What are cysts. How do cysts form. What are the different types of cysts. What symptoms do cysts cause. How are cysts diagnosed and treated. Are cysts dangerous.

Understanding Cysts: Definition and General Characteristics

Cysts are abnormal, sac-like structures that can develop in various parts of the body. These closed capsules typically contain liquid, semisolid, or gaseous material, resembling blisters in some aspects. Cysts have distinct membranes separating them from surrounding tissues, with the outer portion known as the cyst wall.

The size of cysts can vary dramatically, ranging from microscopic to large enough to displace internal organs. While most cysts are benign, some can be cancerous or precancerous, necessitating medical attention.

Key Characteristics of Cysts:

• Enclosed sac-like structure
• Distinct membrane separating from nearby tissue
• Contains fluid, semisolid, or gaseous material
• Size ranges from microscopic to very large
• Can occur in various body parts
• Usually benign, but some may be cancerous

Are all cysts harmful? While most cysts are harmless, some can cause discomfort or health complications depending on their location and size. It’s essential to have any unusual lumps or growths evaluated by a healthcare professional to determine their nature and potential risks.

Common Types of Cysts and Their Characteristics

Cysts can develop in various parts of the body, each with unique characteristics and potential health implications. Understanding these different types can help individuals recognize potential issues and seek appropriate medical care.

Acne Cysts

Acne cysts, also known as cystic acne or nodulocystic acne, represent a severe form of acne. These cysts develop when skin pores become blocked, leading to infection and inflammation. They are often painful and can cause significant scarring if left untreated.

Arachnoid Cysts

Arachnoid cysts form between the arachnoid membrane and the brain or spinal cord. They contain cerebrospinal fluid and can be present at birth (primary arachnoid cysts) or develop later in life due to head injuries, tumors, or meningitis (secondary arachnoid cysts).

Baker’s Cysts

Also known as popliteal cysts, Baker’s cysts typically occur behind the knee. They often result from underlying knee joint problems, such as arthritis or cartilage tears. Symptoms may include knee pain, swelling, and a feeling of fullness behind the knee.

Breast Cysts

Breast cysts are common, especially in women, and can be painful. They may fluctuate in size throughout the menstrual cycle and often resolve on their own. While simple breast cysts do not increase cancer risk, complex cysts may require further evaluation.

Epidermoid Cysts

Often incorrectly referred to as sebaceous cysts, epidermoid cysts typically appear on the face, back, scalp, or scrotum. They contain keratin and can become inflamed or infected if ruptured.

Ganglion Cysts

These small, benign cysts form near joints or tendon coverings, most commonly on the wrist and hand. They can also appear on the foot, ankle, or knee. Ganglion cysts may cause discomfort if they press on nearby nerves.

Ovarian Cysts

Ovarian cysts are fluid-filled sacs that develop on or within the ovaries. While many are harmless and resolve on their own, some can cause complications and may require medical intervention.

Causes and Risk Factors for Cyst Development

The formation of cysts can be attributed to various factors, depending on the type and location of the cyst. Understanding these causes can help in prevention and early detection.

Common Causes of Cysts:

1. Blockage of ducts or glands
2. Hormonal imbalances
3. Genetic predisposition
4. Infections
5. Chronic inflammatory conditions
6. Injury or trauma
7. Developmental abnormalities

Can lifestyle factors contribute to cyst formation? While some cysts are unavoidable due to genetic or developmental factors, certain lifestyle choices can influence the risk of developing certain types of cysts. For example, maintaining good hygiene can help prevent some skin cysts, while a balanced diet and regular exercise may reduce the risk of certain ovarian cysts.

Recognizing Cyst Symptoms and When to Seek Medical Attention

The symptoms of cysts can vary widely depending on their location, size, and type. Some cysts may be asymptomatic, while others can cause significant discomfort or health complications.

Common Symptoms Associated with Cysts:

• Visible or palpable lump
• Pain or discomfort in the affected area
• Swelling or inflammation
• Redness of the skin over the cyst
• Difficulty moving a joint if the cyst is near it
• Pressure symptoms on nearby structures
• Changes in organ function if the cyst is internal

When should you see a doctor about a suspected cyst? It’s advisable to seek medical attention if you notice any unusual lumps or growths, especially if they are painful, growing in size, or interfering with daily activities. Additionally, any cyst that becomes red, inflamed, or starts to drain should be evaluated by a healthcare professional to rule out infection.

Diagnostic Approaches for Identifying and Evaluating Cysts

Accurate diagnosis of cysts is crucial for determining the appropriate treatment approach. Healthcare providers use various methods to identify and evaluate cysts, depending on their location and suspected type.

Common Diagnostic Methods:

1. Physical examination
2. Imaging studies (ultrasound, CT scan, MRI)
3. Fine-needle aspiration
4. Biopsy
5. Blood tests
6. Hormonal assays

How do doctors determine if a cyst is benign or malignant? While most cysts are benign, doctors may use a combination of imaging studies and biopsy to evaluate the nature of a cyst. Factors such as the cyst’s appearance on imaging, its growth rate, and the presence of certain cellular characteristics in biopsy samples can help determine if a cyst is benign or potentially malignant.

Treatment Options for Different Types of Cysts

The treatment of cysts depends on various factors, including the type of cyst, its location, size, and whether it’s causing symptoms or complications. Many cysts do not require treatment and may resolve on their own, while others may need medical intervention.

Common Treatment Approaches:

• Watchful waiting for asymptomatic cysts
• Draining or aspiration of fluid-filled cysts
• Surgical removal (excision)
• Medication to manage symptoms or underlying causes
• Hormone therapy for hormone-related cysts
• Laser therapy for certain skin cysts
• Sclerotherapy for some types of cysts

Is surgery always necessary for cyst removal? Not all cysts require surgical removal. The decision to surgically remove a cyst depends on factors such as its size, location, symptoms, and the risk of complications. In many cases, non-invasive treatments or watchful waiting may be sufficient. However, surgery may be recommended for large cysts, those causing significant symptoms, or cysts suspected of being cancerous.

Preventing Cysts and Managing Recurrence

While not all cysts can be prevented, there are steps individuals can take to reduce their risk of developing certain types of cysts or managing recurrent cysts.

Preventive Measures and Management Strategies:

1. Maintaining good hygiene to prevent skin cysts
2. Regular health check-ups for early detection
3. Managing underlying health conditions
4. Hormone balance through lifestyle or medical interventions
5. Proper wound care to prevent sebaceous cysts
6. Avoiding trauma to susceptible areas
7. Dietary modifications for certain types of cysts

Can lifestyle changes help prevent cyst recurrence? For some types of cysts, lifestyle modifications can play a role in preventing recurrence. For example, maintaining a healthy weight and balanced diet may help reduce the risk of ovarian cysts in some women. Similarly, proper skincare routines can help prevent the recurrence of certain skin cysts. However, it’s important to note that some cysts may recur despite preventive measures due to genetic or other underlying factors.

Long-term Outlook and Potential Complications of Cysts

The long-term outlook for individuals with cysts varies depending on the type, location, and treatment of the cyst. While many cysts are benign and cause no long-term issues, some can lead to complications if left untreated.

Potential Complications of Untreated Cysts:

• Infection
• Rupture
• Chronic pain
• Interference with organ function
• Cosmetic concerns
• Psychological distress
• In rare cases, malignant transformation

What is the prognosis for individuals with cysts? The prognosis for most cysts is excellent, especially when they are benign and properly treated. Many cysts resolve on their own or with minimal intervention. However, the outlook can vary for complex or potentially malignant cysts. Regular follow-up with healthcare providers is essential for monitoring cysts and ensuring optimal outcomes.

Understanding the nature of cysts, their potential causes, and available treatment options empowers individuals to seek appropriate care and make informed decisions about their health. While cysts can be concerning, advances in medical diagnostics and treatments have significantly improved outcomes for those affected by these common growths.

Types, pictures, symptoms, causes, and treatment

Cysts are closed capsule or sac-like structures, typically containing a liquid, semisolid, or gaseous material, much like a blister. There are many types, such as acne cysts and ganglion cysts, and kidney cysts.

Cysts vary in size from microscopic to very large. Very large cysts can displace internal organs.

A cyst is not a normal part of the tissue where it occurs. It has a distinct membrane and is separate from nearby tissue. The outer, or capsular, portion of a cyst is known as the cyst wall.

If the sac has filled with pus, the cyst is infected and will turn into what doctors call an abscess.

They are usually benign, but some cysts can be cancerous or precancerous.

This article looks at the different types of cysts, their causes and symptoms, and some treatment options.

Some common types of cyst include:

Acne cysts

Cystic acne, or nodulocystic acne, is a severe type of acne in which the skin’s pores become blocked, leading to infection and inflammation.

Arachnoid cysts

The National Institute of Neurological Disorders and Stroke notes that arachnoid cysts develop between the arachnoid membrane and the brain or spinal cord. These cysts contain cerebrospinal fluid.

Arachnoid cysts may affect newborn babies. Doctors call these primary arachnoid cysts.

The arachnoid membrane covers the brain. During fetal development, it doubles up or splits to form an abnormal pocket of cerebrospinal fluid. In some cases, a doctor may need to drain the cyst.

Secondary arachnoid cysts develop as a result of head injury, tumors, or meningitis.

Baker’s cysts

Baker’s cysts are also known as popliteal cysts.

Some do not cause any symptoms. However, a person with a Baker’s cyst can experience:

• knee pain
• a lump behind the knee
• a feeling of fullness behind the knee
• swelling in the knee and lower leg
• stiffness or tightness located at the back of the knee

Baker’s cysts usually develop due to a problem with the knee joint, such as arthritis or a cartilage tear.

Bartholin’s cysts

Bartholin’s cysts can occur if the ducts of the Bartholin gland, which are inside the vagina, become blocked.

A doctor may recommend surgery or prescription antibiotics as treatment.

Breast cysts

Breast cysts are common and may be painful.

In females, these cysts can develop or change in size throughout the menstrual cycle, and they often disappear on their own. However, a doctor can drain the fluid if they are causing discomfort.

According to the American Cancer Society, simple cysts do not increase the risk of breast cancer. That said, there is a small chance that complex cysts may contain cancer or increase a person’s risk of cancer later on, depending on the results of a biopsy.

Read more about breast lumps here.

Chalazion cysts

Very small eyelid glands, known as meibomian glands, make a lubricant that comes out of tiny openings in the edges of the eyelids. Cysts can form here if the ducts are blocked. These are known as chalazion cysts.

Colloid cysts

Colloid cysts develop in the brain and contain gelatinous material.

Treatment depends on whether the cyst is causing symptoms or a buildup of fluid in the brain. In these cases, a doctor may recommend surgery to remove the cyst or aspiration (draining).

Dentigerous cysts

Dentigerous cysts surround the crown of an unerupted tooth.

Dermoid cysts

Dermoid cysts comprise mature skin, hair follicles, sweat glands, and clumps of long hair, as well as fat, bone, cartilage, and thyroid tissue.

They can form anywhere on the body.

Epidermoid cyst

A 2021 article notes that people may also refer to these as “sebaceous cysts.” However, these cysts do not involve the sebaceous gland, and healthcare professionals call them epidermoid cysts instead.

These cysts occur on the skin of the face, back, scalp, or scrotum and contain keratin material.

Epididymal cysts

Epididymal cysts, or spermatoceles, form in the vessels attached to the testes.

They are benign and contain a fluid that is white and cloudy. They also contain sperm.

They are not a serious medical issue and rarely need treatment. However, treatment may be necessary if they cause pain or become too large.

Read more about testicle lumps here.

Ganglion cysts

Ganglion cysts are small, benign cysts that form on or near a joint or covering of a tendon.

They usually develop on the wrist and hand but can also appear on the foot, ankle, or knee.

Hydatid cysts

Hydatid cysts develop due to a relatively small tapeworm. These cysts form in the lungs or liver.

Treatment options include surgery and medication.

Kidney cysts

There are several types of kidney cysts, or renal cysts. They are usually harmless.

Solitary cysts contain fluids, sometimes including blood. Some are present at birth, while tubular blockages cause others.

People with renal vascular diseases may have cysts that formed due to dilatation of the blood vessels.

Ovarian cysts

Ovarian cysts are common in females who have regular periods. They form during ovulation.

The majority of ovarian cysts are benign and cause no symptoms. However, some can become so large that the abdomen protrudes.

Polycystic ovary syndrome refers to when the ovaries develop many small cysts.

Pancreatic cysts

Health professionals may refer to them as “pseudocysts” because they do not contain the types of cells present in true cysts.

They occur when the cells of the pancreas are injured or inflamed. They can also occur when pancreatic enzymes leak and damage the tissue of the pancreas.

Periapical cysts

Periapical cysts, also known as radicular cysts, are the most common type of odontogenic cysts, which are related to the formation and development of teeth.

These cysts usually develop due to inflammation of the pulp, pulp death, or tooth decay.

Pilar cysts

Pilar cysts are also known as trichilemmal cysts. They are fluid-filled cysts that form from a hair follicle and usually develop in the scalp.

Pilonidal cysts

Pilonidal cysts form in the skin near the tailbone or lower back, and they sometimes contain ingrown hair.

These cysts can grow in clusters, which sometimes creates a hole or cavity in the skin.

Pineal gland cysts

These are benign cysts that form in the pineal gland in the brain.

According to a review from 2020, pineal gland cysts are common.

Tarlov cysts

Tarlov cysts — also known as perineural, perineurial, or sacral nerve root cysts — occur at the base of the spine and are filled with cerebrospinal fluid.

Vocal fold cysts

There are two types of vocal fold cysts: mucus retention cysts and epidermoid cysts.

Vocal fold cysts can interfere with the quality of a person’s speech, sometimes causing their vocal cords to produce:

• multiple tones simultaneously, known as diplophonia
• breathy speech, or dysphonia
• hoarseness

The signs and symptoms will vary widely depending on what type of cyst it is. In many cases, a person first becomes aware of an abnormal lump, particularly when the cyst is just beneath the skin.

Many internal cysts, such as those that occur in the kidneys or the liver, may not cause any symptoms at all. A person may not notice them until an imaging scan — such as an MRI, CT, or ultrasound scan — detects them.

It is unusual for some cysts, such as skin cysts, to cause pain unless they rupture, become infected, or are inflamed. However, breast cysts can cause pain.

A person may also experience headaches and other symptoms if a cyst develops on the brain.

Cysts are common and can occur anywhere on the body. They can be a result of infection, clogged sebaceous glands, or piercings.

Some other causes of cysts include:

• tumors
• genetic conditions
• a fault in an organ of a developing embryo
• a defect in the cells
• chronic inflammatory conditions
• blockages of ducts in the body that cause fluids to build up
• a parasite
• an injury that breaks a vessel

Cysts are usually benign and develop due to blockages in the body’s natural drainage systems.

However, some cysts may be tumors that form inside tumors. These can be malignant, or cancerous.

Cysts are not the same as tumors.

Learn about tumors versus cysts here.

The treatment options for a cyst will depend on a range of factors, including the type of cyst, where it is, its size, and the degree of discomfort it is causing.

For very large cysts that are causing symptoms, a doctor may recommend surgical removal.

Sometimes, a doctor can drain, or aspirate, the cyst by inserting a needle or catheter into the cavity. If the cyst is not easily accessible, they may use radiologic imaging to accurately guide the needle or catheter.

A healthcare professional may examine the removed liquid under a microscope to determine whether or not any cancerous cells are present. If they suspect that the cyst is cancerous, they may suggest surgical removal, order a biopsy of the cyst wall, or both.

Some cysts develop as a result of a chronic or underlying medical condition, as may be the case with fibrocystic breast disease or polycystic ovary syndrome. In such cases, the focus of the treatment will be on the medical condition itself, not the cyst.

Although cysts and boils can appear similar in appearance, their causes and treatment options are different.

A cyst is a closed sac that consists of liquid, gaseous, or semisolid material.

A boil is a lump that has filled with pus and develops around hair follicles. They usually occur as a result of a bacterial infection.

Learn more about cysts versus boils here.

Cysts are abnormal, fluid-filled sacs that can develop in tissues in any part of the body. They are relatively common, and there are many different types.

Infections, tumors, parasites, and injuries can cause cysts. They are usually noncancerous.

If a person is worried about a cyst or has noticed a new lump, they should see a doctor for an accurate diagnosis and treatment, if necessary.

Arachnoid Cysts – StatPearls – NCBI Bookshelf

Continuing Education Activity

Arachnoid cysts are common incidental findings on cross-sectional neuroimaging of the brain. When they are present in the appropriate location and of significant size, they can be symptomatic and require treatment. Also, they rarely occur in the spine and can result in symptoms. Both spinal and intracranial arachnoid cysts present due to mass effect or secondary to rupture. This activity reviews the clinical presentation, diagnosis, and treatment of arachnoid cysts and highlights the role of the interprofessional team in the care of patients with this condition.

Objectives:

• Outline the typical presentation with an intracranial arachnoid cyst.

• Explain the imaging findings of arachnoid cysts.

• Summarize treatment considerations for arachnoid cysts.

• Describe the importance of collaboration and communication among the interprofessional team to improve outcomes for patients affected by arachnoid cysts.

Access free multiple choice questions on this topic.

Introduction

Arachnoid cysts are common incidentally found lesions in the brain when imaging is being performed. [1][2][3] The majority of arachnoid cysts are in the anterior/middle cranial fossa or in a retrocerebellar location. The etiology of most arachnoid cysts is unknown, but very likely the majority occur during development. These cysts occur as small or large fluid-filled lesions. Even large arachnoid cysts are often incidental and not associated with symptoms. However, many symptoms have been associated with the mass effect caused by an arachnoid cyst, and at times the arachnoid cyst does need to be treated secondary to the anatomical distortion and the neurological symptoms it is causing.

Etiology

The etiology of formation is uncertain, but arachnoid cysts, in theory, are predominantly formed due to abnormal splitting during embryogenesis of the arachnoid. If histopathology shows the presence of inflammatory cells, excess collagen, or hemosiderin staining, then an inflammatory or traumatic etiology is suggested. Underlying gliosis is not usually found in the adjacent brain secondary to mass effect. Some syndromes have been associated with arachnoid cysts, and these syndromes include Aicardi syndrome, mucopolysaccharidosis, acrocallosal syndrome, Marfan syndrome, a missense mutation (c.2576C>T) in the arginine-glutamic acid dipeptide repeats gene (RERE), and Chudley-Mullough syndrome.[4][5][6][7][8][9][10]

Epidemiology

The age range of the presentation of arachnoid cysts is very broad and spans from newborns to the elderly. Males tend to be affected more than females at a ratio of around 2 to 1, but the rate varies.[1][2][3]

Histopathology

The arachnoid cyst consists of a thin membrane. Histologically, the wall has been found to be variable but predominantly composed of arachnoid. There has also been found within arachnoid cysts fibrous tissue with a simple epithelial lining, and non-arachnoid luminal epithelia with plentiful microvilli and/or cilia.[11][12]

History and Physical

A wide range in the percentages of symptomatic versus asymptomatic cysts has been reported, and this reported rate will depend greatly on the population in which it is being calculated. The location of the arachnoid cyst is quite variable, with a clear dominance of lesions consistently found in the middle cranial fossa and the retrocerebellar locations. A smaller number of cysts are present at the convexity and in the suprasellar region. The lowest frequency of lesions is found in the cerebellopontine angle, intraventricular space, supracerebellar cistern, quadrigeminal cistern, ambient cistern, anterior fossa, and brainstem. A significant variation is reported in the incidence of the less frequent arachnoid cysts locations. For instance, Al-Holou et al. report very few intraventricular cysts in children (0.3%), no intraventricular cysts in adults, and Hall et al. reported 12% of cysts to be intraventricular in children.[1][2][3]

Most commonly, the arachnoid cyst will be detected incidentally unless a patient is sent to a referral center due to being symptomatic. Fortunately, the most common locations for cysts in the middle cranial fossa and retrocerebellar region are not associated with symptoms. Cysts in less common locations are found to be more likely symptomatic. In unusual cases, when arachnoid cysts cause symptoms, they present mainly by two mechanisms. One is secondary to mass effect, and the other is due to rupture. Arachnoid cysts are discovered related to many different presentations since they are usually incidental and not associated with the reason the patient is being imaged. Arachnoid cysts have been found during imaging work-up for headache, seizure, increased intracranial pressure, hydrocephalus, suspected stroke, hemiparesis, nausea/vomiting, dizziness, cranial nerve dysfunctions, tinnitus, vertigo, developmental delay/regression, behavior concerns, visual symptoms, and trauma.[1][2][3] 

Even in patients who present with a headache, if an arachnoid cyst is detected, it most likely is not related to the headache and is an incidental finding. However, careful evaluation of each case is required. The arachnoid cyst can be very large and can be a definitive cause of headaches and seizures. [13] Larger cysts are more likely to be symptomatic than small cysts, and larger cysts are more likely to undergo an operation.

It is rare for the arachnoid cyst to be a cause of a significant neurological symptom such as hydrocephalus, ataxia, or cranial nerve impingement. However, given the relatively common incidence and the many locations that arachnoid cysts occur in, an extensive array of symptoms are caused by arachnoid cysts. These include vision loss, nausea/vomiting, macrocephaly, third nerve palsy, trochlear dysfunction, trigeminal neuropathy, hemifacial spasm, sensory neuronal hearing loss, facial palsy, vagus nerve palsy, vertigo, and eighth cranial neuropathy.[3][14][15][16][17][18][19][20][21] The symptoms depend on the cyst location. A quadrigeminal plate cistern arachnoid cyst could compress the trochlear nerves and quadrigeminal plate and result in trochlear nerve dysfunction.[22] An arachnoid cyst impinging the optic nerve could cause a deficit in the ipsilateral visual field in the eye of origin, a cyst in the suprasellar cistern could cause bitemporal hemianopsia, and a cyst affecting the occipital cortex would cause homonymous hemianopsia.

Very unusual symptomatology has resulted from arachnoid cysts. Bobble-head doll syndrome, a rhythmic movement of the head, has been reported related to third ventricular dilation and potentially cerebellar involvement.[23][24] Depression that resolves with marsupialization of an arachnoid has occurred. The presentation of an arachnoid cyst causing depression is quite rare but plausible given the location and marked mass effect the cyst had on the brain.[25]

The rupture of an arachnoid cyst to cause a subdural hygroma is rare.[26][27][28] The rupture can be due to trauma, or the arachnoid cyst can rupture spontaneously. Usually, the resulting subdural hygroma can be followed without treatment, but surgical intervention might be needed.[26][28] Also, the traumatic rupture of an arachnoid cyst rarely results in hemorrhage in the arachnoid cyst or a subdural hematoma.        

The spinal arachnoid cyst is rare.[29] Arachnoid cysts are found throughout the spinal column but most commonly in the thoracic region. The most common symptoms relate to backache and fluctuating leg weakness. There have shown correlations with monoparesis, radicular pain, spastic quadriparesis, neurogenic claudication, sensory disturbance, monoplegia, incontinence, pain, paresthesia, and neurogenic bladder reported. More commonly, the cysts will be located posteriorly but can be located anteriorly.[29][30]

Evaluation

Computed tomogram (CT) imaging is often enough to make a diagnosis of an arachnoid cyst when the lesion is in an expected location with the appearance of a fluid-filled thin-walled cyst. When additional information is needed, an MRI is the imaging modality of choice for evaluating the anatomical location, size, and structures involved by an arachnoid cyst. MRI also can help refine the differential diagnosis when needed. The arachnoid cyst follows cerebrospinal fluid (CSF) on all pulse sequences unless it has experienced traumatic injury and blood products are present. Hemorrhage within an arachnoid cyst is rare.

The wall of the cyst is thin, and special pulse sequences can be employed to visualize the wall. The differential diagnosis for an arachnoid cyst includes epidermoid cyst, dermoid cyst, abscess, and other cysts such as cystic neurocysticercosis. On magnetic resonance imaging (MRI), the arachnoid cyst follows the signal intensity of CSF on T1 (dark signal), T2 fast spin-echo (FSE), or T2 spin-echo (SE) (high signal), T2-FLAIR (dark signal), and diffusion (dark signal). The apparent diffusion coefficient (ADC) maps created from the diffusion data will demonstrate the cyst with similar high ADC values as the CSF. Due to CSF pulsations, there can be mild signal differences between the fluid in the arachnoid cyst and the normal CSF on MRI sequences. Arachnoid cysts do not enhance.

Epidermoid cysts will be similar to CSF on T2 FSE and T2 SE, but on other sequences, will have variations in the signal, will not enhance, and have markedly elevated signal on diffusion-weighted imaging. This is a useful characteristic. Also, epidermoid cysts tend to be located anteriorly and laterally from the brainstem. A dermoid/lipoma can be differentiated on CT or MRI with signal intensities that follow fat. A T1 sequence with and without fat saturation to demonstrate the presence of fat on MRI is very useful to confirm a dermoid cyst/lipoma.

An abscess can be cystic in appearance, but due to inflammatory and cellular debris, the internal signal will not be similar to CSF. Very likely, the central fluid of an abscess will have a markedly elevated diffusion-weighted image (DWI) signal, similar to an epidermoid, and rim enhancement that is most often thin. Although thick rim enhancement is seen with some bacterial and fungal infections.

Neurocysticercosis cysts in the CSF (racemose neurocysticercosis) can have individual cysts that are very similar in appearance to an arachnoid cyst, but these cysts are very likely multiloculated. In cases of neurocysticercosis, there are very likely other findings indicating neurocysticercosis on brain imaging, in history, and by immunology workup. Usually, with neurocysticercosis, there are brain lesions with calcifications.

CT cisternography and MRI cisternography can be performed to confirm a diagnosis and to further evaluate an arachnoid cyst. In CT cisternography, a neuro safe non-ionic iodinated contrast is injected intrathecally, and then dynamic CT images of the arachnoid cyst are obtained. The amount of filling and the time it takes to fill the cyst can be utilized to guide management. Cysts that fill completely and early are considered freely communicating and may not need to be treated.[31] 

MRI cisternography can be performed without contrast or with contrast. Intrathecal contrast-enhanced MRI cisternography has classically been thought to offer the advantage of demonstrating the connection of the arachnoid cyst with the surrounding CSF space. The MRI non-contrast techniques – constructive interference in steady-state (CISS), fast imaging employing steady-state acquisition (FIESTA), and 3D T2-weighted sampling perfection with application-optimized contrast with different flip-angle evolutions (3D SPACE) – demonstrate the arachnoid cyst wall and demonstrate surrounding structures including cranial nerves and vessels. Clear demonstration of the surrounding structures can help decrease surgical morbidities. The 3D SPACE technique is useful for demonstrating a connection to the CSF space. The 3D SPACE demonstrates signal loss in areas of CSF flow, and these areas of signal loss from flow highlight the connection of the cyst and the CSF space.

In a similar fashion, phase-contrast MRI can be utilized to evaluate for a CSF connection to an arachnoid cyst. The flowing CSF is specifically demonstrated as a signal change on phase contrast. However, secondary to false positives, a connection needs to be confirmed with contrast MR cisternography.[32]

The radiologist needs to evaluate the brain structures for mass effect secondary to the arachnoid cyst. This might be for a subtle mass effect on a cranial nerve or a prominent mass effect resulting in brain herniation. The final analysis of the arachnoid cyst should only be made after obtaining an accurate history from the clinician. An accurate history will assure that the radiology report properly reflects information about pertinent cranial nerve or vascular structures that are being clinically affected by the arachnoid cyst. The radiologist also needs to be proactive when there is a cyst in a critical location that is causing hydrocephalus or if a large cyst is present that is resulting in mass effect and brain herniation. In these situations, the ordering clinician needs to be called, or a neurosurgeon needs to be called directly.

Treatment / Management

The vast majority of cases of arachnoid cysts need no treatment. In cases when it has been determined that an arachnoid cyst is causing or is very likely causing symptoms, numerous surgical treatments exist. The surgical approach is often dictated by the location of the cyst and the involvement or lack of involvement of surrounding neurological structures. Surgical excision of the wall is performed with the creation of communication with the subarachnoid space when the lesion is readily amendable.[21][31] Also, surgical fenestration or endoscopic fenestration (opening of the cyst cavity into the closest part of the ventricular system) is utilized. [23][24][29][30] 

Rarely, the placement of a cystoperitoneal shunt is done.[24][33] Shunting is avoided when possible due to the complications that can arise with long-term shunt placement. Unusual treatments are undertaken with unusual locations of the cyst, such as percutaneous aspiration through the foramen ovale.[16] Surgery is almost always curative, but recurrences have been reported.[34] When significant hydrocephalus or mass effect is present, emergency treatment could be needed.

Differential Diagnosis

The differential diagnosis for an arachnoid cyst includes epidermoid cyst, dermoid cyst, abscess, and other cysts such as cystic neurocysticercosis. The differential is defined predominantly on the basis of the radiological evaluation.

Prognosis

In the vast majority of cases, no treatment is necessary. When needed, surgery is almost always curative, but recurrences have been reported.[34]

Complications

There are usually no complications of an arachnoid cyst. If there is a rare complication from the arachnoid cyst, it is dependent on the location and what anatomical structure is distorted by the arachnoid cyst. A ruptured arachnoid cyst can also cause subdural hygromas or subdural hematomas that need to be treated.

Deterrence and Patient Education

Patients need to be informed that the vast majority of arachnoid cysts are incidental and no treatment is necessary. Only in rare situations does the arachnoid cyst result in the need for treatment.

Pearls and Other Issues

• Arachnoid cysts are relatively common, and most are incidental.

• The most common locations for arachnoid cysts are in the anterior, middle cranial fossa, and in the retrocerebellar cistern.

• The arachnoid cyst should have a thin wall and no enhancement.

• The fluid in an arachnoid cyst should follow fluid density on CT and fluid intensities on MRI.

Enhancing Healthcare Team Outcomes

The vast majority of arachnoid cysts are incidental, and no special communication needs to take place outside of the radiology report. In very rare cases when the arachnoid cyst is causing significant mass effect, hydrocephalus, or has ruptured and resulted in a significant subdural hygroma or hematoma, the radiologist will need to emergently call the referring clinician or a neurosurgeon. The patient may need to go to an emergency department and be evaluated. [Level 5]

Review Questions

• Access free multiple choice questions on this topic.

• Comment on this article.

References

1.

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Disclosure: Matthew White declares no relevant financial relationships with ineligible companies.

Disclosure: Joe M Das declares no relevant financial relationships with ineligible companies.

Removal of an ovarian cyst: methods of treatment and preparation for surgery

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👉 How is the removal of an ovarian cyst carried out and by what methods? You will find the answer in our article! ✔ Modern equipment. ✔ Experienced professionals. ✔ Affordable prices. ☎ +7 (495) 181-04-49!

Author

Zhanna Danilovna Novakhova

Posted

08/04/2022

Updated

12/16/2022

• Contents
• Ovarian cyst: What is it?
• Types of cysts
• Causes of occurrence
• Indications for removal
• Contraindications for removal
• Methods for removal of an ovarian cyst
• Preparation for removal of an ovarian cyst
• How is the surgical removal of an ovarian cyst performed?
• Postoperative period

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Ovarian cyst: What is it?

A benign neoplasm appears in the ovary. It consists of a shell with fuzzy edges, which is filled with liquid. The cyst can be detected with the following complaints:

• severe premenstrual syndrome: mood swings, headaches can be caused by hormonal changes;
• pain during intercourse;
• failure of the menstrual cycle.

Not all cysts give clear symptoms. So, the follicular is well palpable on palpation and reaches a size of 3-8 cm, but it does not cause discomfort.

Luteal cysts also do not manifest themselves in numerous symptoms. Sometimes patients complain of unusual pain during menstruation or a delay, but no more. Such neoplasms, like follicular ones, pass on their own.

Cyst types

There are the following types of cysts.

1. Functional. In the risk group of women of childbearing age, less often a functional cyst appears at the age of 40-50 years. Occurs with hormonal failure, when the process of ovulation is disturbed. The egg sac does not dissolve to release the egg, as happens with normal ovulation. Instead, it persists and gradually increases in size. Doesn’t pose a threat. Functional dissolves itself within 2-3 menstrual cycles. The process takes place gradually: first, the neoplasm decreases in volume, and then completely disappears.
2. Organic. It is considered a pathology, since it does not resolve itself. The main difference from the functional one is a denser wall and a different filling: there can be more than just liquid inside. To get rid of such a tumor, it is necessary to perform an operation to remove it. Doctors in this case try to preserve intact tissue as much as possible.

Several subtypes of the described cysts have been identified. Each species has its own characteristics, so the possible risk to a woman’s health is different.

1. Hemorrhagic. Formed when a follicular cyst bursts. Leads to internal hemorrhage. In turn, hemorrhagic tumors are divided into two subtypes: endometrioid and dermoid. The first arise as a result of the fact that the endometrium grows inside the ovary. The edges of such neoplasms are fuzzy, and there are foci of hemorrhage inside the walls. Dermoid appear as a result of violations of the development of the embryo. The reproductive cells that form the sex organs end up in the ovary. As a result, particles of hair and teeth can be found in the cyst.
2. True. Tumors consisting of epithelial particles of the ovary. They can be benign, borderline, or malignant. There are mucinous, serous and germinogenic neoplasms. The first reach considerable sizes, differ in an uneven surface. The latter consist of serous epithelium and are often benign. The reason for the appearance of the latter, germinogenic, is in the primary germ cells. They mutate, develop abnormally, and lead to borderline or malignant tumors.

If there are many neoplasms, and they form a whole cluster, they speak of polycystic ovaries. The main reason why this occurs is due to insulin resistance. This means that the body does not absorb insulin and glucose. With an increase in insulin, a negative effect on the ovaries occurs. As a result, the production of androgens, male hormones, increases. Their excessive amount prevents follicles from developing. Because of this, the release of the egg from the ovary does not occur, and unruptured follicles form sacs with liquid.

Causes

There are certain risk factors that lead to the development of pathology. Neoplasms may appear due to:

• inflammation in the appendages;
• malnutrition, diets;
• physical activity;
• prolonged stress;
• frequent abortions;
• taking hormonal drugs, for example, oral contraceptives;
• preparation for IVF, during which hormonal preparations are also taken.

Indications for disposal

If the tumor does not disappear on its own within 3 menstrual cycles, it is removed. If surgery is not performed, the neoplasm will lead to inflammatory processes or polycystic disease. Also, an operation to remove an ovarian cyst is prescribed if

• the neoplasm reaches a large size – more than 10 cm;
• there is severe discomfort during intercourse or urination;
• a neoplasm appears during menopause – in this case, a tumor is not a violation of the ovulation process, but a dangerous pathology.

How is an ovarian cyst removed? Often the operation is carried out as planned. But if there is a risk of rupture, removal is necessary urgently, on the day the patient complains. Otherwise, damage to the ovary and tube is possible – in case of inflammation from a ruptured tumor, they will have to be removed.

Contraindications for removal

Removal of an ovarian cyst by laparoscopy is contraindicated in:

• obesity of 3-4 degrees – an increased fat layer will interfere with the operation and the introduction of a laparoscope;
• high risk of stroke or heart attack when there are chronic pathologies;
• infectious process, inflammation in the abdominal cavity;
• massive bleeding;
• malignancy – the process in which a benign tumor becomes malignant; in this case, laparoscopy is rarely used and only for biopsy;
• violation of blood clotting – during surgical intervention, this can result in massive blood loss and even death;
• extensive adhesive process, the laparoscope camera will not be able to capture the problem area.

Sometimes patients insist on surgery because they do not want to wait until the tumor disappears. However, doctors recommend waiting 3 months and not making hasty decisions. In most cases, the problem can be solved with medication, with the help of hormonal drugs.

Ovarian cyst removal methods

If expectant management is not possible, and drug therapy does not help, resort to surgical intervention. This method of getting rid of neoplasms is effective when:

• there was a torsion of the legs of the ovarian cyst – dangerous to health, causes severe pain;
• a hemorrhagic tumor – a rupture of the tumor has occurred;
• it is necessary to prevent the development of oncology, for example, if there is a genetic predisposition.

The method of treatment will be selected based on the age of the patient and the clinical picture. If the patient is of reproductive age, preference is given to those methods of removal that will preserve the organs. Enucleation is often chosen, that is, the dissection of ovarian tissue without damaging the organ. The tumor capsule is removed without opening. This allows you to get rid of the neoplasm so that the contents do not enter the abdominal cavity. If this happens, tissue infection will begin.

For menopausal patients, laparoscopic removal of an ovarian cyst is performed by adnexectomy. This is a radical removal of the organ along with the tube. After the operation, biomaterials are sent for a biopsy to check the risk of developing oncology.

But the most popular method of getting rid of tumors is standard laparoscopy. During the procedure, punctures are made in the anterior abdominal wall. The process is controlled by a video camera.

Preparation for ovarian cyst removal

Often patients are interested in what tests are needed when removing an ovarian cyst. Preparation for the operation begins with a consultation with a gynecologist. On-site examination will reveal what tests and diagnostics will be required. So, usually preparation for laparoscopy implies the following.

1. Collection of patient data. The physician must know the history. This will help identify other problems in the reproductive system that led to the development of pathology. Perhaps the appearance of the tumor was provoked by injuries, hypothermia, hormonal disorders.
2. Palpation, manual examination. The tumor is palpated through the abdominal wall. The shape, size, position is determined. Palpation can also determine the density of the neoplasm. This information will help in choosing treatment tactics.
3. Ultrasound of the pelvis. Manual examination is not enough for diagnosis, many details will become known only after an ultrasound examination.
4. Colposcopy. For this, an optical device called a colposcope is used. It not only allows you to learn more about the pathology, but also helps to identify changes in the genital tract that have arisen due to neoplasms.
5. Fluorography. Often, with malignant tumors in the ovaries, metastases appear in other organs. For example, in the mammary glands or lungs. Fluorography will determine whether there is a risk of developing oncology or not.
6. Blood tests. Diagnosis is carried out using general, biochemical, histological analyzes. It is also necessary to determine the prothrombin time – an assessment of clotting. It is equally important to check the patient for infectious diseases.

How is the surgical removal of an ovarian cyst performed?

Removal of an ovarian cyst in women takes place in several stages.

1. The anesthesiologist performs general anesthesia. The doctor will monitor the patient’s condition throughout the procedure.
2. Carbon dioxide is injected into the abdominal cavity. Due to this, the wall rises so that the surgeon has a maximum view of the organs.
3. Small incisions are made on the skin of the abdomen. Their size does not exceed 2 cm. In total, up to 4 incisions are made.
4. Through the slots made, a device for installing the camera is inserted into the cavity.
5. The tumor is removed, and internal sutures are placed at the incision site.
6. The neoplasm is placed in a special container, then to be transferred for histological examination.

With resection or removal of the ovary, the steps of the procedure are the same. With one exception, the neoplasm is removed along with the affected organ.

Postoperative period

How long to stay in the hospital after removal of an ovarian cyst? The postoperative period lasts 2-3 days. On the first day, the patient takes painkillers as prescribed by the doctor. If necessary, an additional course of antibiotics is administered. You can get out of bed on the day of the operation, but not earlier than after 5 hours. If there are no complications, the patient is discharged 2 days after laparoscopy. The stitches are removed after a week.

Important! Until the start of the next cycle, it is not recommended to lift weights, expose yourself to significant physical exertion and have sex.

Depending on the patient’s condition, the doctor may prescribe a special diet. It excludes heavy, fatty foods and alcoholic beverages. Preference is given to broths, fermented milk products, cereals. It is also recommended to adhere to fractional nutrition – eat at least 5 times a day small portions.

Author

Zhanna Danilovna Novakhova

Obstetrician-gynecologist

Experience 22 years

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causes, symptoms, treatment of right or left ovarian cyst in a child

The disease is cured by:
Pediatric gynecologist

Article content

• Types of cysts
• Causes of ovarian cysts in teenagers
• Symptoms
• Possible complications
• How diagnostics is carried out
• Treatment of ovarian cyst in children

An ovarian cyst is a benign neoplasm, a tumor in the form of a capsule. It is filled with liquid. Its dimensions are from 1–2 to 20 cm or more. Such neoplasms are common. They often appear in adult women, but can also occur in children. Most cysts are formed in girls aged 12-15 years. This is due to hormonal changes during puberty. Also, tumors can appear at an earlier age. Most often this is not dangerous, but the condition of the ovaries must be monitored to rule out complications. To do this, you need to contact a gynecologist.

Types of cysts

Depending on the causes of appearance, functional and organic cysts are distinguished. Functional are formed in violation of menstrual function, due to a failure of the menstrual cycle. In girls at puberty, they are most common. Organic cysts are not associated with hormonal changes. For them, there is a risk of malignancy. They are much less common.

There are the following main types of cysts:

• follicular;
• cyst of the corpus luteum, or luteal;
• dermoid;
• paraovarian.

In adolescent girls, cysts are more likely to develop on the right ovary and are follicular or luteal.

The follicular cyst is formed when the maturation of the egg is disrupted. If the follicle with the egg inside does not break, fluid begins to accumulate inside it. If its dimensions remain small (up to 5 cm), it is not dangerous. Most often, such neoplasms resolve in several menstrual cycles. If the tumor is large, there is a risk of complications, and therefore surgical treatment is necessary.

The luteal cyst is formed after ovulation at the site of the follicle. This is associated with excessive synthesis of luteotropic hormone. Such tumors most often do not require treatment and resolve on their own.

A newborn girl may have a congenital dermoid cyst. Inside it is not a liquid, but tissue fragments. It is removed surgically.

Paraovarian cysts form on the ovaries. They can be very large, up to 20–30 cm in diameter. Surgical treatment: such tumors do not resolve.

Causes of ovarian cysts in adolescents

A cyst in a teenager is formed due to hormonal disorders. There are several factors that can provoke them:

• acute or chronic infection;
• malnutrition;
• excess weight;
• hormone therapy;
• early menarche;
• thyroid disease;
• diabetes;
• excessive physical activity;
• stress;
• hypothermia;
• hereditary predisposition.

It is important to consult a gynecologist and undergo a diagnosis in order to accurately determine the causes of the formation of tumors. This will influence the choice of treatment.

Symptoms

When a cyst forms in a child, the following symptoms are possible:

• constant or paroxysmal, pulling or sharp pain in the lower abdomen;
• increased pain after exercise;
• disruption of the menstrual cycle;
• the appearance of spotting in the middle of the cycle;
• if the tumor is large, it can be felt in the abdomen.

Significant symptoms are not always present. Sometimes, despite the appearance of neoplasms, the state of health and the menstrual cycle remain normal. In this case, a tumor can be diagnosed only during a routine examination by a gynecologist.

Possible complications

The cyst may become inflamed, twisted, or ruptured. The risk of torsion or rupture is greatly increased after injury, sports, or heavy lifting.

If complications develop, symptoms worsen:

• The pain in the lower abdomen becomes acute.
• The body temperature rises.
• Possible nausea, dizziness.

The rupture is accompanied by internal bleeding. Its symptoms are abdominal pain, weakness, low blood pressure, pallor, chills, fainting. This condition is life threatening. You need to see a doctor as soon as possible.

If the pedicle of the tumor is twisted, the state of health deteriorates sharply:

• sharp pain appears in the lower abdomen;
• abdominal muscles become tense;
• the abdomen may become bloated;
• possible diarrhea or constipation;
• frequent or difficult urination;
• temperature rise is possible.

Both with torsion and rupture, pain occurs on the side where the neoplasm is located. That is, if there are complications of the cyst Source:
Innovative development of professional competencies in the diagnosis and surgical treatment of various types of complicated ovarian cysts in girls and adolescents (a review of domestic and foreign scientific and practical experience). Kiselev M.A., Kiselev A.S. Sechenovsky Bulletin No. 3 (21), 2015. p. 8-17 of the left ovary, it will hurt on the left. If the neoplasm is on the right, then the pain will be on the right side.

For organic cysts, there is a risk of malignancy when a benign tumor becomes malignant. To avoid this, the state of the neoplasm is controlled. If it does not resolve or grows rapidly, it is removed.

How diagnostics is carried out

If the menstrual cycle is disturbed, and there are often pains in the lower abdomen, you need to contact a gynecologist. He will inspect and diagnose. Source:
Features of differential diagnosis of ovarian tumors in girls. Adamyan L.V., Koltunov I.E., Sibirskaya E.V., Sharkov S.M., Korotkova S.A., Moksyakova E.G., Movsesyan E.Kh. Pediatric Surgery No. 22(4), 2018. pp. 205-208.

Teenage girls need regular preventive examinations by a gynecologist, even if there are no warning signs. With the formation of an ovarian cyst, symptoms do not always appear, but even with an asymptomatic course, the gynecologist will be able to identify it. This is important in order to control the condition of the tumor and exclude complications.

The following examinations are prescribed for diagnostics:

• Clinical blood test.
• Ultrasound of the pelvic organs.
• Puncture of the tumor with ultrasound control – sampling of the contents of the neoplasm for laboratory research.
• Diagnostic laparoscopy is a visual examination of neoplasms.

Most often, an examination by a gynecologist and ultrasound of the pelvic organs is sufficient. The doctor prescribes additional studies if there is a risk of complications, if the neoplasm needs to be removed.

Treatment of ovarian cysts in children

After diagnosis, the gynecologist will prescribe treatment taking into account age, health status, symptoms, and characteristics of the neoplasm.

Adolescents often do not require treatment Source:
Optimization of management tactics for patients with functional ovarian cysts. Khodjaeva A.S. Reproductive Health of Children and Adolescents, Volume 15, No. 1, 2019. pp. 30-34, if the tumor appears due to hormonal failure during puberty. In this case, it is sufficient to control the condition and size of the neoplasm. If the cyst is follicular or luteal, it may resolve in a few menstrual cycles. The doctor will give recommendations for the period while this is happening. It is usually enough to limit physical activity.

Treatment is prescribed if the tumor grows, if there is severe pain, or if new tumors often appear. How to treat an ovarian cyst, the doctor decides. There are two options:

• drug therapy;
• surgical intervention.

With drug treatment, painkillers and anti-inflammatory drugs are prescribed, if there are indications for this. Also, the gynecologist may prescribe hormonal contraceptives. It is important that the doctor determines the drug and its dosage. Do not try to self-select drugs. This is dangerous with new hormonal disruptions and other complications.

Surgical intervention is carried out with complications or if there is a risk of them. Laparoscopy is performed to remove the tumor. This is a minimally invasive intervention that allows you to remove the neoplasm while preserving the ovary. Children rarely require surgical treatment. Most often, simple observation and drug therapy are sufficient to relieve symptoms.

One of the goals of treatment is to exclude the appearance of new neoplasms. This requires the prevention of hormonal disruptions. The gynecologist will give recommendations to reduce their risk. For this you need:

• Healthy food;
• control weight, prevent obesity;
• eliminate stress;
• treat all infectious diseases in time;
• avoid hypothermia;
• take any medications only as prescribed by a doctor and in the dosages recommended by him.

This will help restore normal hormonal levels and reduce the likelihood of ovarian cysts in the future.

Article sources:

1. Optimization of management tactics for patients with functional ovarian cysts. Khodjaeva A.S. Reproductive Health of Children and Adolescents, Vol. 15, No. 1, 2019. p.30-34
2. Innovative development of professional competencies in the diagnosis and surgical treatment of various types of complicated ovarian cysts in girls and adolescents (a review of domestic and foreign scientific and practical experience). Kiselev M.