Cases reported "Cysts"

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1/14. Macrocystic serous adenoma of the pancreas.

    Macrocystic serous adenoma of the pancreas (MSAP) is a rare neoplasm. Its preoperative diagnosis by physical examination and imaging studies is challenging, if not impossible. In recent years, a few cases of MSAP with correct cytodiagnosis by transabdominal fine-needle aspiration (TFNA) have been documented. This paper reports two cases of MSAP that were successfully diagnosed by TFNA cytology. Two adult women presented with epigastric discomfort. Abdominal imaging studies revealed a large pancreatic cystic lesion in both cases. TFNAs of the pancreatic lesions were subsequently performed and revealed a clear serous fluid containing small monolayered sheets of benign cuboidal epithelial cells with scant, clear or granular cytoplasm, vesicular nuclei and micronucleoli. The cell cytoplasm stained positively with periodic acid-Schiff (PAS) and negatively with PAS with prior digestion with diastase (PASD). The cytological findings in both cases were similar and suggested a serous cystadenoma. The two pancreatic lesions were removed by Whipple's operation. They showed features of a macrocystic serous adenoma of the pancreas that were characterized by a small number of large cystic cavities lined by a single layer of non-mucus secreting, PAS-positive and PASD-negative cuboidal epithelial cells. By electron microscopy, the epithelial lining cells showed short and aborted apical microvilli, well-formed desmosomes and a large amount of intracytoplasmic glycogen, suggesting a centroacinar ductal cell origin.
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2/14. adenomatoid tumor of the adrenal gland: a clinicopathologic study of 3 cases.

    Adenomatoid tumors are relatively uncommon benign neoplasms of mesothelial origin, usually occurring in the male and female genital tracts. Rare extragenital adenomatoid tumors have been identified in the adrenal glands, heart, mesentery, pleura, and lymph nodes. In the adrenal gland, adenomatoid tumors may pose a diagnostic challenge. The differential diagnosis includes adrenocortical carcinoma and metastatic carcinoma, especially signet ring cell carcinoma. Because of its glandular pattern, an adenomatoid tumor may be confused with an adenocarcinoma. We present 3 cases of adrenal adenomatoid tumors, including one with a concurrent large hemorrhagic vascular adrenal cyst. The adenomatoid tumors were unilateral, appeared solid and white, and varied from 1.7 to 4.2 cm in diameter. They occurred in 3 male patients aged 33, 33, and 46 years. One patient presented with abdominal pain due to the presence of a concurrent large adrenal cyst. The tumor was an incidental radiological finding in another case and was discovered during the course of a workup for hypertension in the third case. The light microscopic appearances were consistent with those of typical adenomatoid tumors. Immunohistochemical stains for calretinin and cytokeratin 5/6 were positive, confirming the tumors' mesothelial origin. Ultrastructural studies performed in 2 cases revealed microvilli and desmosomes. Follow-up showed no evidence of recurrence or metastasis. In our experience, the key to the diagnosis of this rare benign tumor is to consider adenomatoid tumor in the differential diagnosis of any glandular tumor occurring in the adrenal gland.
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3/14. Cystic adenomatoid tumor of the uterus.

    We describe a case of cystic adenomatoid tumor of the uterus in a 38-year-old woman. The tumor was a subserosal cystic mass with a maximum diameter of 8 cm and located at the posterior wall of the right cornual region. Histologically, the tumor was composed of multiple cavities lined by flattened cells, lying among thin septa of connective tissue. The neoplasm showed small solid areas with a more typical histologic pattern of adenomatoid tumor. Immunohistochemical techniques showed the cells to be positive for keratins. They showed desmosomes, abundant intracytoplasmic filaments, and microvilli on ultrastructural study. The histologic, immunohistochemical, and ultrastructural characteristics of the present case closely resemble those of benign cystic mesothelioma and strongly support the mesothelial origin of the adenomatoid tumor of the uterus.
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4/14. Subarachnoid epithelial cyst of the cerebellum. Immunohistochemical and ultrastructural studies.

    This report describes the immunohistochemical and ultrastructural studies of a subarachnoid epithelial cyst of the cerebellum found incidentally at autopsy of a 76-year-old man. The cyst was composed of an inner epithelial layer, a middle connective tissue layer and an outer arachnoid membrane. The epithelial layer was strongly positive for cytokeratin, carcinoembryonic antigen and epithelial membrane antigen, but negative for glial fibrillary acidic protein, S-100 protein, neuron-specific enolase and vimentin. Ultrastructurally, the epithelial layer had four distinct types of cells: ciliated cells, non-ciliated cells with coated microvilli, basal cells with tonofilaments and desmosomes, and cells with dense-core secretory granules (Kulchitsky cells). The latter two types of cells have not been described previously in epithelial cysts of the CNS. The lining epithelium closely resembled the upper respiratory epithelium. The findings suggest that the cyst was of endodermal rather than neuroectodermal origin.
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5/14. epithelium-lined cyst of the pretectal region: case report and electron microscope study.

    Ultrastructural findings of an epithelium-lined cyst in the left pretectal region are reported. A 38-year-old woman developed a sensory disturbance on her right side and blurring of vision. Computed tomography scans and magnetic resonance images disclosed a round cystic lesion in the left pretectum. light microscopically, the cyst was found to be lined by a single layer of cuboidal epithelial cells. Electron microscope examination revealed that the epithelial cells of the cyst possessed clear nuclei, abundant tonofilaments, and glycogen granules, featured as well as the usual organellae. The free surface of the epithelial cells had numerous finger-like microvilli with coating materials. These cells were interconnected by well-developed desmosomes and interdigitations, and also possessed basal lamina materials on the basal surface. These cytological features suggest a heterogenous origin of the cells rather than a neuroepithelial one.
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6/14. Intraparenchymal epithelial (enterogenous) cyst of the medulla oblongata.

    Intraparenchymal solitary cyst of the medulla oblongata was diagnosed on MRI examination in a 66-year-old woman with a nine year history of progressive brainstem dysfunction and three negative CT scan examinations. craniotomy and drainage of the cyst to the IVth ventricle led to remarkable clinical recovery. biopsy of the wall of the cyst revealed an epithelial lining with tonofilaments, desmosomes and surface coating on ultrastructural examination. immunohistochemistry demonstrated positive reactions of epithelium for keratins, cytokeratins, epithelial membrane antigen and ulex Europeus lectin, indicating endodermal origin of the cyst.
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7/14. Spontaneous intrastromal iris cyst. A case report with immunohistochemical and ultrastructural observations.

    A 39-year-old man had an enlarging intrastromal iris cyst that obstructed the chamber angle inferotemporally and abutted the cornea. No history of ocular trauma or previous surgery was present. Iridocyclectomy with en bloc resection of the cyst was performed. The cyst was lined by one to three cell layers of focally pigmented epithelium that ultrastructurally exhibited desmosomes, tonofilaments, terminal bars, and apical microvilli. Additionally, membrane-bound melanin granules (melanosomal complexes) consistent with phagocytized uveal melanin granules were observed. immunohistochemistry confirmed intracellular keratin. We conclude that the non-traumatic cyst reported herein is of surface ectodermal origin and suggest that such cysts be removed en bloc by sector iridectomy or iridocyclectomy if the lesion has been proven to enlarge.
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8/14. Trichilemmal keratosis (horn): a light and electron microscopic study.

    Three cases of trichilemmal keratosis (horn) were light microscopically examined and all showed numbers of U- or V-shaped epidermal proliferations which keratinized in a fashion either identical or similar to trichilemmal keratinization. Electron microscopy revealed both uneven and linear borders between the keratinized and the keratinizing cells with a few keratohyalin droplets, remnants of desmosomes, no marginal band in the horny layer, perinuclear vacuolation, few spherical bodies in the intercellular spaces (ICS) of the upper epidermis, and widening of the ICS of the lower epidermis. A number of electron dense spherical particles, 40-50 nm in diameter, were observed in nuclei of the upper epidermis. This suggests that ultrastructure of trichilemmal keratosis is similar rather to viral warts than to trichilemmal cysts, although there are close similarities between trichilemmal keratosis and cyst.
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9/14. Proliferating trichilemmal cyst: an ultrastructural study.

    A 73-year-old woman had a walnut-sized tumor in the occipital region for 10 years. The growth consisted of multiple small and large cystic epithelial masses. The cyst wall exhibited trichilemmal keratinization. Numerous squamous eddies as well as many glycogen-rich cells were present in the cyst wall. Some small round keratohyalin granules were observed in the cells below the horny layer. The desmosomes and masses of lipid droplets were seen in the horny layer. The findings described above are similar to those observed in the follicular isthmus and the follicular infundibulum. Other interesting findings include the presence of intranuclear inclusions of tonofilament-like material and/or keratohyalin-like granules within the cells near the mid-layer of the cyst wall.
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10/14. Epibulbar mucogenic subconjunctival cysts.

    Two patients had freely movable epibulbar subconjunctival cysts that occurred in the absence of trauma, inflammation, and infection. Histopathologic examination of these cysts revealed them to be linked by nonkeratinizing epithelial cells and goblet cells. The cysts had little or no stroma and contained PAS-positive mucoid material. Electron microscopy of adjacent conjunctiva indicated that the epithelial cells were actively producing mucous granules and did not form many hemidesmosomes. The mechanical displacement of epithelial cells, as well as their mucous-producing ability, probably contribute to cyst formation. The relative lack of hemidesmosomes may explain why these cysts are freely movable.
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