Simple bone cysts of the proximal humerus presented with limb length discrepancy:A case report

BACKGROUND Simple bone cysts(SBC)are benign tumor-like bone lesions typically identified in children.While SBC may lead to growth disturbances or growth arrest,such cases are uncommon.The mechanisms behind these observations remain unclear.Additionally,research on the etiology of SBC remains inconclusive,and there has been no consensus on the appropriate timing and methodology for treatment.CASE SUMMARY Here,we present our experience in the successful surgical management of a 10-year-old girl with SBC,who presented with a pathological fracture complicated by malunion of the displaced fracture,varus deformity,and limb length discrepancy.We hypothesized two possible etiologies for the patient’s growth arrest and subsequent humerus varus deformity:(1)Direct disruption of the physis by fluid from the cyst itself;and(2)damage to the epiphysis due to repetitive pathological fractures associated with SBC.In addressing this case,surgical intervention was undertaken to correct the proximal humerus varus deformity.This approach offered the advantages of simultaneously correcting angular abnormalities,achieving mild limb lengthening,providing definitive SBC treatment,and reducing the overall treatment duration.CONCLUSION As per current literature,acute correction of acute angular deformity in proximal humeral SBC is not well comprehended.However,in this specific case,acute correction was considered an optimal solution.

Preliminary exploration of animal models of congenital choledochal cysts

BACKGROUND Various animal models have been used to explore the pathogenesis of choledochal cysts(CCs),but with little convincing results.Current surgical techniques can achieve satisfactory outcomes for treatment of CCs.Consequently,recent studies have focused more on clinical issues rather than basic research.Therefore,we need appropriate animal models to further basic research.AIM To establish an appropriate animal model that may contribute to the investigation of the pathogenesis of CCs.METHODS Eighty-four specific pathogen-free female Sprague-Dawley rats were randomly allocated to a surgical group,sham surgical group,or control group.A rat model of CC was established by partial ligation of the bile duct.The reliability of the model was confirmed by measurements of serum biochemical indices,morpho-logy of common bile ducts of the rats as well as molecular biology experiments in rat and human tissues.RESULTS Dilation classified as mild(diameter,≥1 mm to<3 mm),moderate(≥3 mm to<10 mm),and severe(≥10 mm)was observed in 17,17,and 2 rats in the surgical group,respectively,while no dilation was observed in the control and sham surgical groups.Serum levels of alanine aminotransferase,aspartate aminotrans-ferase,total bilirubin,direct bilirubin,and total bile acids were significantly elevated in the surgical group as compared to the control group 7 d after surgery,while direct bilirubin,total bilirubin,and gamma-glutamyltransferase were further increased 14 d after surgery.Most of the biochemical indices gradually decreased to normal ranges 28 d after surgery.The protein expression trend of signal transducer and activator of transcription 3 in rat model was consistent with the human CC tissues.CONCLUSION The model of partial ligation of the bile duct of juvenile rats could morphologically simulate the cystic or fusiform CC,which may contribute to investigating the pathogenesis of CC.

Multiple thoracic and abdominal foregut duplication cysts:A case report

BACKGROUND Congenital enteric duplication cysts are tubular or cystic structures that normally lie alongside the gastrointestinal(GI)tract.Enteric duplication cysts are typically solitary lesions that occur anywhere near the GI tract from the neck to the rectum,but having multiple duplication cysts is rare,and presentation within the pancreas is extremely rare.CASE SUMMARY We herein demonstrate a case of esophageal,gastric,and gastric-type duplication cyst of the pancreas in a seventeen-month-old girl who presented with failure to thrive,abdominal pain,vomiting,hematemesis,and melena since the age of three months.The cysts were excised by thoracoscopy and laparoscopy in the same setting.To our knowledge,no such case has been published.CONCLUSION Enteric duplications can occur throughout the entire alimentary tract.When they occur in the pancreas,they present a formidable challenge in both diagnosis and treatment.Due to the risk of complications and malignant transformation,surgical removal is the recommended treatment of all duplication cysts.

Multilocular thymic cysts can be easily misdiagnosed as malignant tumor on computer tomography:A case report

BACKGROUND Multilocular thymic cyst(MTC)is a rare mediastinal lesion which is considered to occur in the process of acquired inflammation.It is usually characterized by well-defined cystic density and is filled with transparent liquid.CASE SUMMARY We report on a 39-year-old male with a cystic-solid mass in the anterior mediastinum.Computer tomography(CT)imaging showed that the mass was irregular with unclear boundaries.After injection of contrast agent,there was a slight enhancement of stripes and nodules.According to CT findings,it was diagnosed as thymic cancer.CONCLUSION After surgery,MTC accompanied by bleeding and infection was confirmed by pathological examination.The main lesson of this case was that malignant thymic tumor and MTC of the anterior mediastinum sometimes exhibit similar CT findings.Caution is necessary in clinical work to avoid misdiagnosis.

Treatment of Synovial Cysts in Relation to the Tibial Tunnel of Anterior Cruciate Ligament Grafts by Filling the Tunnel with Acrylic Cement

Introduction: Synovial cyst of the tibial tunnel in connection with anterior cruciate ligament (ACL) reconstruction is a rare but particularly troublesome complication. Medical treatment is often doomed to failure, and surgical treatment usually consists of excising the cyst and filling the tunnel with bone. The aim of this study was to evaluate the results of filling the tunnel with acrylic cement. Hypothesis: Filling the tibial bone tunnel with acrylic cement should eliminate communication between the joint cavity and the pre-tibial surface and prevent cyst recurrence. Patients and Methods: This retrospective series is composed of 13 patients, 9 men and 4 women, mean age 48.5 years (31 to 64) operated on between 2011 and 2019 for an intra- and extraosseous synovial cyst consecutive to the tibial tunnel of an ACL graft. Between 1983 and 2016, 12 of the patients had had a bone graft without bone block fixation (DI-DT or Mac Intosh) and one patient, a bone-bone transplant (KJ). The cyst was of variable size, located on the anteromedial aspect of the proximal end of the tibia, and often painful, warranting consultation. At the time of the initial operation, 9 patients had undergone meniscectomies (6 medial, 2 lateral, 1 double). In 7 knees, there were 7 cartilage lesions in the femorotibial and/or patellofemoral compartments (one stage 1 lesion, 2 stage 2 lesions, 4 stage 3 lesions, and no stage 4 lesions). Only 2 knees had neither cartilage nor meniscus lesions. After curettage of the bone tunnel /− removal of the non-resorbed or PEEK interference screw, the tunnel was filled with acrylic cement /− reinforced with a ligament staple to prevent expulsion. All patients underwent regular follow-up consultations until recovery. Results: At a maximum follow-up of 8 years, only 1 cyst recurred, representing a 7.69% failure rate. It was reoperated with another technique, which involved filling the tibial bone tunnel with bone graft taken from a half-bank head. After recovery, the cyst healed definitively. All patients were able to return to their previous activity within 15 days of surgery. Conclusion: Filling the tibial tunnel with acrylic cement reinforced /− with a ligament staple is a reliable and rapid solution for the treatment of intra- and extra-articular synovial cysts in relation to the tibial tunnel of ACL grafts.

Optimal resection of gastric bronchogenic cysts based on anatomical continuity with adherent gastric muscular layer: A case report

BACKGROUND Bronchogenic cysts are congenital lesions requiring radical resection because of malignant potential.However,a method for the optimal resection of these cysts has not been completely elucidated.CASE SUMMARY Herein,we presented three patients with bronchogenic cysts that were located adjacent to the gastric wall and resected laparoscopically.The cysts were detected incidentally with no symptoms and the preoperative diagnosis was challenging to obtain via radiological examinations.Based on laparoscopic findings,the cyst was attached firmly to the gastric wall and the boundary between the gastric and cyst walls was difficult to identify.Consequently,resection of cysts alone caused cystic wall injury in Patient 1.Meanwhile,the cyst was resected completely along with a part of the gastric wall in Patient 2.Histopathological examination revealed the final diagnosis of bronchogenic cyst and revealed that the cyst wall shared the muscular layer with the gastric wall in Patients 1 and 2.In Patient 3,the cyst was located adjacent to the gastric wall but histopathologically originated from diaphragm rather than stomach.All the patients were free from recurrence.CONCLUSION The findings of this study state that a safe and complete resection of bronchogenic cysts required the adherent gastric muscular layer or full-thickness dissection,if bronchogenic cysts are suspected via pre-and/or intraoperative findings.

Effects of 5-Azacytidine(AZA)on the Growth,Antioxidant Activities and Germination of Pellicle Cysts of Scrippsiella acuminata(Dinophyceae)

In this study,we investigated the effects of different concentrations of 5-azacytidine(AZA),a DNA methyltransferase in-hibitor,on the growth,antioxidant activities and germination of pellicle cysts of Scrippsiella acuminata.The purpose of this study is to understand the toxic effects of AZA on marine microalgae,and to demonstrate the effect of DNA methyltransferase inhibitors on the germination of pellicle cysts.Results showed that AZA inhibited the growth of S.acuminata significantly,and displaced a clear dose-dependent inhibition trend with the 96h EC50 of 146.77μmolL^(-1)(35.84mgL^(-1)).Pellicle cysts of S.acuminata were less sensitive to AZA than the vegetative cells,and the EC50 value of AZA to the germination of pellicle cysts of S.acuminata was 8.08mmolL^(-1)(1.97g L^(-1)).After exposed to AZA,the antioxidant activities in S.acuminata responded rapidly and significantly.Among them,soluble pro-tein and superoxide dismutase(SOD)were more sensitive to AZA,and significant promotions occurred after exposed to 10μmolL^(-1)AZA for 24h.Meanwhile,malondialdehyde(MDA)contents in algal cells did not change significantly after exposed to low concen-trations of AZA,but increased firstly and then decreased under high concentration of AZA.The glutathione(GSH)levels in S.acu-minata increased significantly under high concentrations of AZA,and remained unchanged at low concentrations of AZA.The results suggested that the enhanced protein level and SOD activity of S.acuminata eliminated reactive oxygen species(ROS)to a certain ex-tent,and thus protected algal cells against damages of ROS caused by AZA.

Symptomatic Tarlov Cysts and Occupational Outcome: A Case Report

Tarlov cysts are often asymptomatic and incidentally discovered. However, in few cases, these cysts can be symptomatic and may manifest as chronic low back pain. We report a case of a Tarlov cyst incidentally diagnosed by MRI in a wiring factory worker complaining of chronic low back pain exacerbated with the carrying of heavy loads and the hyper solicitation of the lumbar spine during his professional activity. The clinical manifestations of symptomatic Tarlov cysts can influence the life quality of patients and have enormous repercussions on their work ability, which in some cases can lead to job loss. Thus, the socio-professional aspects of symptomatic Tarlov cysts should not be underestimated and maintaining these patients in employment should be considered from the outset as an objective in its own right in the management.

Increased incidence of indeterminate pancreatic cysts and changes of management pattern: Evidence from nationwide data

Background:Pancreatic cysts are common.However,most studies are based on data collected from individual centers.The present study aimed to evaluate the changes of management patterns for pancreatic cystic lesions(PCLs)by analyzing large epidemiologic data.Methods:Between January 2007 and December 2018,information regarding pancreatic cystic lesions was acquired from the nationwide Health Insurance Review and Assessment Service database in Korea.Results:The final number of patients with pancreatic cysts was 165277 among the total claims for reimbursement of 855983 associated with PCLs over 12 years.The total number of claims were increased from 19453 in 2007 to 155842 in 2018 and the prevalence increased from 0.04%to 0.23%.For 12 years,2874(1.7%)had pancreatic cancer and 8212(5.0%)underwent surgery,and 36 had surgery for twice(total 8248 pancreatectomy).After ruling out claims from the first 3 years of washout period,the incidence increased from 9891 to 24651 and the crude incidence rate of PCLs expanded from 19.96 per 100000 to 47.77 per 100000.Compared to specific neoplasm codes(D136 or D377),the use of pancreatic cyst code(K862)has been remarkably increased and the most common since 2010.The annual number of pancreatectomies increased from 518 to 861 between 2007 and 2012,and decreased to 596 until 2018.The percentage of pancreatic cancer in patients who received pancreatectomy increased from 5.6%in 2007 to 11.7%in 2018.Conclusions:The incidence of PCLs is rapidly increasing.Among PCLs,indeterminate cyst is increasing outstandingly.A trend of decreasing in the number of resections and increasing cancer rates among resected cysts may be attributed to the updated international guidelines.

Analysis of the effect of holmium laser flexible ureteroscopic intrapelvic drainage in the treatment of parapelvic renal cysts

Objective:To explore the efficacy,safety,and feasibility of holmium laser flexible ureteroscopic intrapelvic drainage in the treatment of parapelvic renal cysts.Methods:From September 2012 to February 2019,a total of 18 patients,aged from 28 to 62(meanstandard deviation[SD]:46.50±9.14)years,were diagnosed with parapelvic renal cysts and treated by holmium laser flexible ureteroscopic intrapelvic drainage.There were 10 males and eight females.All of the parapelvic renal cysts were unilateral,and two cases were complicated with pyelolithiasis.The diameters of the cysts ranged from 4.1 cm to 8.2 cm.Results:All the patients completed the operation successfully in one stage without conversion to open surgery;in two cases,it was difficult to find the cysts during the operation,and the localization was completed by B-ultrasound and percutaneous injection of methylene blue.The mean operative time was 33.89(SD:9.68;range:22-54)min,and the mean hospitalization time was 2.67(SD:0.91;range:2-5)days.Three months and 6 months of follow-up were performed after surgery.The cysts disappeared in 13(72%)cases,and the diameter of the cysts in five(28%)cases decreased by more than 50%.Conclusion:Holmium laser flexible ureteroscopic intrapelvic drainage in the treatment of parapelvic renal cysts is simple,safe,and effective,and can be used as the first choice for the treatment of parapelvic renal cysts.

Application of apical negative pressure irrigation in the nonsurgical treatment of radicular cysts:A case report

BACKGROUND Radicular cysts are one of the most common odontogenic cystic lesions found in the jaw.Nonsurgical treatment of large radicular cysts is a topic of ongoing debate,and there is still no clear consensus on the most effective therapies.The apical negative pressure irrigation system aspirates the cystic fluid and releases the static pressure in the radicular cyst,representing a minimally invasive approach for decompression.In this case,the radicular cyst was in close proximity to the mandibular nerve canal.We used nonsurgical endodontic treatment with a homemade apical negative pressure irrigation system and the prognosis was good.CASE SUMMARY A 27-year-old male presented to our Department of General Dentistry with complaints of pain in the mandibular right molar when chewing.The patient had no history of drug allergies or systemic disease.A multidisciplinary management approach was designed and included root canal retreatment with a homemade apical negative pressure irrigation system,deep margin elevation and prosthodontic treatment.According to a 1-year follow-up period,the patient showed a favorable outcome.CONCLUSION This report reveals that nonsurgical treatment with an apical negative pressure irrigation system may provide new insights into the treatment of radicular cysts.

Maternal choledochal cysts in pregnancy:A systematic review of case reports and case series

BACKGROUND Choledochal cysts(CC)are cystic dilatations of the biliary tract,usually diagnosed during childhood,with an estimated incidence in the general population of 1:100000.Complications related to CC include rupture,biliary obstruction,and cholangitis.Maternal CC in pregnancy are rarely reported,and there are no guidelines on optimal management.AIM To systematically review maternal CC diagnosed during pregnancy or postpartum with regard to the clinical presentation of CC,the mode of treatment and delivery,and maternal outcomes.METHODS A literature search of cases and case series of maternal CC in pregnancy and postpartum was conducted using MEDLINE/PubMed,Web of Science,Google Scholar,and Embase.There were no restrictions on language or publication year.Databases were lastly accessed on September 1,2022.RESULTS Overall,71 publications met the inclusion criteria,reporting 97 cases.Eighty-eight cases were diagnosed during pregnancy and nine in the puerperium.The most common symptoms were abdominal pain(81.2%)and jaundice(60.4%).Interventions for CC complications were required in 52.5%of the cases,and 34%of pregnancies were induced.Urgent cesarean section(CS)was done in 24.7%.The maternal mortality was 7.2%,while fetal mortality was inconsistently reported.Cholangitis,CC>15 cm,and bilirubin levels>80 mmol/L were associated with a higher likelihood of urgent CS and surgical intervention for CC.Bilirubin levels positively correlated with CC size.There was no correlation between age and cyst dimension,gestational age at cyst discovery,and CC size.CONCLUSION Although rare,maternal CC in pregnancy should be included in the evaluation of jaundice with upper abdominal pain.Symptomatology and clinical course are variable,and treatment may range from an expectative approach to emergent surgical CC treatment and urgent CS.While most cases were managed by conservative measures or drainage procedures,CC>15 cm and progressive cholangitis carry the risk of CC rupture and septic complications,which may increase the rates of unfavorable maternal and fetal outcomes.Therefore,such cases require specific surgical and obstetric interventions.

Laparoscopic management of hydatid cysts using long ribbon gauze:An initial experience of 37 consecutive cases

Objective:The laparoscopic approach is becoming the standard of care for many surgical disorders.However,in the case of hydatid cysts,laparoscopic management is challenging due to the risk of spillage of hydatid fluid,which can cause an anaphylactic reaction and recurrence.Here,we report our initial experience with laparoscopic partial pericystectomy of hydatid cysts using long ribbon gauze to decrease intra-operative spillage.Method:This was a retrospective study(between January 2010 and December 2021)in the Department of Surgical Gastroenterology,Sanjay Gandhi Postgraduate Institute of Medical Science,a tertiary care referral center in northern India.Here,we have included 37 consecutive patients with hydatid cysts of the liver and spleen.Diagnosis was made by laboratory and imaging findings(abdominal sonography or contrast enhanced CT scans).All patients were managed with laparoscopic partial pericystectomy.Intraoperatively,a betadine-soaked long ribbon gauze,high-pressure suction canula,and an endo-bag were used in all patients.The collected data included patient demography,location,size,and number of cysts,WHO type,operative time,blood loss,postoperative complications,hospital stay and follow-up.Result:In our series,the mean age was 38.4±13.6 years,15(40.5%)were men and 22(59.5%)were women.The right lobe of the liver was the most commonly affected site(21,56.8%).The mean operative time was 80.0±32.0 min,and intraoperative blood loss was 23.6±11.5 mL.Bile leak was present in 6(16.2%)patients.There was no mortality.The hospital stay was 5(3,9)days,and no recurrence was observed at a median follow-up of 36 months.Conclusion:Laparoscopic partial pericystectomy using this technique is safe in the management of hydatid cysts.Simply,proper packing and safe removal of soaked gauzes can minimize the incidence of postoperative complications and recurrence.

Sclerotherapy as a primary or salvage procedure for aneurysmal bone cysts:A single-center experience

BACKGROUND Aneurysmal bone cysts(ABC)are benign cystic bone tumors of an osteolytic and locally aggressive nature.As an alternative to the primary treatment of choice,which consists of curettage with bone grafting,alternative treatment methods with promising results have been described.At our department,we have,in recent years,used percutaneous sclerotherapy with polidocanol.The objective of this study was to identify the healing rate and safety of sclerotherapy with polidocanol.AIM To identify the efficacy and safety of sclerotherapy with polidocanol in primary and recurrent ABC.METHODS Twenty-two consecutive patients(median age 12.5 years;range 1-27)with 23 ABCs treated with sclerotherapy with polidocanol from 2016-2021 were included retrospectively.Eleven patients(48%)had undergone different forms of previous treatment with recurrence.Under general anesthesia and fluoroscopic guidance,repeated percutaneous injections of 4mg polidocanol/kg body weight were performed.Through review of the electronic medical records,the following were identified:healing and recurrence rate,number of treatments,gender,age,comorbidity,location of the tumor and side effects/complications,as well as any previous surgery for ABC.The median length of radiographic follow-up was 19.5 mo.RESULTS All ABCs except one(96%)showed healing or stable disease after a median of 4(range 1-8)injections.Complete clinical and radiographic healing was observed in 16 cysts(70%),while partial radiographic healing with resolution of pain was seen in 6 cases(26%)and considered as stable disease.The cyst that failed to heal had previously undergone curettage twice with recurrence.One patient with a large pelvic ABC experienced,right after two injections,a sudden drop in blood pressure,which could quickly be reversed.One patient with a juxtaphyseal ABC in the femoral neck showed a minor limb length discrepancy because of deformity.Beyond that,no complications were observed.CONCLUSION Percutaneous sclerotherapy with polidocanol appears to be a safe alternative for treatment of aneurysmal bone cysts.In our series of both primary and recurrent cysts,it showed the ability to achieve healing or stable disease in 22 of 23 cases(96%).Further studies are needed to decide if this provides a long-lasting effect.

Treatment of hepatic cysts by B-ultrasound-guided radiofrequency ablation

BACKGROUND: The traditional therapy for hepatic cysts has limited success because of recrudescence. Radiofrequency ablation (RFA) has become popular because of its advantages including little damage, therapeutic effect and reduced suffering. This report describes the effects and reliability of RFA in the treatment of 29 patients with hepatic cysts. METHODS: B-ultrasound-guided REA was used to treat hepatic mono-cyst or multi-cysts of 29 patients (63 tumors). Ablative efficiency and complications were assessed by imaging and clinical symptoms. RESULTS: The tumors were abated completely in 34 cysts with a diameter <5 cm and no recurrence was seen after 3 months. In 21 cysts with a diameter of 5-10 cm, tumor volume was decreased by over 70%, then reduction and fiberosis were found. In 8 cysts with a diameter greater than 10 cm, tumor volume was decreased by more than 60%, and in 2 cysts it was increased more slightly than that at I month after REA. In subsequent follow-up (6 and 12 months after REA), tumors <10 cm in diameter were fully ablated. No significant discomfort and complications were found in any patient. CONCLUSION: RFA for the treatment of hepatic cysts is safe, and free from complications.

Predisposing factors and surgical outcome of complicated liver hydatid cysts

AIM: To evaluate the predisposing factors for peritoneal perforation and intrabiliary rupture and the effects of these complications on surgical outcome in liver hydatid disease.METHODS: A total of 372 patients with liver hydatid cysts who had undergone surgical treatment were evaluated retrospectively. Twenty eight patients with peritoneal perforation, 93 patients with spontaneous intrabiliary perforation, and 251 patients with noncomplicated hydatid cysts were treated in our clinics.RESULTS: When the predisposing factors for complications were evaluated, younger age, superf icial position, and larger cyst dimensions (P < 0.05; range, 0.0010.017) increased peritoneal perforation rates. It was shown that older age increased cyst dimensions, and presence of multiple and bilobar cysts increased intrabiliary rupture rates (P < 0.05; range, 0.0010.028). Partial pericystectomy and drainage was the most frequent surgical procedure in all groups (71.6%). The incidence of postoperative complications in the peritoneal perforated group, in the intrabiliary ruptured group, and in the noncomplicated group was 25%, 16.1% and 5.5%, respectively. When compared, complication rates were significantly different (P = 0.002). When length of hospital stay was compared, there was no signif icant difference between the groups (P > 0.05). The overall recurrence rate was 3.8% (14 patients), but there was not any statistical difference among the patient groups (P = 0.13). The early postoperative mortality rate was 1.1%. CONCLUSION: In peritoneally perforated and intrabiliary ruptured cases, the most important steps are irrigation of the peritoneal cavity and clearance of the cystic material from the biliary tree.

Dinoflagellate cysts in recent marine sediment from Guangxi, China

Total of 33 species of dinoflagellate cysts were discovered from surface sediment in the sea region of Guangxi, among them 12 cyst types (Diplopsalopsis sp. 1, D. sp. 2, D. sp. 3, Cochlodinium sp., Protoperidinium sp. 1, P. sp. 2, P. compressum, Scrippsiella sp. 1, S. sp. 2, Alexandrium sp. 1, A. sp. 2, A. sp. 3) were first reported from the South China Sea. And one cyst type (Cochlodinium sp.) was first reported in the world. Scrippsiella trochoidea is the dominant species in this area, accounting for 45% of all the cysts. There are 2 cysts of toxic dinoflagellate (Alexandrium tamarensis and Gymnodinium catenatum) But there is no relationship between cyst number and grain size distribution.

Abundance and distribution of dinoflagellate cysts in Xiamen Western Harbor

In a grid investigation, dinoflagellate cysts were collected from sediments in Xiamen Western Harbor in May of 2000, from which five species of cysts were identified: Alexandrium tamarensis, A. minutum, Lingulodinium polyedra, Gonyaulax scrippsae and Gymnodinium catenatum, account for about 21% in the species composition. The quanti-tative analysis of the sediments shows that the number of dinoflagellate cysts varies from 51 to 256 cysts/g of sediment, the highest value (>200 cysts/g) being recorded at the stations of the central part of the bay, while the lowest (<100 cysts/g) at the bay mouth. A good linear relationship is found between cyst amount and fine-grained sediments. Complex physiognomies on the seabed, topographty in the bay and weak water exchange are the main factors not only in cyst accumulation but also in their distribution pattern, and have resulted in the difference in cyst densities between the inner bay and the outer bay in the harbor.

Clinical approach to incidental pancreatic cysts

The approach to incidentally noted pancreatic cysts is constantly evolving. While surgical resection is indicated for malignant or higher risk cysts, correctly identifying these highest risk pancreatic cystic lesions remains difficult. Using parameters including cyst size, presence of solid components, and pancreatic duct involvement, the 2012 International Association of Pancreatology(IAP) and the 2015 American Gastroenterological Association(AGA) guidelines have sought to identify the higher risk patients who would benefit from further evaluation using endoscopic ultrasound(EUS). Not only can EUS help further assess the presence of solid component and nodules, but also fine needle aspiration of cyst fluid aids in diagnosis by obtaining cellular, molecular, and genetic data. The impact of new endoscopic innovations with novel methods of direct visualization including confocal endomicroscopy require further validation. This review also highlights the differences between the 2012 IAP and 2015 AGA guidelines, which include the thresholds for sending patients for EUS and surgery and methods, interval, and duration of surveillance for unresected cysts.

Lymphoepithelial cysts and cystic lymphangiomas: Underrecognized benign cystic lesions of the pancreas

AIM: To identify their diagnostic and prognostic clinical characteristics in a large series.METHODS: Retrospective review of clinicopathologic and imaging characteristics of patients diagnosed with lymphoepithelial cysts and cystic lymphangiomas of the pancreas at Massachusetts General Hospital.RESULTS: Twelve patients were identified between 1/1/1997 and 8/1/2007. Their median age was 55.5 years(range 19-78 years), and 6 were females. The le-sion was incidentally discovered in half of the patients.Contrast enhanced computed tomography demonstrat-ed that the cysts had thin walls, without calcifications, pancreatic duct dilation or pancreatic parenchyma inva-sion. Endoscopic ultrasound with fine needle aspiration(EUS/FNA) confirmed the diagnosis of a lymphoepithe-lial cyst in 3 patients, one of whom was spared an op-eration and continues to do well after 6 years. Eleven patients had a resection: 3 pancreaticoduodenecto-mies, 7 distal pancreatectomies, and 1 enucleation. The median size of the cysts was 3 cm(range 2-20 cm). At a median follow-up of 57 mo no recurrences or other pancreas-related conditions occurred.CONCLUSION: Lymphoepithelial cysts and cystic lymphangiomas of the pancreas can be diagnosed with a combination of contrast-enhanced computed tomog-raphy scans and EUS/FNA. If the lesion is asymptom-atic, an operation might be avoided.