Intramucosal cysts of the stomach. VIII: Histochemical studies.

Intramucosal cysts of the human stomach have been earlier classified on the basis of their epithelial lining into 1. fundic, 2. foveolar, 3. pyloric, 4. with intestinal metaplasia and 5. with ciliated metaplasia. Four histochemical methods (high iron diamine (HID)-Alcian blue pH 2.5 (AB), PAS, Concanavalin A (ConA), and Grimelius reaction were used. The cells of foveolar cysts contained neutral mucins and sialomucins, and those of pyloric cysts, neutral mucins, sialomucins, mannose-rich glycoprotein and argyrophilic material. The goblet cells in intestinal metaplastic cysts contained neutral mucins and sialomucins as well as sulphated mucins, while ciliated cells in ciliated metaplastic cysts demonstrated mannose-rich glycoproteins and argyrophilic material (although some ciliated cells were negative for both). The cells of fundic gland cysts were negative for all tested methods. The frequency of intramucosal gastric cysts is known to be high in stomachs having adenocarcinoma, and low in stomachs with peptic ulcers. Several reports have demonstrated alterations in the composition of gastric mucins in stomachs harbouring an adenocarcinoma. Consequently, the histochemical stains may prove of value to investigate the true significance of intramucosal cysts in gastric carcinogenesis.

In vitro magnetic resonance properties of CNS neoplasms and associated cysts.

Fresh surgical specimens of central nervous system (CNS) neoplasms were analyzed with particular attention to differences between the T1 and T2 values of the solid and cystic components. Delineation of solid tumor from cyst is important, particularly when surgical intervention is planned, since only the solid portion need be excised. Total protein concentration determinations and microimmunoelectrophoresis for protein distribution and characterization also were performed on the fluid specimens. To diagnose a lesion on magnetic resonance based on T1 and T2 measurements, one must first have a catalog of values on which to base that diagnosis. The authors are reporting such values at 0.25 T. In addition, protein analysis of the fluid specimens has shown that the cysts of the CNS associated with CNS neoplasms are, in fact, transudates rather than collections of cerebrospinal fluid (CSF). Their T1 should permit differentiation from solid portions of neoplasms and from non-neoplastic syringohydromyelia.

Estradiol and progesterone nuclear and cytosol receptors of hydrosalpinx.

Hydrosalpinx is usually associated with a low intrauterine pregnancy rate following restoration of tubal patency by microsurgery. The biochemical evaluation of pathologic tubes from 11 infertile patients showed the presence of estradiol (E2) and progesterone (P) receptors at the cytosol and nuclear levels. The binding constants (Kd) for these specific proteins for E2 and Promegestone (R5020) were of the same magnitude as observed in normal tissue. Mean levels of E2 cytosolic and nuclear receptors and cytosolic P receptors of hydrosalpinx were significantly lower than those of a normal fallopian tube (P less than 0.05). No correlation between the severity of the histologic appearance of the tissue and the subcellular distribution of receptors was observed. We conclude that the decrease in the steroid receptor population of these damaged tubes could be counted as another factor to be considered in the poor intrauterine rate of the salpingoneostomy.

Follicular and luteal cysts after treatment with gonadotropin-releasing hormone analog for in vitro fertilization.

Ovarian cysts are a common complication of GnRH-a administration. We followed 98 patients who were suppressed with GnRH-a before ovarian stimulation with hMG for IVF treatment. Approximately 20% of the patients receiving GnRH-a during the follicular or luteal phase had developed ovarian cysts. However, the number of cysts per patient was significantly higher in the follicular phase compared with luteal phase. Systematic aspiration of those cysts under local anesthesia permitted the start of ovarian stimulation with hMG as scheduled on day 16 after GnRH-a administration. Follicular fluid content of the cysts revealed similar levels of steroids to those in normal follicles. These cysts contained few cells and no egg. In vitro fertilization treatment was more successful in patients whose cysts were aspirated during the luteal phase than in those with cysts during the follicular phase. We concluded that luteal phase cysts are more benign than follicular phase cysts, and it is possible that they represent an enlargement of pre-existing corpora lutea.

Distribution of growth hormone and thyroid-stimulating hormone in cerebrospinal fluid and pathological compartments of the central nervous system.

Human growth hormone (HGH) radio-immunoassay (RIA) was adapted for an accurate measurement of immunoreactive HGH concentrations in the CSF in different cases of hypothalamic-somatotropin dysfunctions. In control subjects (n = 43) mean HGH levels were 0.35 +/- 0.03 ng/ml in CSF and 1.95 +/- 0.2 ng/ml in plasma with a CSF/plasma ratio of 17%. The thyroid-stimulating hormone (TSH) RIA gave in controls mean basal levels of 2.65 +/- 0.2 muU/ml in CSF and 5.95 +/- 0.3 muU/ml in plasma with a CSF/plasma ratio of 44%. HGH and TSH concentrations in CSF and plasma show a very good correlation; but the regression curves for both hormones are distinctly different and appear specific for each polypeptide hormone. Hypothalamic-somatotropin hyperreactivity was reported in diabetic retinopathy (DR). CSF and plasma HGH concentrations in a group of diabetic patients with progressing retinopathy (n = 27) were not different from those in normal subjects (respectively 0.35 +/- 0.05 in CSF and 2.10 +/- 0.25 ng/ml in plasma with a CSF/plasma ratio of 16%). The HGH regression curve obtained in diabetics is similar to that of controls. These data do not substantiate the hypothesis of an HGH hyperreactivity in diabetic retinopathy. In somatotropin hypersecretion (acromegaly) without adenoma suprasellar extension, higher HGH concentrations recorded in CSF than in plasma cannot be attributed to an anatomical break-down of the CSF blood-brain barrier and suggest an active transport process of pituitary hormones to the CNS. HGH and TSH concentrations were measured in the cystic fluid of CNS tumors. In 1 case of a cystic dysembryoma, the HGH and TSH of CF were considerably increased. In gliomas (n = 8) the HGH and TSH cystic fluid concentrations were more elevated (respectively 0.72 +/- 0.2 ng/ml and 3.6 +/- 0.7 muU/ml) than in the CSF of controls.

Electron density and atomic number determination by computed tomography. Part I: Methods and limitations. Part II: A study of colloid cysts.

The feasibility of extracting electron density and effective atomic number from measurements of tissue in vitro and in vivo has previously been reported. The method requires scans to be obtained at two different beam energies. Optimization of these energies at 40 keV and 80 keV could enable a variation of 1 part in 400 of effective atomic number to be detected. The method is subject to certain limitations related to accuracy and sensitivity. The effect of varying the concentrations of certain atoms has been modelled demonstrating the limits below which variation in effective atomic number is unlikely to be detectable at acceptable radiation doses. A series of 12 patients with colloid cysts has been considered. All were treated by bilateral ventriculo-cisternostomy from one to 23 years ago. Nine of these patients, and the colloid cyst of one patient who died before treatment could be instituted, have been subjected to double energy scanning. The results suggest that the high attenuation values observed in colloid cysts are due to increased electron density and not to any increase in high atomic number elements. The cysts do not appear to change in size or content over long periods.

Symptomatic neuroepithelial cysts in the posterior cranial fossa. Immunohistochemical and electron-microscopic studies.

A 2-year-old boy had increased intracranial pressure and convulsions because of two extraventricular cysts in the posterior cranial fossa. Releasing the watery cyst contents resulted in disappearance of such clinical manifestations. Immunohistochemically, the epithelial cytoplasm of the cyst was strongly positive for glial fibrillary acidic protein. Electron-microscopically, the cells that lined the cysts had microvilli which were coated with finely granular material to represent "fuzzy" coat, intercellular junctions linking the plasma membranes of adjacent cells, and numerous cytoplasmic glial filaments. The strong positivity for glial fibrillary acidic protein, then, is well correlated with an abundance of the latter. Cilia were also identified. Thus, the cysts were unequivocally neuroepithelial (ependymal) cysts. Only nine cases of neuroepithelial cysts in the posterior cranial fossa, including the current one, have been reported. Three patients were children; six were adults. The age of the patients ranged from 7 months to 60 years. The average age was 21.7 years The sex was known in eight patients with a male to female ratio of 3:5. The pathogenesis of these neuroepithelial cysts was proposed as related to developmental anomalies.

Biliary manometry in choledochal cyst with abnormal choledochopancreatico ductal junction.

Intraoperative manometry of the biliary tract and measurement of amylase levels in choledochal cysts were performed in seven patients, aged 14 months to 5 years, with choledochal cysts, in an investigation of the pathophysiology of the biliary tract. An abnormal choledochopancreatico ductal junction was observed in these seven patients by preoperative endoscopic retrograde cholangiopancreaticography (ERCP) or intraoperative cholangiograms. All six patients examined showed a high amylase level in the choledochal cyst (5,450 to 46,500 Somogyi Units). The intraoperative manometry of the biliary tract showed that a remarkable high pressure zone as was found in the area of sphincter of Oddi was not found in the area of abnormal choledochopancreatico ductal junction. The pressure recordings also demonstrated that the sphincter of Oddi pressure in the patient with choledochal cyst was increased by gastrin stimulation. On the contrary, no pressure reaction to gastrin or secretin was found in the area of abnormal choledochopancreatic ductal junction. From these results it seems that free reflux of pancreatic juice into the biliary system occurs, and the reflux stream depends upon the pressure gradient between pancreatic ductal pressure and common bile duct pressure because of the lack of a sphincter function at the choledochopancreatico ductal junction.

[Lipid analysis in jaw cysts]. / Lipiduntersuchungen bei Kieferzysten.

In patients with jaw cysts, cyst content and blood serum are examined by means of thin section chromatography with regard to their contents of cholesterol, free fatty acids, triglycerides and cholesterol esters. The increase in lipid content found in the cyst is primarily due to the increase in free cholesterol. Since the serum values are within normal ranges, it is unlikely that cysts are the result of endogenous causes. Our examinations showed that they are primarily due to local processes.

Recurrent parathyroid cystic disease.

Cystic masses of the neck may represent thyroid, parathyroid, thyroglossal duct or branchial cleft cysts. Analysis of the cyst fluid may establish the etiology. Elevated levels of parathyroid hormone can be found in parathyroid cysts without concomitant hyperparathyroidism. A high concentration of cholesterol without the finding of thyroglobulin or parathyroid hormone in the fluid aspirated from a lateral neck mass suggests a branchial cleft cyst.

Electrolytes of breast-cyst fluid.

We constructed an electrolyte balance sheet for 11 individual specimens and two pooled specimens of breast-cyst fluid. Na+ and K+ ranged in concentrations from those representative of extracellular fluids (147 and 9 mmol/L, respectively) to those of intracellular fluid or a high K+ secretion (23 and 168 mmol/L, respectively). Cl- concentrations ranged from 9 to 98 mmol/L (mean, 31), bicarbonate concentrations from 0 to 34 mmol/L (mean, 16). Ca2+ concentrations did not exceed 2.1 mmol/L. Total protein ranged from 14.7 to 35.8 gL. Fluid osmolality ranged from 249 to 300 mOsm/kg of water (mean, 280). The difference between measured cations and anions indicates an "anion gap" of 140 mmol/L, which must be carried by 46 mOsm/kg of water. We suggest that tricarboxylic acids of the Krebs cycle may account for the missing trivalent anions.

Characterization of neutrophil alkaline phosphatase-inducing factor (NAP-IF).

A factor, termed neutrophil alkaline phosphatase-inducing factor (NAP-IF), that has the capacity to increase the NAP activity of granulocytes was characterized by using two samples: cystic fluid (CF) and conditioned medium of a tumor cell line (T3M5). The molecular weight of NAP-IF was shown to be between 13,000 and 45,000, and its isoelectric point was between 5.5 and 6.2. It was sensitive to heat and proteolytic enzymes, but was resistant to DNase and RNase, suggesting that NAP-IF is an acidic protein or glycoprotein. These characteristics of NAP-IF seem to be similar to those of granulocyte-macrophage colony-stimulating factor (GM-CSF) that is also present in the CF. NAP-IF rich fractions obtained by isoelectric focusing from CF were also found to be rich in a subclass of GM-CSF: granulocyte-CSF (G-CSF). Furthermore, a high correlation was noted between the activities of G-CSF and NAP-IF (gamma = 0.798, P less than 0.005). These results suggest that the two activities, i.e., G-CSF and NAP-IF, may be attributable to an identical macromolecule.

Eleven cases of nonfunctioning parathyroid cyst--significance of needle aspiration in diagnosis and management.

Eleven cases of nonfunctioning parathyroid cyst are reported. Ultrasonography revealed the cystic nature of the asymptomatic lump in the neck. Clear watery fluid obtained by needle aspiration and the increased parathyroid hormone concentration in the fluid established the diagnosis. Five patients, in four of whom the cysts reappeared after one (3 cases) or seven (1 case) needle aspirations, underwent surgical resection of the cysts. Six other patients were followed conservatively after the aspiration maneuver. In four patients with enough follow-up time for evaluation, the cyst fluid has not reaccumulated 5, 2 and 2 years after only one aspiration, and 1 year after two aspirations. In one patient, the cyst reappeared 9 months after the initial aspiration. Simple percutaneous aspiration may be curative in some cases of nonfunctioning parathyroid cysts.

Pigmented follicular cysts.

This report deals with seven examples of an epithelial cyst for which we have found no proper designation in the classification of epithelial skin cysts. Clinically, the lesion is often hyperpigmented, located in mid-dermis and shows epidermoid keratinization. The cyst contains laminated keratin, many pigmented hair shafts and the cyst wall displays one or two growing hair follicles.

Unilateral galactocoele in a male infant.

An otherwise healthy 1 1/2-year-old boy slowly developed a marked enlargement of his right breast during several months. The lesion was soft, round, fluctuant and translucent. Aspiration revealed the presence of a milk-like fluid. Surgical extirpation was performed. Histologically the cyst showed areas of actively secreting acinar mammary cells.

Macropuncture study of polycystic disease in adult human kidneys.

Solute composition, volume, and hydrostatic pressure were measured in cysts from eight patients with the adult form of polycystic kidney disease (PCKD). Five azotemic patients had elective nephrectomies in preparation for renal transplantation, two nonazotemic patients had their polycystic kidneys removed several weeks after a successful renal allograft, and one nonazotemic cadaver was inadvertently nephrectomized as a potential kidney donor. In all patients, the pattern of solute concentrations in cyst fluid segregated into two principal groups: Proximal cysts had sodium, potassium, chloride, hydrogen ion, creatinine, and urea values virtually equal to their respective sera, whereas distal cysts had sodium and chloride concentrations lower and potassium, hydrogen ion, creatinine, and urea concentrations greater than serum. In the two subjects who received renal allografts and were not azotemic, creatinine and urea concentrations in the proximal cysts reflected nonazotemic values, indicating redistribution of these solutes across proximal cyst walls after the extracellular fluid was normalized. By contrast, distal cysts maintained steep concentration gradients for creatinine and urea. Transmural hydrostatic pressures were similar in proximal and distal cysts and were not different from normal intratubular pressures. These studies provide strong support for the view that cysts are massively enlarged segments of nephrons and collecting tubules that qualitatively maintain their basic solute transport functions throughout the life of the patient.