Management of nonparasitic hepatic cysts

We congratulate Mazza and colleagues for a comprehensive article on their 17-year experience treating nonparasitichepaticcysts (NPHC). Although some mention was made of malignant cystic neoplasms in their reference to the use of tumor markers in the diagnostic workup, as well as the radiologic appearance of irregular, thickened cystic walls, we feel that this important component of cystic hepatic lesions was not sufficiently emphasized. After all, the title of the article is "Management of NPHC," and the consequence of missing a malignant lesion can be catastrophic. Intrahepatic biliary cystadenoma (IBCA) is one of the most common premalignant cystic hepatic lesions, accounting for approximately 5% of all symptomatic cystic lesions. The typical ultrasonographic feature of an IBCA is that of a solitary, multiloculated cyst; whereas the computed tomography scan appearance reveals thin, internal septae. Magnetic resonance imaging shows gadolinium enhancement of the septae. Elevated levels of CA 19-9 in the cystic fluid has also been shown to differentiate between benign and malignant lesions. It would therefore be quite interesting to know the radiologic features of the 7 patients diagnosed with cystic neoplasms by Dr Mazza and his team and what specific measures they would recommend to exclude malignancy prior to embarking on definitive management.

Management of Hepatic cysts by percutaneous drainage and instillation of tetracycline hydrochloride

This paper reports two cases of benign hepatic cysts successfully treated by the instillation of tetracycline hydrochloride. The patients presented with solitary large symptomic hepatic cysts and underwent ultrasound guided needle aspiration followed by the instillation of tetracycline hydrochloride. The cyst size diminished without complication and the patients have remained symptom free. We review the treatment of this uncommon entity and propose that injection of tetracycline hydrochloride is an effective non-operative treatment of symptomatic solitary hepatic cysts. (AU)

Splenic cysts - a Jamaican experience

A total of eleven (11) cases of non-parasitic splenic cysts have been studied at the University Hospital of the West Indies by routine haematoxylin and eosine and immunohistochemical staining, using epithelial markers (cytokeratin, low molecular weight keratin and epithelial membrane antigen). The majority (eight of eleven) were found to epithelial or true cysts. This is in contrast to findings previously reported in the literature, based on light microscopic examination, that the majority of splenic cysts are non-epithelial in origin. We therefore suggest that immunohistochemical studies should be used routinely to accurately define the nature of all splenic cysts. (AU)

Congenital solitary non-parasitic cyst of the liver

Although non-parasitic cysts of the liver have often been described in adults, solitary non-parasitic cysts are rare in infants. We report a 17-month-old child with a large hepatic cyst(AU)

Omental cyst masquerading as ascites

This report describes a three-year-old girl with an omental cyst masquerading as ascites. A review of the literature has shown that large omental cysts are frequently misdiagnosed as ascites. Ultrasonography is a valuable aid in the diagnosis (AU)

Thymic cyst of the neck

A case of cervical thymic cyst in a 16-year old male is described. The lesion is quite rare and was seen for the first time at the University Hospital of the West Indies. The literature has been reviewed and the embryology and pathogtenesis of the condition have been discussed. A pre-operative diagnosis of thymic cyst in the neck is difficult and should be included in the differential diagnosis of swellings in the neck (AU)

Extradural spinal arachnoidal cyst

A case of congenital extradural spinal archnoidal cyst is reported. This is a rare cause of spinal cord compression and usually presents in adolescence with symptoms of progressive spastic paraparesis. Both spine and prone myelography is recommended in order to demonstrate possible filling and emptying of the cyst with alteration in posture. Surgical removal is associated with a favourable outcome (AU)

Endometrial stromal sarcoma of the broad ligament arising in an area of endometriosis in a paramesonephric cyst: case report

A 63-year-old Jamaican negress had an endometrial stromal sarcoma arising in a paramesonephric cyst of the broad ligament. Morphological evidence is presented to show that the tumor arose from an area of endometriosis within the cyst wall. Subsequent metastases responded for a few months to cyclophosphamide therapy and the patient died 14 months after the onset of symptoms. (Au)

Uterine leiomyoma: incidence of degenerative change and a correlation of associated symptoms

A clinical and pathologic study of 298 patients with uterine leiomyomas revealed no significant relationship between the presenting symptoms and degenerative changes in the tumors. Some form of degeneration was demonstrated in 65 percent of specimens. Hyaline degeneration occurred most frequently, accounting for 63 percent of all types of degeneration. Sarcomatous change occurred in two tumors, giving a corrected incidence of 0.37 percent.(AU)

Cysts of the spleen

Cysts of the spleen are rare and a case recently encountered in a patient with antecedant malaria is recorded. Details of classification, pathogenesis and diagnosis are reviewed. It has been emphasized that the majority of secondary cysts of the spleen are the result of intraparentymatous haemorrhage. An attempt has been made to correlate the factors responsible for cysts with spontaneous rupture of the spleen, with particular emphasis on the role played by malaria. (AU)