Pineal epidermoid cysts: diagnosis and management.

OBJECT: The results of surgical treatment of epidermoid cysts of the pineal region in six cases are presented. METHODS: Six patients with pineal epidermoid cysts underwent surgery at the Institute of Neurosurgery "N. N. Burdenko," in Moscow, during the period 1976 to 1995. The duration of the patients' preadmission clinical history varied from 6 months to 2 years (average 1.4 years). Headache, diplopia, and vertigo were the most frequently occurring symptoms. Neurological examination demonstrated papilledema, impaired pupillary reaction, ataxia, and long-pathways deficit; Parinaud's syndrome was found in only one case. Computerized tomography and magnetic resonance imaging constituted the primary diagnostic tools. Surgery was performed using either an infratentorial-supracerebellar approach (two cases) or an occipital-transtentorial approach (four cases). CONCLUSIONS: Surgical results can be excellent if a removal, as extensive as possible, is performed using either the supracerebellar or occipital-transtentorial approach.     

Adrenal cysts Diagnosis and management

Four patients with adrenal cysts have recently been treated at the Urology Service of this center. Presentation, diagnostic evaluation, and treatment are described, and the literature regarding frequency of presentation, symptoms, and diagnostic differential is reviewed.     

Intramedullary epidermoid cysts

Intramedullary inclusion cysts are extremely rare within the rostral spinal cord. In this case report the authors outline the clinical features and surgical treatment of one dermoid cyst and one epidermoid cyst of the cervicothoracic junction. The authors also include a relevant literature discussion regarding the treatment and the embryological origin of these lesions.     

Transtentorial epidermoid cysts

Summary Epidermoid cysts may occur simultaneously above and below the tentorium. Eleven patients with involvement of both infra- and supra-tentorial cisterns are presented. In two cases the epidermoid, located mainly in the cerebello-pontine angle, spread into the middle cranial fossa; in three the epidermoid extended from the parasellar cisterns to the posterior cranial fossa; in six patients the epidermoid, enlarging the tentorial notch, occupied extensively both cranial fossae.The surgical approach was influenced both by the experience of the surgeon and by the main extension of the epidermoid. Total removal was feasible in two patients only but only one of the eleven patients had a recurrence of the epidermoid. The long term results appear to be unrelated to the size of the epidermoid and to the choice of approach.     

脾囊肿诊治现状

脾囊肿是临床上的少见病,可分真性和假性两大类.脾囊肿的诊断主要依靠B超、CT或MRI.根据囊肿直径及有无临床症状,采取保守治疗或外科治疗.外科治疗应尽量保留脾脏,提倡使用腹腔镜脾脏切除术治疗脾囊肿.保守及手术治疗的患者皆应定期行B超检查,以动态观察囊肿变化及有无复发.     

Diagnosis and management of periurethral cysts

BACKGROUND/AIMS: Periurethral cysts are a rare entity that may be confused with urethral diverticula. The protocol for diagnosis and management of these lesions is still unclear. We present our experience with six patients presenting with periurethral cysts. METHODS: From 2001 to 2005 we evaluated six patients with a paraurethral mass. History, physical examination, laboratory and radiographic findings were analyzed to determine factors helpful in mass diagnosis. Cyst excision was performed via trans-vaginal approach in all patients and outcomes of this approach were assessed. RESULTS: Six female patients, average age of 29.7 years, presented with the complaint of a paraurethral mass. Transvaginal sonography was performed in two patients to confirm the presence of a periurethral cyst. Cystourethroscopy in all patients revealed no communication between the cyst and the urethra or presence of other lesions. Pathology revealed a benign cyst in all patients. No cyst recurrence has been seen in any patient. CONCLUSION: Most periurethral cysts can be diagnosed by physical examination. The diagnosis may be confirmed with transvaginal sonography. Cystourethroscopy should be performed to rule out other pathology, but may be done in the same setting as surgical excision. Complete surgical excision is effective and is associated with minimal risk of recurrence during short-term follow-up.     

Intraspinal epidermoid and dermoid cysts

Summary Seven cases of intraspinal inclusion cysts, surgically treated between 1970 and 1984, are reported in this paper. Four were epidermoid cysts and three dermoid. Two cysts were located in the thoracic spine (one dermoid and one epidermoid) and five in the lumbosacral region (three epidermoid and two dermoid). Associated spinal dysraphia was noted in five cases. Congenital dermal sinus was found in two cases, spina bifida cystica in one, spina bifida occulta in one, and diastematomyelia in one case. The average postoperative follow-up period was 5 years. No neurological symptoms were found in the five patients who received early surgical treatment, but for the two patients whose operations were late, there were some residual neurological deficits. Therefore, early and accurate diagnosis and radical surgical extirpation are emphasized.

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Zusammenfassung In diesem Bericht wird eine Serie von sieben Fallen eingeschlossener Cysten in der Wirbelsaule beschrieben, die zwischen 1970 und 1984 behandelt wurden. Vier dieser Cysten waren epidermoid, drei dermoid. Zwei befanden sich im Brustwirbelbereich (eine Epidermoidcyste and eine Dermoid cyste) und fünf in der lumbosakralen Region (drei Epidermoid- und zwei Dermoidcysten). In fünf Fällen wurden hiermit verbundene Disraphismen in der Wirbelsäule festgestellt, ein angeborener Dermalsinus in zwei Fällen, spina bifida cystica, spina bifida occulta und diastematomyelia jeweils in den drei übrigen. Im Durchschnitt betrug die postoperative Nachbehandlung 5 Jahre. Die Rolle der frühen und

     

Intrasellar epidermoid cysts]

Two patients presenting with an intrasellar epidermoid cyst and operated on through a transsphenoidal approach, are reported. Problems regarding pathological controversies about the differential diagnosis (particularly craniopharyngiomas) are addressed. In order to establish the adequate preoperative diagnosis, the interest of MRI is discussed.     

Splenic epidermoid cysts.

Four patients with splenic masses were operated upon and found to have epidermoid cysts of the spleen, a rare lesion comprising less than 10% of benign, nonparasitic splenic cysts. The patients were young and had vague, non-specific symptoms which were related to the size of the slowly enlarging splenic mass. Three patients had palpable masses. Contrast gastrointestinal studies and intravenous urography will help exclude mass lesions of the gastrointestinal or genitourinary tract. Sonar scan may confirm the cystic nature of the lesion and localize it to the spleen. A review of 42,327 autopsy records at the Los Angeles County--University of Southern California Medical Center revealed 32 benign splenic cysts found incidentally at autopsy. Hemorrhage, infection, rupture, and rarely, malignant change are complications of splenic cysts. Splenectomy is recommended to eliminate the symptoms produced by the cyst and prevent the potential complications.     

Sprouting epidermoid cysts.

Five unusually shaped (i.e. 'sprouting') epidermoid cysts in the upper lip, elbow and foot are reported. The tumours seldom produced symptoms. The maximum diameter was 25-48 mm. The complete removal including a sprouting bud is necessary. Histologically, partial to complete cyst wall rupture was recognised. A pulsion diverticulum due to variations in the thickness and strength of the cyst wall, a foreign body reaction against inner keratinous mass without obvious bacterial infection, and/or outer fibrous band(s) acting as constriction band(s), are proposed as possible causes of the 'sprouting'.     

Simple epidermoid cysts of testis

Four cases of simple epidermoid cysts of the testis are described, and the entity is discussed.     

Giant epidermoid cysts of the skull

The authors describe two cases of giant intradiploic epidermoid cysts of the cranial vault and a case of a large epidermoid arising from the frontal sinus and extending intracranially. The aetiology of epithelial cysts is reviewed. The characteristic radiological and CT scan appearances of diploic epidermoid cysts are described, their clinical presentation and surgical management briefly discussed.