Laparoscopic surgery for an esophageal duplication cyst using a near‐infrared indocyanine green fluorescence system: A case report

We herein describe a case of laparoscopic surgery for an esophageal duplication cyst using a near‐infrared indocyanine green fluorescence system. A 64‐year‐old woman with a cystic tumor adjacent to the esophagogastric junction was referred to our hospital for treatment. Esophagogastroduodenoscopy and abdominal CT revealed a 70‐mm submucosal tumor derived from the abdominal esophagus. We performed laparoscopic resection and then evaluated the tissue perfusion of the abdominal esophagus by using a near‐infrared indocyanine green fluorescence system. A Dor fundoplication was performed to prevent postoperative gastroesophageal reflux disease and reinforce the mucosal layer defect. The postoperative course was uneventful, and pathological evaluation confirmed that the tumor was an esophageal duplication cyst. The patient did not develop recurrence in the 24 months after surgery. We have demonstrated that laparoscopic resection of an esophageal duplication cyst may be performed effectively with intraoperative assessment of tissue perfusion using a near‐infrared indocyanine green fluorescence system.     

Laparoscopy-assisted spleen-preserving pancreatic resection for epidermoid cyst in an intrapancreatic accessory spleen

A rare case of an epidermoid cyst originating in an intrapancreatic accessory spleen in a 50-year-old Japanese female is reported. A hypoechoic cystic tumor was detected incidentally by abdominal ultrasonography. It appeared to be a single cyst in the pancreatic tail with a contrasted mass lesion beside it. Laparoscopy-assisted spleen-preserving pancreatic tail resection was performed. Microscopic examination revealed that the cyst was surrounded by fibrous tissue and a thin layer of splenic tissue, adjacent to normal pancreatic parenchyma. The inner surface of the cyst was lined with non-keratinizing squamous epithelium. The diagnosis of an epidermoid cyst occurring in an intrapancreatic accessory spleen was confirmed. Laparoscopy-assisted spleen-preserving pancreatic resection is a safe and effective procedure for benign or low-grade malignant cystic diseases in the pancreas.     

Laparoscopic distal pancreatectomy without needle aspiration before resection for giant mucinous cell neoplasms

Laparoscopic resection of large mucinous cystic neoplasms (MCN) has recently been reported. However, in most reports, needle aspiration of the cyst contents was performed before resection and can cause dissemination. Here, we report two patients with giant MCN: a 26‐year‐old woman with a 23‐cm MCN and a 41‐year‐old woman with an 18‐cm MCN. The MCN were successfully resected without aspiration by laparoscopic surgery. CT revealed no tumor involvement of the origins of the splenic artery and vein in either case. In case 1, we performed hand‐assisted laparoscopic surgery while dissecting around the spleen, whereas case 2 underwent pure laparoscopic surgery. No postoperative complications occurred in either case, indicating that laparoscopic distal pancreatectomy for giant MCN is feasible without aspiration in patients without splenic artery and vein origin involvement.     

Endoscopic partial resection of a duodenal duplication cyst

A case of symptomatic duodenal duplication cyst is reported. The patient underwent endoscopic partial resection of the cystic wall using the O-ring ligation kit. After resection, the abdominal pain disappeared. Endoscopic partial resection is useful for diagnosis and treatment of duodenal duplication cyst.     

Endometriosis of the pancreas presenting as a cystic pancreatic neoplasm with possible metastasis

The authors report a case of endometriosis that presented as a cystic mass in the tail of the pancreas, leading to extensive evaluation and ultimately a major surgical resection. The diagnosis was made by histopathological evaluation, revealing endometrial glands and stroma in the wall of the mass with hemorrhagic fluid in the cystic lumen, compatible with pancreatic involvement by an endometrial cyst.     

Sonographic findings in a duodenal duplication cyst

We report the sonographic features of a duodenal duplication cyst containing ectopic pancreatic tissue in a 5-month-old boy who presented with symptoms of partial gastric outlet obstruction. Sonography revealed an anechoic, double-walled, bilobed cystic lesion containing debris in the pyloroduodenal region. There was sound through-transmission but no air or communication with the gastrointestinal tract. Surgical resection and histopathologic examination confirmed a duodenal duplication cyst containing pancreatic tissue.     

Video‐assisted segmental resection of an intrapulmonary bronchogenic cyst mimicking a middle mediastinal cystic tumor

We report a case of an intrapulmonary bronchogenic cyst that radiologically mimicked a cystic tumor of the middle mediastinum. During video‐assisted thoracoscopic surgery, the lesion was confirmed to be in the lung parenchyma rather than in the mediastinum. A video‐assisted thoracoscopic anterior basal segmentectomy was eventually performed, and an intrapulmonary bronchogenic cyst was the diagnosis based on histology.     

Chronische Rückenschmerzen als Folge eines retroperitonealen Lymphangioms

A 39-year-old female patient presented with a 3-year history of lower back pain which had not been alleviated by pain treatment combined with physiotherapy. Radiological findings were normal with the exception of a cystic paravertebral tumor in the left retroperitoneum. The cyst was primarily regarded as a coincidental finding because no criteria for malignancy were present. Magnetic resonance tomography, however, the cyst showed a progressive increase in size and the pain remained unchanged so that surgical resection was performed. The histopathological examination showed a lymphangioma and the pain was nearly completely resolved after surgery.     

Intraoperative fluorescent cholangiography using indocyanine green for laparoscopic fenestration of nonparasitic huge liver cysts

Bile duct injury is one of the known serious complications of laparoscopic fenestration for nonparasitic liver cysts. Herein, we report the case of a huge liver cyst for which we performed laparoscopic fenestration using intraoperative fluorescent cholangiography with indocyanine green. A 71‐year‐old woman with abdominal distention was referred to our hospital. CT demonstrated a 17 × 11.5‐cm simple cyst replacing the right lobe of the liver, so laparoscopic fenestration was performed. Although the biliary duct could not be detected because of compression by the huge cyst, fluorescent cholangiography with indocyanine green through endoscopic naso‐biliary drainage tube clearly delineated the intrahepatic bile duct in the remaining cystic wall. The patient had no complications at 3 months after surgery. Fluorescent cholangiography using indocyanine green is a safe and effective procedure to avoid bile duct injury during laparoscopic fenestration, especially in patients with a huge liver cyst.     

心包囊肿的超声诊断价值

目的探讨心包囊肿的超声诊断价值。方法对2013-2018年7例心包囊肿患者的超声特征及其相关资料分析并随访。结果超声心动图显示心包囊肿大多(5/7)位于心脏右缘膈水平,呈均质类圆形囊性回声,未探及血流信号。3例有症状。6例行手术切除,术后无复发;1例保守处理,复查囊肿较前相仿。结论超声心动图可以检出心包囊肿,具有重要诊断价值;提高对其的认识有助于临床的诊治和预后。     

神经内镜及内镜辅助显微手术治疗颅内囊性病变

目的 :总结微侵袭内镜神经外科手术治疗颅内囊性病变的适应证、方法及其优缺点。方法 :应用神经内镜及内镜辅助显微神经外科手术治疗颅内囊性肿瘤、蛛网膜囊肿、脑室内囊肿、透明膈囊肿及脑脓肿共 4 5例。结果 :11例囊性肿瘤全切 7例、次全切除 4例 ,术后症状均明显改善或消失 ;18例蛛网膜囊肿全部行囊壁部分切除、囊肿 -脑池 /脑室造瘘 ,症状 (13/ 16例 )明显缓解或消失 ,2例缓解 ,1例无变化 ;3例脑室内囊肿均切除 ,症状均消失 ;10例透明膈囊肿全部行囊肿 -脑室造瘘 ,症状消失或明显改善 9例 ,1例无缓解 ;3例脑脓肿行囊肿引流 ,症状均消失。并发症共 7例 ,无伤残及死亡。结论 :神经内镜手术具有微创、安全、疗效好等优点 ,适用于囊性肿瘤、蛛网膜囊肿、脑室内囊肿、透明膈囊肿及脑脓肿等颅内囊性病变。     

Mullerian cyst of the uterus misdiagnosed as ovarian cyst on pelvic sonography

Mullerian cyst of the uterus, also known as endosalpingiosis, is rare and often can be misdiagnosed as adnexal cyst on pelvic sonography. A 47‐year‐old woman was referred for an incidental finding of a right adnexal mass on pelvic sonography, suspected to be an ovarian cyst. During laparoscopy, a pedunculated cystic mass arising from the right anterior uterine wall was seen. The mass was resected laparoscopically and histologic examination showed a benign Mullerian cyst of the uterus. Diagnosis of Mullerian cyst of the uterus can be challenging. However, with increased awareness, preoperative diagnosis of this condition should be possible sonographically. © 2013 Wiley Periodicals, Inc. J Clin Ultrasound 42 :183–184, 2014     

Mucinous cystic neoplasms of the pancreas

Mucinous cystic neoplasms of the pancreas (MCNP) are rare tumors with presentation and findings that differ in most cases from pancreatic pseudocysts. A simple pancreatic cystic lesion in a younger-aged patient with a history of pancreatitis and endoscopic retrograde cholangiopancreatography (ERCP) demonstration of ductal communication with the cyst strongly suggests the diagnosis of a benign pseudocyst. MCNP may have extensive areas without an epithelial lining, adding histologic sampling error to the potential for confusing these two entities. Pancreatic pseudocysts are benign lesions treated by enteric drainage procedures, while MCNP have significant malignant potential, and resection is advised. Even when clinical presentation and imaging are persuasive for a benign cyst, MCNP of the pancreas should be considered in planning, evaluation, and treatment.     

输液管抽吸联合经阴道良性卵巢囊肿切除术的应用

目的：探讨输液管抽吸联合经阴道手术切除良性卵巢囊肿切除术的可行性及临床应用价值。方法：对2004年3月—2011年12月收治的58例良性卵巢囊肿患者经阴道行囊肿切除术,术中用输液器针管抽吸囊液,缩小囊肿体积后切除。结果：手术时间平均为45 min,平均出血量56 mL,术后平均排气时间12 h,平均住院时间4 d。结论：应用输液管抽吸联合经阴道切除良性卵巢囊肿手术,恢复快、出血少、创伤小,值得进一步推广。     

超声包裹征预测附件囊性包块蒂扭转的价值

目的探讨超声"包裹征"预测附件囊性包块蒂扭转的应用价值。方法回顾性分析193例因急性下腹痛就诊且超声检查存在附件囊性包块女性患者的超声图像,以手术结果为金标准确定附件扭转组131例,非扭转组62例,比较两组间超声包裹征的出现率,计算包裹征预测附件囊性包块蒂扭转的诊断效能。结果 (1)包裹征对应病理表现为扭转后输卵管及囊壁组织的广泛梗死水肿,半包绕扭转蒂部远端的囊肿;(2)扭转组131例中,出现包裹征共36例(27.5%),非扭转组中62例中出现1例(1.6%)包裹征,两组间差异具有统计学意义(P<0.001)。包裹征诊断附件囊性包块蒂扭转灵敏度、特异度和准确度分别为27.5%、98.4%、50.3%。当囊性包块最大长径<75.5mm时,包裹征诊断附件囊肿蒂扭转灵敏度、特异度和准确度分别为51.9%、97.6%、71.6%。结论超声包裹征预测附件囊性包块蒂扭转中具有高特异度。对于因下腹痛来诊女性患者,当合并包裹征时,应敢于提出疑似扭转的诊断。     

Cystic pilomatrixoma of the wrist mimicking a ganglion cyst in a child

We describe a patient with a cystic pilomatrixoma mimicking a ganglion cyst on ultrasound. A 9‐year‐old boy had a subcutaneous mass on his left wrist. Ultrasound displayed a well‐defined, multilobulated anechoic mass containing a few internal septa between the extensor pollicis longus and the extensor carpi radialis longus tendons. Sonographic findings suggested that the mass was a ganglion cyst. After excisional biopsy, histopathologic examination confirmed the diagnosis of pilomatrixoma. © 2012 Wiley Periodicals, Inc. J Clin Ultrasound, 41:313–315, 2013     

Laparoscopically resected foregut cyst adjacent to the right adrenal gland

A case of 49-year-old woman with a retroperitoneal undifferentiated foregut cyst attached to the right adrenal gland is reported. The bronchogenic cyst is a type of foregut cyst with a cartilage component, but in this case the multicystic tumor lacked both cartilage and gland. It is quite rare among retroperitoneal tumors and has not been reported so far to have malignant potential. The preoperative diagnosis was an adrenal benign incidentaloma, and the patient successfully underwent laparoscopic resection of the cystic tumor together with the right adrenal gland by lateral transabdominal approach. Laparoscopic surgery for a retroperitoneal tumor is problematic, however, since benignancy cannot be predicted. In laparoscopic adrenalectomy for non-functioning adrenal tumor, therefore, a differential diagnosis from retroperitoneal tumor should be given serious consideration.     

Prenatal sonographic findings of duodenal duplication: Case report

We report a rare case of duodenal duplication cyst that was suspected prenatally. Routine prenatal sonography (US) at 19 weeks' gestation showed an abdominal cystic mass on the left side of the abdomen. Follow‐up US examinations showed a partial “double‐wall” sign, highly suggestive of enteric duplication, and changes in cyst size and wall thickness. Postnatal US examination suggested enteric duplication cyst. A laparotomy revealed a duodenal cyst that was completely resected. The antenatal US findings associated with this condition, the accuracy of its antenatal diagnosis, and its differential diagnosis are discussed. © 2012 Wiley Periodicals, Inc. J Clin Ultrasound 41 :1–5, 2013     

23例先天性胆管囊性扩张症的诊疗分析

目的总结先天性胆管囊性扩张症的临床诊疗经验。方法回顾性分析该院1997年3月至2008年3月诊治的23例先天性胆管囊性扩张症病例的诊疗过程及随访结果。结果大部分患者临床表现不典型,具有典型的腹痛、黄疸和腹部包块三联征者仅占4.35%;B超诊断率为78.26%,CT、磁共振胰胆管造影(MRCP)和经内镜逆行胆胰管造影(ERCP)诊断率均为100%;手术以囊肿切除加胆道重建为主,全组无手术重大并发症病例,随访4个月至3年,无术后癌变病例。结论先天性胆管囊性扩张症诊断依靠影像学资料,B超可用于筛查,术前检查推荐MRCP,ERCP不作首选;治疗依靠外科手术,手术方式以囊肿切除加胆道重建为基本原则。     

Diagnosis of cystic neoplasms with endoscopic ultrasound

From the data that are currently available, it appears that EUS can help to reliably distinguish between the majority of benign and neoplastic cystic lesions. In equivocal cases, or cases where a high suspicion for malignancy exists, the use of EUS-guided FNA for obtaining cytology and cystic fluid for analysis of various tumor markers, gives the best diagnostic yield. Occasionally, despite a complete evaluation of a cystic mass, the cyst type may not be determined. The decision regarding further management of these lesions should be based on a combination of factors including symptoms, cyst size, EUS morphology and the patient's overall medical condition. In the case of symptomatic, large, or suspicious lesions where the patient is a good surgical candidate, surgical resection should be performed. However, it becomes more difficult in the case of asymptomatic, small cystic lesions where the patient is not an optimal surgical candidate. In the latter scenario, applying EUS criteria for follow-up of small pancreatic cystic lesions as reported by Ikeda et al can help in the decision-making process. In this study, Ikeda et al reported on 31 patients with pancreatic cystic lesions of unknown etiology that were followed-up with semi-annual EUS exams over a 3-year period. In 87.1% of these lesions, the size was less than 2 cm. Their criteria included 1) a clear thin wall, 2) smooth contour, 3) round or oval shape, 4) no septum or nodules, 5) asymptomatic clinical presentation, and 6) no findings of chronic pancreatitis. The cystic lesions remained stable in 30/31 patients, and only one lesion increased in size. This lesion was resected and was found to be a retention cyst. We are optimistic that the role of EUS in the management of cystic neoplasms will continue to evolve and expand as future studies evaluate the clinical utility of imaging modalities for the optimal practice algorithm for managing these neoplasms.