Are Hygromas and Hydrocephalus After Decompressive Craniectomy Caused by Impaired Brain Pulsatility, Cerebrospinal Fluid Hydrodynamics, and Glymphatic Drainage? Literature Overview and Illustrative Cases.

BACKGROUND: Poorly understood cranial fluid accumulations are frequently observed after decompressive craniectomy and often termed "external hydrocephalus." These findings are difficult to explain using traditional models of hydrocephalus. METHODS: Representative cases, clinical management, and literature overview are presented. RESULTS: We present a hypothesis that abnormal cranial fluid accumulations develop after decompressive craniectomy in a vulnerable subset of patients as a result of 1) the large compliant cranial defect with durotomy causing reduced internal brain expansion, ventricular squeezing, and pulsatile cerebrospinal fluid (CSF) circulation; 2) impaired pulsatile CSF flow along major cerebral arteries and the adjoining perivascular spaces (Virchow-Robin spaces); 3) reduced clearance of interstitial fluid by the glymphatic system; and 4) redistribution of CSF from the subarachnoid space into the subdural and subgaleal compartments and the ventricles. CONCLUSION: Closure of the cranial defect with cranioplasty improves cerebral blood flow and CSF pulsatile circulation and is frequently sufficient to resolve the external hydrocephalus.

Cystic lymphangioma of pancreas: A rare case report and review of the literature.

RATIONALE: Lymphangiomas are benign lymphatic malformations that mostly occur in the neck and axillary regions. Abdominal lymphangioma is a rare type of this tumor, and pancreatic lymphangioma accounts for less than 1% of all lymphangiomas. In this report, we firstly reveal the application of ultrasound-guided puncture drainage combined with cell morphological examination for the diagnosis of pancreatic lymphangioma. PATIENT CONCERNS: A 35-year-old male patient was admitted to our hospital with recurrent abdominal pain and general weakness for 1 week. From abdominal ultrasound (US) showed that a large cystic lesion occupied the abdomen, about 30.0cm×25.0cm, leading to suspicion of lymphatic cyst. Computed tomography (CT) was performed for further diagnosis and staging. DIAGNOSES: According to pathological findings in combination with immunohistochemical features, pancreatic lymphangioma was made. INTERVENTIONS: To relieve symptoms of discomfort in the patient, distal pancreatectomy and splenectomy was carried out 1 week after the CT scan. OUTCOMES: The patient recovered to normal status within 19 days after surgery. LESSONS: The abdominal cystic lymphangiomas are difficult to be differential diagnosed from other cystic lesions. And the origin of the tumor is also hard to be detected before operation. We should combine image and pathological examination to clarify a diagnosis. Although lymphangiomas are benign tumours, they can encroach on adjacent organs and grow to an enormous size and that, resection of these invaded organs may be required for a complete excision.

Predicting the intrauterine fetal death of fetuses with cystic hygroma in early pregnancy.

We investigated whether it was possible to predict the prognosis of fetuses with cystic hygroma in early pregnancy based on the degree of neck thickening. We retrospectively analyzed 57 singleton pregnancies with fetuses with cystic hygroma who were examined before the 22nd week of pregnancy. The fetuses were categorized according to the outcome, structural abnormalities at birth, and chromosomal abnormalities. Here, we proposed a new sonographic predictor with which we assessed neck thickening by dividing the width of the neck thickening by the biparietal diameter, which is expressed as the cystic hygroma width/biparietal diameter ratio. The median cystic hygroma width/biparietal diameter ratio in the intrauterine fetal death group (0.51) was significantly higher than that in the live birth group (0.27). No significant difference in the median cystic hygroma width/biparietal diameter ratio was found between the structural abnormalities group at birth and the no structural abnormalities group, and no significant difference in the median cystic hygroma width/biparietal diameter ratio was found between the chromosomal abnormality group and the no chromosomal abnormality group. We used receiver operating characteristic analysis to evaluate the cystic hygroma width/biparietal diameter ratio to predict intrauterine fetal death. When the cystic hygroma width/biparietal diameter ratio cut-off value was 0.5, intrauterine fetal death could be predicted with a sensitivity of 52.9% and a specificity of 100%. It is possible to predict intrauterine fetal death in fetuses with cystic hygroma in early pregnancy if cystic hygroma width/biparietal diameter ratio is measured. However, even if cystic hygroma width/biparietal diameter ratio is measured, predicting the presence or absence of a structural abnormality at birth or a chromosomal abnormality is difficult.

Endometriosis extrapélvica asociada a hernia crural incarcerada / Extrapelvic endometrisosis presenting as a incarceraced crural hernia

La endometriosis es una enfermedad que afecta a la mujer en edad fértil. La endometriosis pélvica es mucho más frecuente que la extrapélvica y generalmente está asociada a una cicatriz de una intervención quirúrgica ginecológica, mientras que la endometriosis asociada a una hernia inguinocrural constituye un evento excepcional. Presentamos el caso de una paciente mujer de 38 años de edad, que consultó por presentar una tumoración dolorosa en la región inguinocrural derecha. La resonancia magnética mostró una lesión sugestiva de linfagioma quístico. En la intervención quirúrgica se encontró una tumoración asociada a una hernia crural incancerada. Tras la extirpación radical de la lesión se realizó la reparación de la hernia. El estudio histológico mostró una tumoración endometrial. Tras 6 meses de seguimiento la paciente está libre de enfermedad. Se discuten los aspectos relacionados con las manifestaciones clínicas, el diagnóstico, el tratamiento y el diagnóstico diferencial de esta patología

Endometriosis is a disease that affects women of childbearing age. Pelvic endometriosis is much more common than Extrapelvic and is usually associated with a scar gynecological surgery, while endometriosis associated with groin hernias is an exceptional event. We report a 38-year-old woman, who consulted for a right painful groin lump. The MRI showed a lesion suggestive of cystic lymphangioma. At surgery a cystic tumor associated with incarcerated femoral hernia was found. After radical excision of the tumor hernia repair was performed. Histological study showed an endometrial tumor. After 6 months follow-up the patient is free of disease. Clinical manifestations, diagnosis, treatment and differential diagnosis of this condition are discussed

Cystic adrenal lymphangioma--report of two cases and review of the literature.

Cystic adrenal lymphangiomas are very rare, benign vascular lesions. They are usually found during a work up for abdominal pain or incidentally during imaging studies for an unrelated cause. We report two cases of cystic adrenal lymphangiomas. They presented with flank discomfort, hypertension and flushing. Their laboratory findings were in normal limits. Radiologic imagings showed adrenal cystic neoplasm and the patients underwent adrenelectomy. Histopathologic examination and immunohistochemical findings were consistent with lymphangioma. Cystic lymphangiomas may imitate other adrenal neoplasms and must be kept in mind in the clinical and radiologic differential diagnosis of cystic adrenal lesions.

Linfangioma quístico mesentérico: a propósito de un caso de abdomen agudo / Mesenteric cystic lymphangioma: a case report presenting with acute abdomen

Los linfagiomas mesentéricos, en ocasiones asintomáticos, pueden presentarse como un hallazgo incidental en pruebas de imagen realizadas por otro motivo. El tumor también puede ser descubierto por sus complicaciones al comprimir estructuras vecinas, con signos inespecíficos de distensión abdominal o datos de abdomen agudo y obstrucción intestinal. Presentamos el caso de una niña de seis años de edad con clínica de abdomen agudo, compatible con cuadro de apendicitis aguda que no se descarta tras la realización de las pruebas de imagen. La laparotomía evidencia una malformación linfática intestinal con confirmación anatomopatológica de linfagioma quístico mesentérico (AU)

Mesenteric lymphangioma, sometimes asymptomatic, may course as an incidental finding on imaging performed for another reason. Sometimes the tumour is discovered because of its complications, by compressing neighbouring structures, with nonspecific signs of bloating or data of acute abdomen and obstruction. We report a 6 year old girl with symptoms of acute abdomen, resembling acute appendicitis not discarded with imaging tests. The laparotomy shows an intestinal lymphatic malformation with anatomo-pathological confirmation of cystic mesenteric lymphangioma (AU)

Vólvulo yeyunal incompleto por linfangioma quístico mesentérico / Partial jejunal volvulus due to a mesenteric cystic lymphangioma

Los quistes mesentéricos son tumoraciones benignas poco frecuentes entre las que se encuentran los linfangiomas. Su presentación clínica es variable y pueden producir síntomas agudos debido a complicaciones. Se diagnostican sobre todo en edad pediátrica y su pronóstico, tras exéresis completa, suele ser excelente. Presentamos el caso de una paciente de 15 años con dolor abdominal postprandial y palpación de masa blanda en hipogastrio. Los estudios radiológicos mostraron una gran masa polilobulada de contenido quístico que englobaba un asa de yeyuno con volvulación incompleta. El tratamiento fue la exéresis del quiste y del asa de yeyuno y el diagnóstico anatomopatológico fue de linfangiomaquístico mesentérico. La paciente está asintomática después de más de 3 años de la intervención (AU)

Mesenteric cysts are unusual benign tumours thatinclude lymphangioma. Their clinical presentation is variable and acute symptoms can be produced due to complications. This tumour appears especially in childhood, and its prognosis after surgical removal is excellent. We present the case of a 15 year old female patient with symptoms of postprandial abdominal pain and palpation of smooth mass in hypogastrium. Radiological studies showed a big polilobular mass of cystic substance that included a portion of jejune within complete volvulus. The treatment was the removal of the cyst and a je junal portion and the pathological diagnosis was mesenteric cyst lymphangioma. The patient is asymptomatic more than three years after the intervention (AU)

Omental cyst presenting as tubercular ascites.

Cystic lymphangiomas are uncommon congenital benign tumours of vascular origin with a lymphatic differentiation originating across various anatomical locations. Large intrabdominal cysts may mimic ascites. We report the case of a one-and-a-half-year-old male child with a giant cystic lymphangioma originating in the greater omentum presenting as tubercular ascites. This report aims to highlight the limitations of biochemical investigations such as ascitic adenosine deaminase (ADA) in differentiating the epidemiologically prevalent tubercular ascites from an intrabdominal cyst, especially in a resource-poor nation as ours, where invasive diagnostic procedures pose an economic burden.

Papillary endothelial hyperplasia of the orbit: report of a case highlighting a pitfall on fine needle aspiration biopsy.

BACKGROUND: Papillary endothelial hyperplasia (PEH) is an unusual form of thrombus organization that occurs predominantly in the extremities, including the head and neck. However, it is rare in the orbit/ocular region. Although the histologic features of PEH have been well described, the cytologic diagnosis remains difficult. CASE: A 63-year-old man presented with a left intraorbital mass that was increasing in size and associated with paresthesia and a recent history of excision of squamous cell carcinomas (SCC) from his left cheek. Fine needle aspiration biopsy (FNAB) yielded very limited material, predominantly blood. However, 1 Papanicolaou-stained slide showed groups of atypical cells with scanty but dense cytoplasm and large, hyperchromatic nuclei with prominent nucleoli. SCC was favored, and excision was performed. Histology showed PEH within an assumed cystic lymphangioma, associated with inflammatory and fibrotic change in the compressed supraorbital nerve. CONCLUSION: To our knowledge this is the third report on the cytology of PEH and the first report of FNAB in PEH of the orbit. The case was also unusual as it was the second metachronous PEH in the patient.

Lesiones quísticas testiculares en la infancia / Cystic testicular lesions in infancy

Presentamos el caso de un niño de 11 meses diagnosticado de quiste intratesticular derecho. Analizamos la etiología, el diagnóstico diferencial y el manejo de las lesiones quísticas testiculares en la infancia. La edad del paciente, la exploración física, los marcadores tumorales y los hallazgos ecográficos contribuyen a la sospecha diagnóstica y en ocasiones al diagnóstico definitivo preoperatoriamente. El diagnóstico diferencial incluye el quiste simple, el quiste epidermoide, los quistes de túnica albuginea, el teratoma testicular, el tumor de células granulosa juvenil-tumor del estroma gonadal, la displasia quística de la rete testis, el linfangioma quístico y la torsión testicular. La enucleación es habitualmente el tratamiento de elección. El conocimiento de las lesiones quísticas testiculares en la infancia permite un adecuado manejo de las mismas y un tratamiento más conservador

The present article reports a case 11 month- old infant with a right intratesticular cyst. We analyze the etiology, differential diagnosis and management off all cystic lesions of the pediatric testis. Patient age at presentation, examination features, tumor markers and sonographic appearance may assist in making a presumptive and occasionally definitive diagnosis preoperatively. The differential diagnosis include intratesticular simple cyst, epidermoid cyst, tunica albuginea cyst, testicular teratoma, juvenil granulosa cell tumor-gonadal stromal tumor, cystic dysplasia of the rete testis, cystic lymphangioma, and testicular torsion Ussually enucleation is the best treatment. A thorough understanding of potentially cystic testis lesions in children leads to the best management choices and often to preservation of a substantial portion of the affected testis

Management of aneurysm sac hygroma.

PURPOSE: To document the management strategies and outcome of patients diagnosed with sac hygroma following open or endovascular abdominal aortic aneurysm (AAA) repair. METHODS: Seven men (median 68 years, range 43-79) with previous open (n=3) or endovascular (n=4) AAA repairs and increasing aneurysm diameters documented on spiral computed tomography (CT) were diagnosed with sac hygroma based on the lack of a demonstrable endoleak on CT imaging; the presence of a gelatinous, clear fluid in the sac; and a nonpulsatile sac pressure that was about one third of the systemic blood pressure. The patients were followed at regular intervals with spiral CT and percutaneous CT-guided translumbar intrasac pressure measurements. Surgical interventions were performed for sac diameter increase >5 mm or expansion-related pain. Blood samples and fluid aspirated from the sac were analyzed to detect activation of the coagulation and fibrinolytic systems. RESULTS: Over a median 21.5-month follow-up, open fenestration with resection of the aneurysm wall or open tight wrapping of the wall around the graft in 4 patients did not prevent hygroma reoccurrence, nor did repeated punctures with aspiration of fluid in the other 3 patients. Aneurysm diameters remained unchanged during the observation period. CONCLUSIONS: Only symptomatic hygromas need be treated, but the treatment of choice remains to be established, since puncture, fenestration, or resection of the sac do not seem to be adequate.

Cystic hygroma in a tactical aviator: a case report.

Cystic hygroma of the neck is a benign, congenital tumor of lymphatic origin rarely seen in adults, with approximately 100 cases presented in the literature. The etiology of this lesion is poorly understood, with spontaneous occurrence, upper respiratory infection, or trivial trauma being suggested. We present a recent unique case report of an adult male tactical aviator who experienced a progressively enlarging cystic hygroma of the neck over a 2-week period without history of infection or obvious trauma. This case is unusual in that there may have been an element of continuous microtrauma to the area given the individual's occupation and required flight head gear. A successful surgical dissection and removal of the cystic hygroma was performed. A discussion and brief literature review of cystic hygroma in adulthood is presented.

Aneurysm sac hygroma: a cause of endotension.

PURPOSE: To describe a new pathophysiological mechanism for endotension. CASE REPORTS: Four patients developed aneurysm sac expansion after repair of abdominal aortic aneurysms, one with a conventional polytetrafluoroethylene (PTFE) graft and the others with a variety of commercially made endografts (2 PTFE, 1 Dacron). Pressures within the sacs were nonpulsatile and approximately half the systemic blood pressure. Attenuation on computed tomography (CT) was significantly less in the sac than in the graft in 3 of the patients. A clear, highly viscous fluid was aspirated from all 4 sacs, supporting the diagnosis of aneurysm sac hygroma. Prominent local hyperfibrinolysis in the sac was combined with signs of local coagulation activation. CONCLUSIONS: A new mechanism for continued sac expansion based on aneurysm sac hygroma is proposed. Measurement of attenuation may be of diagnostic value. It is further proposed that local hyperfibrinolysis/coagulation may promote rebleeding, liquefaction, and continued expansion analogous to the chronic subdural hematoma.

Linfangioma quístico del mesenterio: análisis clínico, radiológico y morfológico / Cystic mesenteric lymphangioma: clinical, radiological and histopathological features

Antecedentes: los linfangiomas quísticos del mesenterio (LQM) son neoplasias benignas raras, que pueden confundirse con tumores originados en otros órganos de la cavidad abdominal. Objetivo: mostrar las características clínicas, radiológicas y morfológicas de un caso de LQM. Material y método: masculino de 17 años de edad, que inició su padecimiento 17 días antes a su ingreso con dolor en fosa iliaca derecha, náusea, vómito, fiebre y un tumor abdominal. Inicialmente se diagnosticó como apendicitis aguda, en el transoperatorio le encontraron un tumor en el mesenterio y sólo le efectuaron apendicectomía. El paciente fue enviado a un centro especializado. En la tomografía axial computada de abdomen se encontró un tumor quístico que se interpretó como cistadenoma del páncreas. Se sometió a laparotomía exploradora, en la que se encontró tumor retroperitoneal multiquístico que infiltraba el mesenterio del colon derecho, el duodeno, el yeyuno proximal y la cabeza del páncreas. Se efectuó pancreatoduodenectomía con hemicolectomía derecha. En el postoperatorio desarrolló colestasis intrahepática por la administración de nutrición parenteral endovenosa con recuperación al discontinuarla. El paciente fue egresado sin complicaciones al 15§ día de posoperatorio. El estudio histopatológico correspondió a un LQM. A un año de seguimiento se encuentra asintomático. Conclusión: el LQM debe ser incluido en el diagnóstico diferencial de los tumores quísticos intraabdominales. Debido a las localizaciones que presenta este tumor, el cirujano debería planificar la cirugía adecuada para evitar complicaciones porque este tratamiento es curativo.