Congenital cystic adenomatoid malformation: a rare serial case report

Congenital cystic adenomatoid malformation (CCAM) is a rare congenital lung malformation which a part of the lung becomes polycystic. CCAM accounts for 25% of congenital lung malformations and 95% of lung lesions. Case 1 was a 5-month-old female infant who was diagnosed with pneumothorax, with multiple cysts in the right lung, using chest computed tomography (CT). Thoracotomy lung resection was performed. Case 2 was one-day-old newborn infant who had respiratory distress with Downe score 3. Multiple cystic lesions with septations in left lung was observed on chest CT. Lobectomy inferior lobes of left lung was performed. Both patients were diagnosed as CCAM type 1 pathologically. CCAM can be detected in the gestation by ultrasonography or after delivery through the appearance of respiratory distress signs.

Two rare cases of cystic angiomatosis and a literature review

Cystic angiomatosis is a rare disease characterized by disseminated multifocal hemangiomatous and/or lymphangiomatous cystic lesions of the skeleton with possible visceral organ involvement. Only a few dozens of such patients worldwide have been described in the literature. This article presents two case reports of the patients admitted to the D. Rogachev NRMCPHOI with suspected Langerhans cell histiocytosis. The patient’s parents gave their consent to the use of their child’s data, including photographs, for research purposes and in publications. During the investigation, multiple cysts of the skull bones, spine, pelvic bones and limbs, as well as of the spleen were found in both patients. A biopsy of the bone cysts of the skull revealed no data in favor of histiocytosis or other neoplasms. Cystic angiomatosis was diagnosed in both cases. This is a rare disease that should be kept in mind in the differential diagnosis in patients with cystic lesions of the bones and visceral organs.

A Rare Case of Facial Multiple Epidermal Cysts: Successfully Treated by Surgical Excision

Background Epidermal cysts are common skin tumors that are composed of a keratinocytic cyst wall and central keratin material, which can occur anywhere in the body, especially on the face. However, there are no relevant reports of multiple epidermal cysts coexisting at the same location.Case presentation Here, we report one rare case of facial multiple epidermal cysts, who underwent sequential resection of all cysts. A 45-year-old male presented with facial multiple masses for over 2 years. Physical examination showed multiple cysts with varied sizes on the face. All cysts were smooth, dome-shaped, freely movable, and some of them were attached to the skin by a central pore. The histopathology revealed cysts in the dermis, the wall of which were composed of stratified squamous epithelium, and the cavity were filled with keratin. Therefore, the patient was diagnosed as facial multiple epidermal cysts.Conclusions This is the first well-documented case of multiple epidermal cysts on the face. We report this rare case to highlight that although epidermal cysts usually appear single, they may also appear multiple in the same location, especially in those patients with vigorous sebaceous gland function. Surgical excision is the first-line effective treatment for epidermal cysts.

Tarlov cysts in back pain patients: prevalence, measurement method and reporting points

Objective: Determining the prevalence of Tarlov cysts in low back pain patients. Methods and materials: The picture archiving & communication system (PACS) & hospital information system (HIS) of a corporate hospital were retrospectively analyzed to determine the percentage of Tarlov cysts among patients undergoing spinal MRI for back pain over 3 years (January 2017 to December 2019). Results: 384 patients had undergone spinal MRI for back pain over the study period, and 25 of them (6.51%) had Tarlov cysts. Vast majority (15 cases) showed cysts located at S2/S3 level, and few were found at S1/S2 and other levels. Single cysts were found in most (=18) of the cases, while 7 cases of multiple / bilateral cysts were found. Cyst dimensions were higher in craniocaudal than anteroposterior or transverse directions. In case of multiple cysts, one or two cysts were noted as dominant, having higher dimensions than the others. The study data revealed no gender or age predilection. Conclusions: We conclude that including the entire sacrum with a T2 sagittal sequence in all MRI for low back pain can increase detection of Tarlov cysts, and thereby provide more data for further analysis. Advances in knowledge: We propose the concept of one “dominant” cyst when there are multiple Tarlov cysts. We recommend that diameter or size of Tarlov cysts be specified to their craniocaudal dimension. We also suggest reporting points for contextual structured reporting, viz. presence or absence of bony scalloping, neural foraminal narrowing, nerve root compression or extraforaminal extension.

Giant pulmonary hydatid cyst in children

Hydatid disease is still endemic in Tunisia. It is mostly seen in young people less than 40 years and children are affected in one third of cases. The lungs are the predominant location in children. Our study aims to define the particularities of children PHC's (pulmonary hydatic cyst) management, the characteristics of giant cyst and to study predictive factors of complications. We included retrospectively 105 children with PHC followed between 1999 and 2019. Patients were aged less than 16 years with surgically confirmed diagnosis of PHC. Two groups of cysts were defined: giant cysts which were 10 cm across or more, and no giant cysts.The sex-ratio was 1,38 with a mean age of 10.5±3 years. The symptomatology was dominated by cough (59%), thoracic pain (51%) and hemoptysis (46%). Giant cysts were observed in 24 (22.9%) patients. Dyspnea (29% vs 5% p<0.001) and thoracic pain (88% vs .41% p<0.001) were significantly more frequently reported in giant cysts. Eighty-six patients had a single cyst (83%) and 19 had multiple cysts (17%). Giant cysts accounted for 22,9% (24 cases). Thoracic ultrasonography was diagnostic in 77.4%. The thoracic CT scan was performed in 27 children with inaccessible cysts in thoracic ultrasonography or in diagnostic doubt.Patients were all treated surgically. Surgical procedures consisted of cystectomy (59%), pericystectomy (18%) and pulmonary resection when parenchyma was destroyed (23%). Parenchymal resection was more often performed in complicated cysts (27% vs 20% p>0.05) and in giant cysts (41% vs 18% p<0.05). A two-stage thoracotomy was performed in the 4 patients with bilateral cysts. Thirteen patients presented immediate post-operative complications which occurred more frequently in complicated and giant cysts. Hospital stay was longer in complicated cysts (16±9 days vs 7±3 days; p<0.001) and in giant cysts (14±9 days vs 11±8 days; p>0.05). In endemic regions, the diagnosis of PHC in children should be based on the combination of thoracic radiography and ultrasonography which are effective, not costly, safe and accessible. Complicated and giant PHC cause lung damage leading to extensive parenchymal resection. They are more associated with post-operative complications prolonging hospital stay and increasing expenses.

Squamous metaplasia of the rete ovarii do not suppress ovarian cyclicity and pregnancy in cattle: case report

ABSTRACT Squamous metaplasia of the rete ovarii is an ovarian pathologic change characterized by replacement of the normal single layered cuboidal epithelium of the rete ovarii by a stratified squamous keratinized epithelium. Uterus and ovaries from a local slaughterhouse pregnant crossbreed cow were evaluated through ultrasound, macroscopically and histologically. Grossly, there were multiple cysts in both ovaries, which were histologically characterized as rete ovarii cysts with squamous metaplasia and intraluminal accumulation of keratinized material. Squamous metaplasia of the rete ovarii has been previously reported in cows, however this is the first report of this condition in a pregnant animal, demonstrating that this ovarian change is compatible with pregnancy.

Mediastinal hydatidosis with an unusual presentation

Hydatidosis is a common zoonotic disease with high prevalence in developing countries. While solitary cyst with unilateral lung involvement is common, bilateral involvement and multiple cysts are rare, seen in 20% and 30% of the cases. Likewise, extensive involvement of extrapulmonary tissues and mediastinum is rare. We report an unusual case of mediastinal hydatidosis mimicking an intrathoracic malignancy in a 24-year-old female. She presented with a history of left-sided chest pain and heaviness in the left hemithorax for a period of two months. Diffuse, multiple fluid-filled cystic lesion with internal echoes throughout the mediastinum, lung, pericardium, diaphragm and chestwall were observed in contrast-enhanced computed tomography of the thorax. An incidental cystic lesion in liver was noted. Since serology for echinococcosis was negative, a differential diagnosis of intrathoracic malignancy was considered. However, intraoperative and histopathologic findings were suggestive of hydatidosis. Keywords: Hydatid cyst; intrathoracic malignancy; computed tomography; magnetic resonance imaging; mediastinum

To Evaluate the Outcome of Epididymal Cystectomy at Liaquat Medical College Hospital Jamshoro Pakistan

Introduction: Epididymal cystectomy is the procedure in which removal of cyst attached to epididymis is done. The cyst contains cleat/straw colored fluid. It is excised because of its increasing size causing discomfort or pain to patient. Methodology: A Cross sectional observational study was conducted at Surgical Unit 1, Department of of Surgery LMC Hospital Jamshoro from January 2020 to January 2021. All the patients were admitted through Surgical OPD (SOPD) with cystic swellings in scrotum. History and clinical examination of inguino-scrotal region was done. Transillimination test was also done. Ultrasound was obtained to confirm the diagnosis, number of cysts, sizes and site of cyst. Hydrocele, spermatocele and testicular malignancies were ruled out through investigations. Surgery was planned after getting cardiac and anesthesia fitness. The surgery was done. Patients were shifted to ward and assessed for 3 to 5 days. Patient was called for follow up for 6 months. Results were analyzed using statistical package for social sciences (SPSS) version 23. Results: Total patients included in our study are 49.32 (65%) patients had solitary cyst and 17 (35%) had multiple cysts. 30 (61.2%) patients had left sided epididymal cysts and 19 (38.7%) had right sided cysts. Hematoma was developed by 6.1%, chronic pain by 12.2%, infection by 8.1%, scrotal edema by 10.2% and recurrence by 6.1% patients. Conclusion: Epididymal cystectomy is the procedure with better outcome and least complications rate.

Localized Aortic Dissection in a Patient with Polycystic Kidney Disease: A Case Report

Aortic dissection (AD) is the most frequent life-threatening aortic disorder. It is commonly associated with hypertension; however, aortic dissection occasionally represents a complication of more complex syndromes. In this article we aim to report. A 40-year-old male patient, with a known case of ADPKD and a strong family history of ADPKD. He presented to the emergency department with prolonged sharp retrosternal chest pain radiating to the back and uncontrolled hypertension. Computed tomography angiography showed a localized dissection flap at the aortic root and multiple cysts in the right kidney. AD is a life-threatening condition and should be suspected in patients presenting with acute chest pain with history of ADPKD.