Vaginal cysts: a common pathologic entity revisited

PURPOSE: To further study the clinicopathological features of benign vaginal cysts. METHODS: We retrospectively studied all cases of benign vaginal cysts diagnosed in our laboratory over the last decade. Pathological findings were correlated with the clinical records of the patients and histochemistry results. RESULTS: Forty cases of benign vaginal cysts were retrieved. There were 12 cases of mullerian cysts (30.0%), 11 cases of Bartholin's duct cysts (27.5%), ten cases of epidermal inclusion cysts (25.0%), five cases of Gartner's duct cysts (12.5%), one endometrioid cyst (2.5%) and one unclassified cyst (2.5%). Patient age ranged from 20 to 75 years with a mean of 35 years, and a peak incidence between 31-40 years (13 cases, 32.5%). The majority of patients were asymptomatic (31 cases, 77.5%). The cyst type which was more frequently associated with symptoms was Bartholin's duct cyst. Most lesions were located in the left-lateral vaginal wall (13 cases, 32.50%). Mullerian cysts were lined by columnar endocervical-like or cuboidal epithelium, whereas Gartner's duct cysts were all lined by cuboidal epithelium. Epidermal inclusion cysts were lined by stratified non-keratinizing squamous epithelium. Bartholin's duct cysts were lined by transitional, mucin-rich columnar or squamous epithelium and were frequently accompanied by inflammation. CONCLUSION: Benign vaginal cysts are in the majority of cases asymptomatic and are often incidentally discovered during gynecological examination for other purposes. The differential diagnosis between Mullerian and Gartner's duct cysts requires histochemical evaluation of epithelial mucin production. The pathogenesis of most types of vaginal cysts remains to be clarified.     

Urogenital sinus origin of mucinous and ciliated cysts of the vulva

The origin of mucinous and ciliated cells in the vulva and the pathogenesis of cysts lined by these epithelia were investigated. Small mucinous glands numbering from one to more than a hundred were encountered in 9 of 19 vulvas (53%) that were consecutively examined at autopsy. Eleven other cysts were encountered clinically. Six were lined by mucinous epithelium, three by pseudostratified cells with cilia plus small foci of mucinous epithelium, and two by ciliated epithelium only. Four of the cysts with ciliated epithelium were otherwise typical Bartholin's gland cysts. It is concluded that glands lined by either mucinous or ciliated epithelia are normal constituents of the vulvar vestibule, are derived from urogenital sinus, and develop into cysts when the neck leading to the vulvar surface becomes inflamed and obstructed.     

Retrorectal cyst hamartoma (tailgut cyst) with malignant transformation

BACKGROUND: Tailgut cyst [retrorectal hamartomas] is an unusual cystic lesion, located in the retrorectal space. It develops from post anal foetal gut remnants, present anterior to the sacrum and posterior to the rectum. A high index of clinical suspicion is required to diagnose this rare tumour. This malformative lesion should be distinguished from teratomas, mullerian cysts, anal gland cysts and duplication cysts of the rectum. The treatment of choice is complete surgical excision. CASE: A tailgut cyst is hereby reported, which had undergone malignant transformation, with development of an adenocarcinoma. Only 16 additional cases of tailgut cysts with adenocarcinoma were recovered, in an extensive search of world literature. CONCLUSION: The identification of this rare entity provides an opportunity to examine this pathological rarity in the context of the few previously reported cases of this type.     

Some observations of the structure of the choroid plexus and its cysts

The structure of the choroid plexus was studied in five normal human embryos, three normal fetuses and three fetuses with choroid plexus cysts. These were detected by ultrasound and the fetuses were karyotypically normal. The choroid plexus appears in the lateral cerebral ventricles at the seventh developmental week. The early structure is lobulated with vessels running in the mesenchymal stroma and forming capillary nets under the single-layered ependymal epithelium. This embryonal structure is converted into the fetal type during the ninth developmental week as the embryonal capillary net is replaced by elongated loops of wavy capillaries that lie under regular longitudinal epithelial folds. The choroid plexus cysts exhibited accumulation of fluid within distended mesenchymal stroma and did not show the wavy folds on this surface, which was smooth. Within this connective tissue of the cyst wall were distended angiomatous interconnecting thin-walled capillaries. Therefore, filled cavities were not lined by any epithelium. We suggest that fetal choroid plexuses cysts (at least in many cases) are in fact pseudocysts exhibiting angiomatous patterns of capillaries in their walls.     

Adenomyotic Cyst in a 25-Year-Old Woman: Case Report

Adenomyotic cysts are uncommon findings, usually in the context of diffuse adenomyosis and <5 mm in diameter. Herein we report a 4.5-cm adenomyotic cyst in a 25-year-old nulliparous woman with severe dysmenorrhea and pelvic pain. Transvaginal ultrasonography and magnetic resonance imaging revealed a well-circumscribed hypoechogenic mass in the posterior uterine wall, well separated from the uterine cavity. Pathologic analysis demonstrated that the cyst was lined with endometrial epithelium and stroma and was surrounded by smooth muscle hyperplasia. In the literature, we found 30 reports of cysts with similar characteristics. Because this cyst has not been clearly defined, it has been called by various names including adenomyotic cyst, cystic adenomyosis, and cystic adenomyoma. We believe this lesion should not be called an adenomyoma, but is more correctly called an adenomyotic cyst or, depending on age at onset, a juvenile adenomyotic cyst.     

Unusual presentation of Bartholin's gland duct cysts: anterior expansions

The medical records of 32 patients who underwent surgery for a vulvar mucinous cyst located between the urethral meatus and the fourchette were reviewed. Nineteen (59%) patients had been referred to our centre because of cyst recurrence after incision or excision. The majority of the cysts were lined by a single layer of tall columnar cells with zones of squamous metaplasia. Subacute or chronic bartholinitis was demonstrated in 94% of the cases demonstrating that these cysts were anterior expansions of Bartholin's gland duct cysts. No ipsilateral recurrence was observed after cyst and gland excision.     

Parovarian cysts

Histologic material from 117 cases of parovarian cysts through 1979 to 1984 was reviewed. The majority of these lesions were paramesonephric (mullerian), mesonephric and mesothelial in origin. Most patients were without symptoms. On microscopic examination a basement membrane may be demonstrated beneath the mesonephric epithelium, although such a layer is usually absent in the mullerian structures. Eight specimens show stratification of the epithelial lining of the papillae, four of these are parovarian cysts of low grade malignancy. These neoplasms were associated with normal tubes and ovaries. Follow up data on four low grade malignant cases showed they were living and well.     

Sclerosis of gross cysts of the breast: a three-year study

Breast cysts can be separated into two types: Type I cyst with a lining epithelium which shows apocrine metaplasia, and Type II cyst with an epithelium which is markedly attenuated or absent. The risk of subsequent breast cancer among patients with Type I cysts can be up to 4. The standard treatment is fine needle aspiration, but 20% of the cysts recur. Pharmacological treatment has been tried, which reduces size and volume, but has side-effects and a high recurrence rate post-treatment occurs. The objectives of this prospective study were to sclerose the cyst, induce its regression and prevent or reduce recurrence rate, with the administration of a sclerosing solution (Sclerovein) within the cyst post-aspiration. Fifty-seven patients were followed in the study, 37 with Type I cysts and 20 with Type II cysts. At the end of six months all patients with Type II cysts had no detectable cyst. On the other hand, two patients still had a residual Type I cyst. At the end of three years our recurrence rate appears to be less than 2%, with one patient with a possible recurrence. No significant side-effects were observed. The use of Sclerovein is a simple and safe alternative in the treatment of recurring cysts.     

Non-neoplastic ovarian cysts with ectopic pregnancy.

Thirty non-neoplastic ovarian cysts, discovered at laparotomy in association with 27 cases of tubal ectopic pregnancy, were examined to document changes seen in early pregnancy and possibly to identify precursor lesions to the luteinized cysts of later pregnancy. The ages of the patients ranged from 16 to 40 years, and length of gestation varied between 5 and 11 weeks. Of the 30 cysts, 12 were corpus luteum cysts; 10 were called lutein cysts, nonspecific, and had a lining of luteinized cells of a single cell type; three cysts were luteinized follicles; four cysts were unlined or lined by a single layer of cells. The origin of these four was not obvious, and they were called "simple cysts." The last was a granulosa-theca lutein cyst. Corpus luteum cysts are assumed to arise from the corpus luteum, and simple cysts appear to arise from both corpus luteum cysts and other follicular structures. The nonspecific lutein cysts appeared to arise from structures other than the corpus luteum or corpus luteum cysts; these nonspecific lutein cysts may be precursors to the so-called large solitary luteinized follicle cyst of pregnancy.     

Maintaining squamous epithelial architecture in a human cervical epithelium to SCID mouse xenograft model system.

OBJECTIVE: To establish a mouse model system of human cervical epithelium that maintains the stratified squamous architecture overlying a well-defined basement membrane. METHODS: Normal cervical tissue specimens were obtained from the transformation zone of hysterectomy specimens. Small (2 mm) cubes of tissue containing stroma and epithelium were placed subdermally into severe combined immunodeficient (SCID) mice and harvested between 7 and 45 days. Specimens were examined histologically for the presence of stroma, epithelium, and basement membrane. RESULTS: In 49 xenograft attempts in 24 mice, 35 (71%) were identified microscopically. Of these, 28 (80%) had identifiable epithelium and 20 (57%) formed cysts lined with stratified squamous epithelium. A cuboidal basal layer clearly defined the basement membrane. Proliferation within the cyst epithelium was demonstrated by expression of the Ki67 proliferation marker and the presence of mitotic figures. CONCLUSIONS: A human to mouse xenograft model system is described that maintains, in high yield, stratified squamous epithelium overlying a well-defined basement membrane. Advantages of this model system include the following: (1) The tissue originates from readily available human specimens; (2) A stratified squamous epithelial architecture is maintained for a sufficient time to study viral effects on proliferation; (3) The basement membrane of the epithelium is well defined, allowing for investigation of connective tissue factors in cervical intraepithelial neoplasia and cervical cancer.     

Characteristics of calcifying odontogenic cyst in Taiwanese.

BACKGROUND AND PURPOSE: Calcifying odontogenic cyst (COC) is a rare type of odontogenic cyst. This retrospective study analyzed the clinical, radiographic, and histopathologic features of COC in Taiwanese. METHODS: Ten cases of COC in 2 male and 8 female patients with a mean age of 29 years (range, 11 to 48 years) treated from January 1985 to December 2002 were included. Microscopic slides, clinical histories, and radiographic features of these 10 COC cases were reviewed and analyzed. RESULTS: COCs occurred in the maxilla in 3 cases and in the mandible in 7 cases. COCs were associated with impacted teeth in 6 cases and with odontomas in 3 cases. All COCs appeared as either unilocular (9 cases) or multilocular (1 case) radiolucencies. In 7 cases, spotty radiopaque materials were scattered throughout the radiolucency. Histologically, all of the lesions were at least partially lined by epithelium with cuboidal to columnar basal cells and stellate reticulum-like suprabasal cells. Variable numbers of ghost cells, some of which were calcified, were observed in the lining epithelium or in the fibrous connective tissue wall of all 10 cases. Juxta-epithelial dentinoid was also found in all cases. However, proliferation of ameloblastoma-like tumor nests was observed in only 1 case. Based on the above histologic findings, 6 COC lesions were classified as simple unicystic type, 3 as unicystic odontoma-producing type, and 1 as unicystic ameloblastomatous proliferating type. CONCLUSIONS: COC occurs frequently in the second and third decades and is commonly associated with an impacted tooth or an odontoma. It usually appears as a mixed radiolucent and radiopaque lesion radiographically. Simple unicystic type is the most common type of COC. No recurrences were found after conservative surgical removal in this series.     

Unusual features of parovarian cysts. A report of two cases

In two cases, parovarian cysts were well characterized by ultrasonography and presented with unusual clinical features. In one case the cysts were present bilaterally and associated with an arcuate uterus. In the other, histology of the cyst revealed a papillary serous cystadenoma. The lesion was also associated with an arcuate uterus.     

Clinical and histologic classification of endometriomas. Implications for a mechanism of pathogenesis.

One hundred eighty-seven consecutive patients with persistent ovarian cysts and endometriosis underwent laparoscopic evaluation and ovarian cystectomy. All patients had been followed for a minimum of 6 weeks prior to surgery. The cysts were identified initially to be endometriomas based on their gross appearance and the presence of endometriosis at other pelvic sites. Presumed endometriomas were classified into three types based on size, cyst contents, ease of removal of the capsule, adhesions of the cyst to other structures and location of superficial endometrial implants relative to the cyst wall. After clinical laparoscopic classification, the cysts were evaluated histologically without knowledge of the clinical assessment. Histologically small (< 2 cm), superficial ovarian cysts were always endometriomas, and the cyst wall was very difficult to remove (type I). Large cysts with easily removed walls were usually luteal cysts (type II). Large cysts with walls adherent in multiple areas adjacent to superficial endometriosis were generally endometriomas but some also had histologic characteristics of functional (luteal or follicular) cysts (types IIIa and IIIb). These findings led to the conclusion that superficial ovarian endometriosis is similar to endometriosis in extra-ovarian sites in that the formation of superficial cysts is limited in size by fibrosis and scarring. In contrast, large endometriomas may develop as a result of secondary involvement of functional ovarian cysts by the endometriotic process.     

巨大宫颈纳氏腺囊肿一例

宫颈纳氏腺囊肿为妇科常见的良性疾病,多为分娩、炎症、人工流产等因素对宫颈的损伤所致。此病为直径在数毫米至4厘米的较小的宫颈囊肿,可为单发或多发,患者多无自觉症状,较大者罕见,性生活可有不适。临床对于宫颈巨大纳氏腺囊肿的术前识别至关重要,与宫颈恶性疾病相鉴别可避免扩大手术范围,提高患者的术后生存质量。巨大宫颈纳氏腺囊肿与阴道苗勒管囊肿、宫颈恶性腺瘤术前易混淆,超声检查不具有绝对性诊断价值。巨大宫颈纳氏腺囊肿病因不清,报告1例合并完全性纵隔子宫且妊娠至足月分娩病例,巨大宫颈纳氏腺囊肿的发生与子宫先天性畸形之间是否有关仍有待研究。     

Retroperitoneal Pelvic Cyst: A Diagnostic and Therapeutic Challenge

BackgroundRetroperitoneal cysts can be asymptomatic or can present with vague symptoms such as abdominal pain or distension. Their clinical implications vary significantly.CaseA 45-year-old woman, gravida 2, para 2, presented with vague, non-specific pelvic symptomatology. Imaging indicated a right-sided pelvic cyst 5 cm in diameter. At laparoscopy a retroperitoneal cyst was identified, with a normal pelvis and intra-abdominal organs. No attempt was made at laparoscopy to drain, biopsy, or excise the cyst. CT-guided biopsy of the cyst was performed and small intestine mucosa was identified with goblet cells and smooth muscle. Repeat biopsy confirmed areas of tissue necrosis and small intestine mucosa, with additional tissue containing respiratory epithelium. Following laparotomy and excision of the cyst, the final pathologic diagnosis was benign epithelial cyst consistent with a duplication or hindgut cyst.ConclusionAlthough most retroperitoneal cysts are benign, surgical excision is required to rule out malignancy definitively.     

腹腔镜手术治疗卵巢囊肿蒂扭转43例临床分析

目的:探讨腹腔镜手术治疗卵巢囊肿蒂扭转的临床价值.方法:回顾性分析我院2001年2月至2008年10月间接受腹腔镜诊治的43例卵巢囊肿蒂扭转患者的临床资料.结果:43例患者平均年龄26.6岁,有腹痛病史41例,其中急性腹痛27例,伴恶心、呕吐21例.34例行腹腔镜下患侧附件切除术,9例行腹腔镜下患侧卵巢囊肿剥出术.所有病例均在腹腔镜下顺利完成手术治疗,平均手术时间65.0±16.5分钟,术中出血2-150 ml,中位出血量10 ml,无术时术后并发症发生.术后病理诊断卵巢成熟性畸胎瘤34例(79.1%),卵巢单纯囊肿3例(7.0%),卵巢粘液性囊腺瘤2例(4.7%),卵巢甲状腺肿1例(2.3%),卵巢巧克力囊肿1例(2.3%),副中肾管源性囊肿(卵巢冠囊肿)1例(2.3%),组织出血梗死不能辨认1例(2.3%).术后平均肛门排气时间27.3±11.4小时,术后平均放置尿管时间11.2±9.5小时,术后平均住院时间4.2±1.3天.结论:腹腔镜诊治卵巢囊肿蒂扭转具有及时准确、创伤小、出血少、术后恢复快等优点.     

An unusual theca lutein cyst. Report of a case

An unusual cyst lined by spontaneously lutenized theca cells--which appears to be the first reported in an adult female--is presented. It is postulated that its formation was due to an abnormal end-organ response and that the progesterone produced by it caused amenorrhea. It is suggested that theca lutein cysts may have two origins--an increased quantity of chorionic gonadotropin or end-organ hypersensitivity. When a unilateral, unilocular theca lutein cyst is found, the presence of associated trophoblastic disease can be ruled out.     

Cysts (cystadenomas) and tumors of the rete ovarii

Cysts and tumors of the rete ovarii have been described only rarely and little is known of their pathology. We describe herein 16 cases of cysts (cystadenomas), 2 solid adenomas, and 1 adenocarcinoma of rete ovarii origin. The patients with the cysts were 23-80 years of age (mean age, 59 years). The cysts averaged 8.7 cm in diameter and were characterized by a location in the hilus; a flat, cuboidal, or columnar, usually nonciliated-lining epithelium; crevices along the inner surfaces; and a fibromuscular wall that often contained hyperplastic hilus cells. The cysts showed many similarities to microscopic dilatations of the rete. The rete adenomas were incidental microscopic findings in two women 45 and 68 years of age. They were located in the hilus and were composed of cords and tubules lined by cells resembling closely those of the normal rete. The rete adenocarcinoma occurred in a 52-year-old woman, was bilateral, and could be partly localized to the hilus. Microscopic examination revealed retiform spaces containing papillae and nests of transitional-like epithelium. Criteria for distinguishing cysts and tumors of rete origin from other ovarian tumors are discussed.     

Pelvic mass-like florid cystic endosalpingiosis of the uterus: a case report and a review of literature

Introduction  

Endosalpingiosis is a disorder of Mullerian system characterized by benign glands lined by tubal type epithelium and involves the peritoneum, subperitoneal tissues, and retroperitoneal lymph nodes. Endosalpingiosis is almost an incidental finding on microscopic examination. Seldom it appears as a cyst and it can be confused clinically for an ovarian tumor.     

Neurenteric cyst at craniocervical junction: report of a case.

The authors report a rare case of neurenteric cyst at the foramen magnum presenting with a central cord syndrome and dysfunction of the lower cranial nerves. A magnetic resonance imaging study showed a cystic lesion over the lower medulla oblongata and C1-2 spinal cord. Differentiation between a neurenteric cyst and an epidermoid cyst was difficult. Successful total removal of the cyst was performed. The lesion consisted of an enteric cyst lined with a mucus-secreting columnar epithelium, containing highly proteinaceous supernatant and thick mucus deposit. The patient recovered dramatically after surgery.