Interhemispheric choroidal epithelial cyst associated with partial agenesis of the corpus callosum: case report and review of the literature]

A case of interhemispheric choroidal epithelial cyst is reported. The patient is a 9-month-old female who was transadmitted to our hospital for further examination because of the enlargement of her head. She had no neurological deficits nor symptoms of increased intracranial pressure. CT scanning performed on admission showed multiple cystic lesions in the right frontoparietal interhemispheric space, whose circumference was partially enhanced with contrast medium. Metrizamide CT cisternography demonstrated no communication between the lesions and the ventricular system. The signal intensity of the cysts was higher than that of cerebrospinal fluid on both T1-weighted and T2-weighted MR images. Sagittal T1-weighted images showed partial agenesis of the corpus callosum. The surgical exploration was performed via interhemispheric approach. The cyst wall was found to be white, relatively rich in vascular components, and was removed as much as possible. The examination of the cyst fluid showed total protein levels of 1250 to 3440 mg/dl, and sugar contents of 43 to 99mg/dl. Callosal agenesis was confirmed at operation. The light microscopic examination revealed that the cyst wall was composed of a single layer of columnar or cuboidal epithelium with occasional papillary configuration and thick collagenous connective tissue. The epithelial cells contained PAS-positive granules in the cytoplasm. Electron microscopy showed numerous club-shaped microvilli with no coating materials, continuous basement membrane, tight junction, interdigitation, and multiple fenestrations of endothelium of stromal vessels. On the basis of these findings, the lesion was diagnosed as choroidal epithelial cyst. In the literature, interhemispheric choroidal epithelial cyst associated with partial callosal agenesis, confirmed ultrastructurally, has not, to out knowledge, been reported.     

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.     

Interhemispheric arachnoid cyst in the elderly: case report and review of the literature

BACKGROUND: Preoperative differential diagnosis of interhemispheric cysts is sometimes difficult. CASE DESCRIPTION: We recently experienced a case of symptomatic interhemispheric arachnoid cyst in a 62-year-old woman. We reviewed interhemispheric arachnoid cysts in the elderly and the management of symptomatic interhemispheric arachnoid cysts in elderly patients. Symptomatic interhemispheric arachnoid cysts in the elderly are predominantly located on the right side, have a long history of progressive symptomology, occur predominantly in females, and have no communication with the subarachnoid space. Interhemispheric arachnoid cysts are usually not associated with agenesis of the corpus callosum in elderly patients, whereas interhemispheric nonarachnoid cysts are usually associated with agenesis of the corpus callosum, which will be clearly demonstrated on magnetic resonance imaging. CONCLUSIONS: It is highly possible that an interhemispheric cyst without agenesis of the corpus callosum in an adult is an arachnoid cyst.     

A case of symptomatic interhemispheric arachnoid cyst in the elderly]

The incidence of interhemispheric cyst is rare. There have been only 12 cases reported in adults since the advent of CT. We encountered a case of an interhemispheric arachnoid cyst in a 54-year-old patient who had developed paraparesis. Excision of the cystic wall produced a satisfactory result. The CT and MRI scans were not contributory to histological differentiation of the lesions. According to the literature, however, it is highly likely that these patients are suffering from an arachnoid cyst, when the interhemispheric cyst without agenesis of the corpus callosum occurs in adults.     

Two cases of symptomatic arachnoid cysts in elderly patients--a comparison and analysis with child cases

A symptomatic arachnoid cyst in an elderly patient is rare. We report two cases of symptomatic arachnoid cysts in elderly patients. The first case is that of a 73-year-old woman complaining of headache and speech disturbance. She had an arachnoid cyst in the left interhemispheric fissure. This is rare. Only two interhemispheric arachnoid cysts in the elderly have ever been reported. The other case is that of a 64-year-old woman, having right hemiparesis and dementia and a cyst is shown in her left temporal lobe. Both patients underwent a cystectomy which resulted in the disappearance of their symptoms. Only 56 cases of symptomatic arachnoid cyst over the age of 60 years have ever been reported. We made an analysis of 58 cases, including our two cases, and compared it with child cases. In cases of the elderly, the symptoms are usually headache, hemiparesis, gait disturbance and dementia, which are similar to symptoms of chronic subdural hematoma and normal pressure hydrocephalus. On the other hand, child cases usually reveal signs of intracranial hypertension. Several authors have reported their therapeutic method for child symptomatic arachnoid cysts. However, it is difficult to determine the best method for treating child cases at this time. We think a cystectomy is the first choice of operative procedure for symptomatic arachnoid cyst in the elderly.     

Epidermoid cyst of the third ventricle.

The authors report a case of a cystic epidermoid of the third ventricle in a young female presenting with headache and mental disturbances. The cyst filled completely with gas during ventriculography and was subtotally removed through an interhemispheric callosal-splitting approach.     

Interhemispheric arachnoid cyst; report of three cases]

Three operated cases of the interhemispheric arachnoid cyst were reported. Case 1: a 58-year-old female suffering from progressive right hemi-rigidity and gait disturbance for the past two years. Case 2: a 66-year-old female was admitted with chronic headache. MRI demonstrated a large interhemispheric cyst in these two patients. Case 3: a 6-month-old male had frequent episodes of tonic seizure. MRI demonstrated interhemispheric cyst and agenesis of the anterior part of corpus callosum. The resection of the cystic wall via the interhemispheric approach was performed for all cases. General convulsive seizure developed in the early stage following operation in case 1 and case 2, in spite of routine administration of prophylactic anticonvulsant. The seizures were well controlled thereafter. In all cases, the cyst disappeared on the follow up CT. Simple resection of cyst wall is effective in the surgical treatment of interhemispheric arachnoid cysts.     

Epidermoid cyst of the corpus callosum]

Epidermoid cysts are most commonly located in the cerebellopontine angle and the parasellar regions. The authors report a case of an epidermoid cyst of unusual location: it arises in the midline and involves the body of the corpus callosum with interhemispheric exophytic growth. Reviewing the literature they did not find any similar report. C.T. scan and M.R.I. are the methods of choice for establishing the diagnosis and differentiating between epidermoid cyst, dermoid cyst, lipoma and arachnoid cyst. M.R.I. is highly sensitive and is especially useful in determining tumour extension, particularly in the sagittal and coronal planes, essential for surgical treatment planning. Treatment should be complete surgical resection in order to avoid recurrence and chemical meningitis.     

An epithelial cyst at the frontal convexity

We report a rare case of an epithelial cyst at the right frontal convexity. A 60-year-old woman came to our hospital suffering from dysarthria and gait disturbance. Computed tomography (CT) of the brain on admission showed a round low-density area, 6 cm in diameter, at the right frontal convexity. Midline shift and displacement of the lateral ventricle are seen. There is no contrast enhancement effect. Excision of the cyst wall and fenestration into the subarachnoid space was carried out and the patient was discharged with no neurological deficits. After 5 years, regrowth of the cyst was seen. Cyst-peritoneal shunt was performed and she was discharged uneventfully. Light microscopy showed the cyst wall consisted of a monolayer of flat epithelium and loose connective tissue. An electronmicrograph of the cyst wall showed a non-ciliated epithelial layer with microvilli and basement membrane. The epithelial cells connecting with each other through desmosome have numerous endoplasmic reticulum and mitochondria. Interdigitation of the cytoplasmic membrane was not seen. The term "epithelial cyst" seems ambiguous. We discuss the pathogenesis and the nomenclature for intracranial benign cystic lesions based on the previous literature.     

Glandular odontogenic cyst: A case report and clinicopathologic analysis of the relationship to central mucoepidermoid carcinoma

Glandular odontogenic cyst (GOC), an unusual multilocular cystic lesion of jaws exhibiting the features of both botryoid odontogenic cyst and mucoepidermoid tumor has been reported recently as a new entity with uncertain histogenesis. The World Health Organization named GOC as an independent pathologic entity and classified it as a developmental odontogenic epithelial cyst. We report an additional case, describe its clinicopathologic features, and discuss the similarity to the central mucoepidermoid carcinoma. © 1997 John Wiley & Sons, Inc. Head Neck 19: 227–231, 1997.     

Multilocular Mediastinal Cyst with Rim Calcification: Report of a Case

We report a case of a multilocular anterior mediastinal cyst with rim calcification and severe adhesion to the adjacent organs. We excised the cyst completely, with resection of the left phrenic nerve, pericardium, and left lung because of the severe adhesion. Histological examination revealed that the multilocular cystic walls were composed of fibrous connective tissue and calcifications, but the lining epithelial cells were absent because of dystrophic calcification resulting from chronic inflammation. On the basis of the location and pathological findings, we diagnosed a multilocular mediastinal cystic tumor; most likely a multilocular thymic cyst. It is important to distinguish a multilocular thymic cyst from a unilocular thymic cyst because a multilocular thymic cyst may recur postoperatively and coexist with a thymic epithelial tumor. Dense adhesion to the surrounding mediastinal structures may make removal difficult, especially if there is rim calcification.     

Bronchioloalveolar carcinoma arising in a bronchogenic cyst

We report the case of a 37-year-old woman with a radiographically cystic lung lesion. Lobectomy was performed. Histopathologic examination showed a bronchioloalveolar carcinoma arising in a bronchogenic cyst. This suggests that epithelial cells of bronchogenic cysts can undergo malignant transformation. It may be prudent to recommend complete resection of any bronchogenic cyst.     

Suprasellar epithelial cyst. Case report

This case report describes an epithelial cyst lying above the diaphragma sellae and causing hypopituitarism and chiasmal compression in a 17-year-old girl. The epithelial lining of the cyst showed similarities with enteric epithelium rather than with "classic" Rathke's cleft. The problem of the true origin of Rathke's cleft, and of cysts so labeled, and the possible role played by neuroepithelium are discussed briefly.     

Thoracoabdominal foregut duplication cyst with respiratory epithelium and alimentary epithelium

Thoracoabdominal foregut duplication is a rare congenital abnormality. The authors report a case of thoracoabdominal foregut duplication cyst in a 13-year-old male patient. The pathologic report revealed that a thoracic mass with a pseudostratified, ciliated, columnar epithelial lining (respiratory tract epithelium), an abdominal mass with gastric mucosa (alimentary tract epithelium), and the cyst originated from the foregut.     

Hand-assisted laparoscopic splenectomy for a huge splenic cyst: operative technique and case report

We report the case of a huge splenic cyst that was successfully treated by hand-assisted laparoscopic splenectomy. A 17-year-old girl with a chief complaint of left-sided abdominal pain was admitted to our department for investigation of a splenic tumor. Ultrasonography, computed tomography, and magnetic resonance imaging revealed a huge cystic lesion in the spleen measuring approximately 10 cm in diameter. Hand-assisted laparoscopic splenectomy was safely performed to diagnose and treat the splenic tumor. The histologic diagnosis was an epithelial cyst of the spleen with no atypical cells in the cyst wall. Hand-assisted laparoscopic splenectomy may be a good method of managing a huge splenic cyst that becomes symptomatic and potentially life-threatening through enlargement, rupture, and secondary infection.     

Enteric duplication cyst of the pancreas with duplicated pancreatic duct

Enteric duplication cyst is one of the rarest forms of cystic lesion of the pancreas. We report a unique case of an enteric duplication cyst of the pancreas that was communicating with a duplicated pancreatic duct. A 7-year-old girl with severe acute abdominal pain was found to have a large cyst that was smoothly communicating with the dilated pancreatic duct in the pancreatic tail. Analysis of cyst fluid showed elevated levels of amylase, carcinoembryonic antigen (CEA) and CA 19-9, and no epithelial cells. Intraoperative cyst pancreatography revealed that the pancreatic duct was duplicated in the tail: 1 duct was communicating with the cyst, and the other was dilated within the pancreatic tail. The patient underwent spleen-preserving distal pancreatectomy and complete cyst excision without complication. Because preoperative diagnosis of duplication cyst of the pancreas is difficult, this condition should be considered during differential diagnosis of atypical cystic lesions of the pancreas. Complete excision is desirable for the management of duplication cyst of the pancreas.     

Intracerebral epithelial cyst: immunohistological diagnosis and endoneurosurgical treatment

This report details an additional case of the very rare instance of a respiratory epithelium-lined intracerebral cyst without communication with the ventricular system. Immunohistologic analysis supports an epithelial rather than neuroectodermal origin. Management using endoneurosurgical techniques is described.     

Epithelial cyst of the gallbladder associated with adenocarcinoma

Epithelial cyst of the gallbladder associated with papillary adenoma and adenocarcinoma is presented herein. A 70-year-old male patient with general malaise was admitted to our hospital during the follow-up of an elevated mucosal lesion in the fundus of the gallbladder. Endoscopic ultrasonography revealed a cystic lesion adjacent to the elevated lesion, and interruption of the hyperechoic third layer of the gallbladder wall next to the gallbladder bed of the liver. He was diagnosed as having an epithelial cyst of the gallbladder associated with gallbladder carcinoma that directly invaded the gallbladder bed. He underwent resection of the gallbladder with partial resection of the liver and regional lymph node dissection. The resected specimen, which showed multiple cysts with septum formation, measured 1.9 cm in size and was located in the subserosal layer of the gallbladder wall. The wall of the cyst was lined with columnar epithelium and papillary adenoma, and adenocarcinoma was scattered in some portions of the cyst wall. Furthermore, papillary adenoma associated with adenocarcinoma was independently identified in the luminal surface of the gallbladder epithelium covering the cysts. These histological findings were compatible with epithelial cyst of the gallbladder associated with papillary adenoma and adenocarcinoma. The tumor was diagnosed as T1bN0M0, stage I, in the TNM clinical classification. To our knowledge, this is the first report of an epithelial cyst of the gallbladder associated with papillary adenoma and adenocarcinoma, and provides some insight into the relationship between epithelial cyst and adenoma or cystadenocarcinoma of the gallbladder. Received: December 25, 2001 / Accepted: April 14, 2002     

Obstructing ileal duplication cyst infected with Salmonella in a 2-year-old boy: a case report and review of the literature

Alimentary tract duplications (ATDs) are rare congenital anomalies, with an incidence of 1 in 4500 individuals. Patients with these lesions present in a variety of ways, and although histologically benign, ATDs can lead to lethal complications including volvulus, intussusception, or bowel obstruction. Irrespective of anatomical location, the epithelial lining of ATDs contains ectopic acid-secreting mucosa in more than 50% of cases, which can lead to ulceration, bleeding, or transmural erosion and perforation. We report an unusual case of a child who presented with small bowel obstruction caused by an ileal duplication cyst that had become infected with Salmonella. Although reports of infected mesenteric cysts and duodenal duplication cysts have been published, this is the first reported case of an infected ileal duplication cyst. We also present a review of the literature regarding these interesting lesions.     

Pancreatic epithelial cyst in an adult treated by central pancreatectomy

The infrequent occurrence of benign epithelial cysts of the pancreas is the reason why little is known regarding their clinical relevance and surgical management. We report the case of a 38-year-old woman with a benign epithelial cyst that was resected by the rarely performed central pancreatectomy. The presentation, evaluation, and differences between this and other cystic lesions of the pancreas are discussed. The benefits of central pancreatectomy for this benign lesion are reviewed.