Colloid cysts of the third ventricle: correlation of MR and CT findings with histology and chemical analysis.

Eight patients with colloid cysts of the third ventricle were examined with CT and MR. In six, surgical resection was performed and the material was subjected to histologic evaluation; the concentrations of trace elements were determined by particle-induced X-ray emission. Stereotaxic aspiration was performed in two. The investigation showed that colloid cysts are often iso- or hypodense relative to brain on CT (5/8), but sometimes have a center of increased density. Increased density did not correlate with increased concentration of calcium or other metals but did correlate with high cholesterol content. Colloid cysts appear more heterogeneous on MR (6/8) than on CT (3/8), despite a homogeneous appearance at histology. High signal on short TR/TE sequences is correlated with a high cholesterol content. A marked shortening of the T2 relaxation time is often noticed in the central part of the cyst. Analysis of trace elements showed that this phenomenon is not related to the presence of metals with paramagnetic effects. Our analysis of the contents of colloid cysts does not support the theory that differing metallic concentrations are responsible for differences in MR signal intensity or CT density. We did find that increased CT density and high MR signal correlated with high cholesterol content.

Occurrence of colloid-containing follicles and ciliated cysts in the hypophysial pars tuberalis from guinea pigs of various ages.

Colloid-containing follicles and ciliated cysts in the hypophysial pars tuberalis of guinea pigs at various ages ranging from 5 days to 36 months were examined by periodic acid-Schiff (PAS) reaction, immunohistochemistry, and electron microscopy. The follicles storing PAS-positive colloid were encountered in the pars tuberalis of all guinea pigs examined, although only a few were present in young animals. The follicles gradually increased in number with age. The largest number of follicles was found in the senile male group: 141.3 +/- 11.9, about 10 times the number in the 5-day-old male group. The follicles were scattered throughout the entire length of the pars tuberalis. Follicles with enlarged luminal cavities were concentrated in the ventral caudal region surrounding the infundibular stem and merges with the pars distalis. Three different types of follicles were found by electron microscopy: 1) those surrounded by nongranulated follicular cells that may correspond to the stellate-follicular cells in the pars distalis, 2) those surrounded by specific cells that were packed with vesicular inclusions, and 3) those surrounded by granulated cells that may be gonadotropes. In the follicles lined by non-granulated follicular cells, long, prominent microvilli and cytoplasmic processes protruding into the lumen and invaginations of colloid were often observed at the apical cell region. The follicles lined by the specific cells having numerous vesicles were localized only in the ventral caudal portion. The vesicles ranged from 200 to 700 nm in diameter, and the outer surface of their limiting membrane was partly studded with ribosomes. Gonadotropes immunoreactive to the luteinizing hormone (LH) and follicle-stimulating hormone (FSH) antisera were distributed in the guinea pig pars tuberalis. As well as the typical follicles described above, the follicles composed solely of granulated cells showed microvilli protruding into the cavities and junctional complexes at the apical lateral surface. They stored heterogeneous materials in the lumina. Some secretory granules gave the appearance of being discharged into the lumen. Ciliated cysts were frequently observed in the pars tuberalis; their incidence was 71.7%. The ciliated cysts were much larger than colloid-containing follicles. Cystic cavities were only partly filled with heterogeneous materials showing colloid-like, flocculent, and granular features.

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.

Functional similarities of hepatic cystic and biliary epithelium: studies of fluid constituents and in vivo secretion in response to secretin.

Hepatic cysts are a frequent manifestation of autosomal dominant polycystic kidney disease, but little is known about their functional characteristics. The goals of our study were to define the composition of hepatic cyst fluid and to determine whether hepatic cysts secrete in response to intravenously administered secretin. We percutaneously punctured five hepatic cysts and one proximal renal cyst from six subjects with autosomal dominant polycystic kidney disease and one solitary hepatic cyst from a subject without autosomal dominant polycystic kidney disease. Most fluids had an electrolyte composition similar to serum. Fluid from all hepatic cysts had glutamyltranspeptidase concentrations above those found in serum [( cyst]/[serum] = 4.93 +/- 5.92), contained secretory component (the epithelial receptor for polymeric IgA) and had glucose concentrations less than 15 mg/dl. Fluid from both hepatic and renal cysts of subjects with autosomal dominant polycystic kidney disease, but not from the subject with the solitary hepatic cyst, demonstrated extensive changes in the electrophoretic mobility of several serum proteins. Initial intracystic pressures ranged from 16 to 40 cm H2O, were reduced 57% to 97% after aspiration of a portion of cyst fluid and were held constant during the secretion study. Within 8 min of the intravenous administration of secretin, secretion of fluid increased in two of three hepatic cysts and in the renal cyst. The electrolyte composition of cyst fluids was not altered by secretin. These data suggest that hepatic cystic epithelium has functional characteristics of biliary epithelium and that secretion by both hepatic and renal cysts may be hormonally regulated.

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.

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.

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.

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.

Intramucosal cysts in gastric mucosa adjacent to carcinoma and peptic ulcer: a histochemical study.

Histochemical characteristics and the distribution of gastric intramucosal cysts were studied in 50 cancerous and 51 benign gastrectomy specimens. The frequency of such cysts was significantly higher in stomachs with carcinoma (70%) than in stomachs with peptic ulcer (43%) (P less than 0.01). Intramucosal cysts were classified into gastric type, small intestinal type, colonic type and non-mucous type. There were significant differences in the constituent ratios of the four types of cyst between gastric carcinoma and gastric ulcer (P less than 0.01), as well as between intestinal type and diffuse type cancer (P less than 0.001). The present results reveal a close relationship between intramucosal cysts and gastric carcinoma. Cysts of small intestinal, colonic and non-mucous types were associated with intestinal type cancer while cysts of gastric type were related to diffuse type cancer of the stomach.

Biologic characterization of human bone tumors. VI. The aneurysmal bone cyst: an enzyme histochemical, electron microscopical, and immunohistological study.

The etiology of aneurysmal bone cyst is still unknown. Most theories of the histogenesis of this lesion assume a vascular origin and speculation has focused on the characteristic pseudoendothelial lining of the cyst walls. In the present study, this structure has been subjected to enzyme histochemical, electron microscopical, and immunohistochemical investigation. Of the enzymes tested only alkaline phosphatase was present in the cyst lining. Electron microscopy revealed fibroblast-like cells covering the walls of cystic cavities, but no genuine endothelium, basement membranes or pericytes were identified. For the immunohistochemical studies a panel of poly- and monoclonal antibodies against HLA-DR antigens, mature and immature macrophages/histiocytes, smooth muscle fibers and endothelial cells, as well as the lectin Ulex europaeus I agglutinin were used. None of these markers demonstrated the presupposed vascular characteristics in the cells constituting the pseudoendothelial lining of the cyst walls. Despite current theories to the contrary, it was concluded that aneurysmal bone cyst is unlikely to originate from the vascular system, and that a new concept of its pathogenesis must be sought.

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.

Pneumatosis cystoides intestinalis. A review of the literature.

Pneumatosis cystoides intestinalis is a condition in which submucosal or subserosal gas cysts are found in the wall of the small or large bowel. Both fulminant and benign forms exist. Fulminant pneumatosis cystoides intestinalis is associated with an acute bacterial process, sepsis, and necrosis of the bowel, while benign pneumatosis cystoides intestinalis can be totally asymptomatic and observed as an incidental finding at laparotomy. Many different causes of pneumatosis cystoides intestinalis have been proposed, including mechanical and bacterial causes. A review of the literature is presented with emphasis on the etiology of pneumatosis cystoides intestinalis, which probably can be attributed to bacterial and mechanical factors. Diagnosis and different forms of therapy and their efficacy are also discussed.

Penetration of trimethoprim and sulfamethoxazole into cysts in a patient with autosomal-dominant polycystic kidney disease.

This study examines the causes for the therapeutic failure of trimethoprim-sulfamethoxazole in a patient with infected cysts caused by a sensitive strain of Escherichia coli. We determined the concentration of trimethoprim and sulfamethoxazole in eight cysts (four proximal, four distal) following therapeutic nephrectomy in a patient treated eight days with trimethoprim-sulfamethoxazole in appropriate doses. In four proximal cysts, mean trimethoprim level was 16.1 +/- 0.8 micrograms/mL with mean sulfamethoxazole level of 94.7 +/- 13.0 micrograms/mL. In distal cysts, mean trimethoprim level was 227.8 +/- 16.8 micrograms/mL with mean sulfamethoxazole level of 9.7 +/- 3.6 micrograms/mL. Serum peak and trough trimethoprim concentrations were 9.8 micrograms/mL and 5.4 micrograms/mL with peak and trough sulfamethoxazole concentrations of 136.0 micrograms/mL and 65.0 micrograms/mL. Significant WBC counts were present in seven cysts, three proximal and four distal. All three proximal cysts were sterile; in contrast, the four distal cysts grew the same strain of E coli isolated from the blood and urine of this patient. The infection resolved following nephrectomy. We conclude that the failure of trimethoprim-sulfamethoxazole to eradicate the infection was caused by the inability of sulfamethoxazole to enter distal cysts in sufficient concentration for the synergistic effect commonly seen with trimethoprim and sulfamethoxazole in combination. Treatment of cyst infections with trimethoprim-sulfamethoxazole should probably be avoided in instances when the organism is resistant to trimethoprim alone.

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.

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.

The differential diagnosis of cystic neck masses by the determination of thyroglobulin concentrations in the aspirates.

Thyroglobulin (Tg) concentrations in the aspirates of various types of cystic neck masses were measured by RIA to assess the usefulness of this determination in differential diagnosis. The subjects consisted of 16 patients, whose final diagnoses were all established on the basis of operative results; three patients had follicular thyroid adenomas (F-Ad), 11 had papillary thyroid carcinomas (P-Ca), one had a thyroglossal duct cyst (TDC) and one had a lateral cervical cyst (LCC). Tg concentrations in the cyst fluids of F-Ad and P-Ca were very high (0.042-2.83 mg/ml) compared with serum Tg concentrations. There was no difference in Tg concentrations in the fluids of P-Ca between primary lesions (n = 5) and metastatic lesions (n = 6). On the other hand, Tg concentrations of TDC and LCC were very low (less than 100 ng/ml). Difficulty was experienced in diagnosing three patients, even though they had been examined by all nonsurgical diagnostic techniques. However, an occult thyroid carcinoma with lymph node metastasis was diagnosed by demonstrating a high Tg concentration in the aspirate of the cystic lymph node. T3 concentrations in cyst fluids of F-Ad were higher than those of P-Ca. T3 concentrations in the fluids of P-Ca, TDC and LCC did not differ, and were similar to serum T3 levels. Cytology of cyst fluids was positive in four of 10 patients examined with P-Ca. In conclusion, we can clearly confirm the thyroid origin of a cystic neck mass by demonstrating a high Tg concentration in the aspirate. This is especially useful for diagnosis in patients with thyroid carcinoma, including occult thyroid carcinomas with cystic lymph node metastasis.