胰腺假性囊肿的腹腔镜处理

胰腺假性囊肿是常见的胰腺囊性损害。急慢性胰腺炎和胰腺损伤是其主要成因。腹腔镜下治疗方式主要包括囊肿内引流术、囊肿外引流术、囊肿切除术。治疗方式的选择与囊肿大小、位置及引起的临床症状密切相关，不同的治疗方案临床治疗效果也不相同。     

Epidermoid cyst of the brain stem. Case report

Brain stem epidermoid cysts are extremely rare lesions. Only nine cases have been reported. Management of the epidermoid cyst is decompression of cyst contents and removal of cyst capsule. But in some cases resection of the cyst may result in a poor outcome because of cyst wall adhesion into the brain stem.     

An Unusual Presentation of a Breast Lump

Trichilemmal cyst also known as pilar cyst is a rare cyst arising from the external root sheath of the hair follicle. These cysts are observed on the scalp most commonly in females. The occurrence of trichilemmal cysts in areas other than the scalp is extremely rare. We report a case of an 80-year-old female with trichilemmal cyst of the breast which was first misdiagnosed as a sebaceous cyst because of the unusual disease site and our unfamiliarity with the disease. The patient underwent excision of cyst along with the cyst wall and histopathological diagnosis was trichilemmal cyst of the breast. A review of literature shows that trichilemmal cyst of the breast is an extremely rare condition which accounts for 0.1 % of the skin biopies reported till to date. We report a case of trichilemmal cyst of the breast with relevant discussion on trichilemmal cysts.     

Thymic Cyst Extending into the Pericardium: A Case Report and Review of Thymic Cysts

The cases of 8 patients with cyst of the thymus are reviewed. The patients were all asymptomatic. Pathological features are described that emphasize the spectrum of findings depending on the degree of cyst degeneration. A case of pericardial extension of a thymic cyst, thought to represent rupture of an anterior mediastinal thymic cyst into the pericardium, is described.     

Solitary Extra-Hepatic Hilar Peribiliary Cyst Presenting with Obstructive Jaundice: A Case Report

Peribiliary cyst is a poorly recognized and under-reported clinico-pathologic entity around the biliary tree. Peribiliary cysts are cystic dilatations of obstructed peribiliary glands, which are normal elements of the biliary tract. They are generally asymptomatic and rarely cause biliary obstruction. They are usually discovered incidentally at autopsy or in explants following liver transplantation.

A 59-year-old male patient presenting with obstructive jaundice due to a large extra-hepatic hilar peribiliary cyst is reported here. We briefly discuss its differential diagnoses such as bile duct cyst, liver cyst or lymph cyst, and its management.

Radiological imaging demonstrated a solitary large (5 cm) well-defined, smooth, thin walled cystic lesion at the porta hepatis paralleling but not communicating with the bile duct. A wide cyst de-roofing was performed and histological examination of the cystic wall revealed an inflammatory cyst.

The patient made an uneventful recovery and remained asymptomatic with normal liver function tests 36 months post-operatively.     

Solitary extra-hepatic hilar peribiliary cyst presenting with obstructive jaundice: a case report

Peribiliary cyst is a poorly recognized and under-reported clinico-pathologic entity around the biliary tree. Peribiliary cysts are cystic dilatations of obstructed peribiliary glands, which are normal elements of the biliary tract. They are generally asymptomatic and rarely cause biliary obstruction. They are usually discovered incidentally at autopsy or in explants following liver transplantation. A 59-year-old male patient presenting with obstructive jaundice due to a large extra-hepatic hilar peribiliary cyst is reported here. We briefly discuss its differential diagnoses such as bile duct cyst, liver cyst or lymph cyst, and its management. Radiological imaging demonstrated a solitary large (5 cm) well-defined, smooth, thin walled cystic lesion at the porta hepatis paralleling but not communicating with the bile duct. A wide cyst de-roofing was performed and histological examination of the cystic wall revealed an inflammatory cyst. The patient made an uneventful recovery and remained asymptomatic with normal liver function tests 36 months postoperatively.     

A case report of renal cell carcinoma in a renal cyst]

We report a case of renal cell carcinoma within a simple renal cyst in the upper pole of the right kidney. The renal cyst was found incidentally by ultrasonography. During the 3 years of follow-up, the cyst size was increasing and a small solid mass was arising from the cyst wall. Angiography revealed a hypervascular tumor stain in the renal cyst. At operation a 15 mm tumor arose from the wall of the cyst. Histopathological examination showed clear cell type renal cell carcinoma and "cyst" with sheets of carcinoma within the cyst wall. The coexistence of renal cyst and tumor is considerably rare. Fifty two cases were collected from the Japanese literature including this, and they are reviewed briefly.     

Epidural hematoma secondary to a rupture of a synovial cyst.

BACKGROUND CONTENT: With modern advances in imaging studies, synovial cysts are becoming more evident as a common component of erosive lumbar degenerative disc disease causing spinal stenosis and radiculopathy. Whereas hemorrhage can occur inside the cyst and is reported, rupture causing epidural hematoma is a rare complication and finding of this disorder. PURPOSE: To report a rare clinical presentation of a synovial cyst and spinal stenosis, where rupture of the cyst leads to an early cauda equina syndrome. STUDY DESIGN: Case report with a review of literature. METHODS: Clinical history, physical findings, and magnetic resonance imaging studies of a patient with an intraspinal synovial cyst at L4-5 1 week before a sudden worsening of symptoms are reported. RESULTS: A case report is presented of a male with a known synovial cyst at L4-5, presenting initially with neurogenic claudication. This patient developed sudden worsening of symptoms with bilateral lower extremity pain, weakness, and radiculopathy with difficult voiding. The patient had developed an epidural hematoma, secondary to rupture of a synovial cyst, documented at surgical decompression. CONCLUSIONS: Although synovial cyst associated with erosive facet and erosive degenerative disc disease are common, rupture of the cyst is not. A case report of a ruptured synovial cyst leading to an early cauda equina syndrome is presented. This case illustrates the spectrum of clinical features and presentations possible with spinal stenosis complicated by lumbar synovial cyst formation.     

Congenital Solitary Intrahepatic Biliary Cyst in a Newborn: Report of a Case

A solitary liver cyst (SLC) is a nonparasitic cyst of congenital origin. Its cause is unknown, but it may develop in the form of a simple cyst or a biliary cyst. Solitary liver cysts are extremely rare and usually symptomatic in infancy whereas they are most often detected incidentally in adulthood. Despite advanced imaging techniques, the differential diagnosis of SLC may still be difficult. Surgical intervention is required for histopathological verification, to relieve symptoms and prevent complications such as infection, cyst rupture, and hemorrhage. Although total excision of SLC is desirable to impede recurrences, partial excision may be adequate when total excision is impossible. We report the case of a newborn with a progressively enlarging solitary intrahepatic biliary cyst. We discuss the etiology, differential diagnosis, and treatment options for this rare entity.     

The role of lysosomes in the pathogenesis of unicameral bone cysts.

Unicameral bone cyst fluid possesses N-acetyl-beta-D-glucosaminidase, beta-glucuronidase, PZ-peptidase, cathepsin D, acid phosphatase, N-acetyl-beta-D galactosaminidase, and beta-galactosidase activities. The activities of lysosomal enzymes in the cyst fluid are, as a rule, higher than in the serum, whereas the total protein content is lower. The content of collagen degradation products in the cyst fluid is higher compared to the serum. In bone cavity wall tissues, the collagen content is decreased. Adenosine 3':5'-cyclic phosphate and cyclic guanosine 3,5'-monophosphate accumulate in the cyst cavity. However, in some cases, there is no correlation among the activities of lysosomal enzymes in the cyst fluid, blood serum, and cyst wall tissues. The ratios of lysosomal enzyme activities in the cyst fluid differ from those in the cyst wall tissues, cultured skin fibroblasts, and blood polymorphonuclear leucocytes. The lack of coincidence of enzymatic spectra of the cyst fluid, wall tissues, and serum is suggestive of the diversity of ways of lysosomal enzyme enter the cyst cavity, i.e., blood, cyst fluid cells, and cyst cavity walls. The cysts with different locations (i.e., active and latent cysts) have similar lysosomal lytic potentials. The presence in the cyst cavity of extracellular lysosomal enzymes and collagen degradation products testifies to the permanent corrosion of the cyst cavity walls from the inside as well as to the increase in the osmotic pressure of the cyst fluid. Lysosome destruction should be regarded as an important pathogenetic factor that requires surgical or pharmacologic correction or both in the course of bone cyst management.     

Echinococcal tension pneumothorax

Hydatid cyst is rarely mentioned among the causes of pneumothorax in text-books or monographs, especially those written in English. Five examples of tension pneumothorax secondary to ruptured hydatid cyst of the lung are reported: the mechanism of this tension effect and helpful diagnostic points are discussed. We think that surgical correction is the only satisfactory treatment of tension pneumothorax due to ruptured hydatid cyst: surgery is advocated in any suspected cyst as soon as it is discovered so as to avoid any such serious complication.     

Laparoscopic excision of a newborn rectal duplication cyst

Congenital rectal duplication cyst is a rare entity treated with surgical excision. Without treatment, a rectal duplication cyst may cause a variety of complications, most notably, transforming into a malignancy. We report on a 7-week-old girl who was found to have a rectal duplication cyst. The rectal duplication cyst was successfully excised laparoscopically. Rectal duplication cysts are rare alimentary tract anomalies generally discovered during childhood. Complications include symptoms arising from the cyst and the possibility of malignant degeneration. They are typically managed by surgical excision.     

Surgical treatment of sacral perineural cyst--case report

A 67-year-old man presented with persistent penis and scrotum pain due to S-2 and S-3 radiculopathy caused by a sacral perineural cyst. The cyst was treated with microsurgical partial cyst removal and cyst wall imbrication, together with closure of the point through which cerebrospinal fluid (CSF) flowed from the subarachnoid space into the cyst cavity. His pain resolved without recurrence of the cyst or complications. Symptomatic perineural cysts are quite rare. Surgical closure of the point through which CSF flows from the subarachnoid space into the cyst cavity is the most important intervention for symptomatic perineural cysts. If the source of CSF leakage cannot be detected, placement of a cyst-subarachnoid shunt should be considered in addition to partial cyst removal and cyst wall imbrication.     

Aneurysmal bone cyst: a review of 26 cases

Twenty-six cases of aneurysmal bone cyst are reviewed to determine the frequency, preferred treatment and prognosis. Some observations are made as to the existence of aneurysmal bone cyst as a primary entity or a secondary manifestation of a more serious underlying condition. The difficulty of differentiating an aneurysmal bone cyst from a giant cell tumor of bone is acknowledged and certain similarities to unicameral bone cyst are noted, with reference to some intriguing hypotheses put forward in the literature.     

Percutaneous surgery of kidney cysts

A symptomatic renal cyst causing pain, hypertension, or obstruction requires surgery. A new endourological method as alternative to an open surgical procedure is presented. The renal cyst is punctured percutaneously under ultrasound guidance. The channel is dilated under radiological control, the cyst is then inspected endoscopically with the flexible endoscope and the cyst wall is resected. The technique is presented and the results in the first 5 patients are discussed.     

小儿单纯骨囊肿腔内激素注射5年随访

目的：探讨小儿单纯性骨囊肿腔内激素注射治疗其远期疗效。方法：对17例本病进行回顾性分析,男11例,女6例,年龄4－12岁,17例行骨囊 肿腔内强地松龙注射治疗,2－3月注射1次,总疗程共给药3－5次,其中9例5次、5例4次、3例3次。每例每次注射均行X线摄片作比较。结果：本组17例随访5－14年,根据骨囊肿完全消失或尚存残微小囊腔而不必治疗者为痊愈,囊腔消失50％以上者为好转和经注射2次骨囊肿无变化为无效。本组17例痊愈、好转和无效为零例。但本组有4例从放射学角度属异常。17例均无激素并发症。结论：本病激素注射治疗远期疗效良好,简易易行。     

Total splenectomy for a recurrent giant splenic cyst

Primary splenic cysts are a rare finding. Some are large and require surgical removal. The Authors report a case of a recurrent huge splenic cyst in a 41-year-old female patient. A marsupialization was performed at another hospital 6 years before. Ultrasonography and computed tomography imaging revealed a cystic lesion in the spleen measuring approximately 20 cm in diameter. A total open splenectomy was performed. Postoperative course was uneventful. The histologic diagnosis was an epithelial cyst of the spleen with no atypical cells in the cyst wall, as previously found at the first operation. The epidermoid cysts have an epidermal lining, and prevention of recurrence is dependent on complete resection of the cyst wall preserving, whenever possible, the splenic tissue. Recurrence can be avoided with partial splenectomy in polar localization of the cyst, or complete removal of the cyst by "peeling" it off the splenic parenchyma. Marsupialization of the cyst, either via a laparoscopic or an open approach, is often ineffective.     

Diagnosing aneurysmal and unicameral bone cysts with magnetic resonance imaging

The differential between aneurysmal bone cysts and unicameral bone cysts usually is clear clinically and radiographically. Occasionally there are cases in which the diagnosis is not clear. Because natural history and treatment are different, the ability to distinguish between these two entities before surgery is important. The authors reviewed, in a blinded fashion, the preoperative magnetic resonance images to investigate criteria that could be used to differentiate between the two lesions. All patients had operative or pathologic confirmation of an aneurysmal bone cyst or unicameral bone cyst. The authors analyzed the preoperative magnetic resonance images of 14 patients with diagnostically difficult bone cysts (eight children with unicameral bone cysts and six children with aneurysmal bone cysts) and correlated these findings with diagnosis after biopsy or cyst aspiration and contrast injection. The presence of a double density fluid level within the lesion strongly indicated that the lesion was an aneurysmal bone cyst, rather than a unicameral bone cyst. Other criteria that suggested the lesion was an aneurysmal bone cyst were the presence of septations within the lesion and signal characteristics of low intensity on T1 images and high intensity on T2 images. The authors identified a way of helping to differentiate between aneurysmal bone cysts and unicameral bone cysts on magnetic resonance images. Double density fluid level, septation, and low signal on T1 images and high signal on T2 images strongly suggest the bone cyst in question is an aneurysmal bone cyst, rather than a unicameral bone cyst. This may be helpful before surgery for the child who has a cystic lesion for which radiographic features do not allow a clear differentiation of unicameral bone cyst from aneurysmal bone cyst.     

A case of interhemispheric glio-ependymal cyst in a newborn infant

An interhemispheric glio-ependymal cyst in a male neonate is reported. Neuroradiologically, the cyst, which had a septum like component within it, was located in the right frontoparietal interhemispheric and displaced the third and lateral ventricles. It had no communication with the ventricular system. As for anomalies associated with it, the total callosal agenesis and congenital hydrocephalus were revealed in CT scan. Angiogram suggested that polymicroglia accompanied with the cyst. It was confirmed that the cyst was divided into two parts by the septum during surgery. Microscopic examination showed that the cyst wall was composed of ependyma, connective tissue and glial cells. Choroid plexus component was also found in the septum. On the basis of the fact above, it was diagnosed interhemispheric glio-ependymal cyst. We believe that this interhemispheric cyst described above is a true cyst and differs morphologically and embryologically from the midline cyst which is produced with callosal agenesis and due to increased intraventricular pressure. In fact, the latter is an encystic third ventricle but not a true cyst. Both of them are, however, usually called interhemispheric cyst in the literature. We conclude that this case is appeared to be a true cyst because we can differentiate it from third ventricle by neuroradiological findings. We discussed nature of different interhemispheric cysts with callosal agenesis and suggested that recognition of the morphological relationship between the interhemispheric cysts and third ventricle was utmost important to make a correct diagnosis.     

Surgical strategy for intracranial endodermal cyst--case report

Two cases of endodermal cyst of the posterior fossa are reported. A 12-year-old girl presented with severe headache and vomiting caused by increased intracranial pressure. Computed tomography and magnetic resonance (MR) imaging showed a cystic mass occupying the ambient and quadrigeminal cisterns. A 65-year-old woman presented with dizziness, and MR imaging revealed a cystic mass in the posterior fossa. The two patients underwent surgery for decompression and resection of the cyst. Surgical specimens of the cyst walls consisted of a single layer of ciliated columnar epithelium. The diagnoses were endodermal cyst. The optimal surgical goal is total resection of the cyst wall, but the cyst wall sometimes tightly adheres to the adjacent nerves, vessels, and vital structures. The cyst must communicate adequately with the surrounding cerebrospinal fluid space, and a newly closed cyst space must be avoided, by the widest possible resection of the cyst wall.