laparoscopic ports were created. After the spleen and pancreatic tail were dissected from the retroperitoneum laparoscopically, they were pulled out through a 7-cm left subcostal incision and resected with an endoscopic linear stapler. The operative time was 227 min and the blood loss was 400 ml. The postoperative course was uneventful. The final pathological diagnosis was in agreement with the preoperative diagnosis. This case demonstrates that the minimally invasive approach of laparoscopic surgery can be used safely and successfully for difficult-to-diagnose pancreatic tumors. This is the first report describing a laparoscopic resection of an epidermoid cyst originating from an intrapancreatic accessory spleen.     

Cerebral medulloepithelioma with long survival

An 8-year-old boy presented with a rare cerebral medulloepithelioma manifesting as headache, nausea, and vomiting. Neuroimaging demonstrated a mass containing a cyst in the left frontal lobe. Gross total resection of the tumor with a 1-cm margin was performed under intraoperative monitoring. The histological diagnosis was medulloepithelioma. Stereotactic radiotherapy (total dose 20 Gy) was given to the brain up to 1 cm from the surgical margin. Follow-up neuroimaging 5 years later showed no signs of recurrence. He now attends junior high school, with normal mental and physiological development. Medulloepitheliomas are rare, highly malignant embryonal tumors of the central nervous system. Combined gross total tumor resection and radiotherapy are recommended to obtain the most favorable outcome.