Evaluating the prognostic significance of biomarkers in pancreatic cyst fluid,accessed through endoscopic ultrasound-guided fine-needle aspiration,is essential for improving the clinical management of pancreatic cysts...Evaluating the prognostic significance of biomarkers in pancreatic cyst fluid,accessed through endoscopic ultrasound-guided fine-needle aspiration,is essential for improving the clinical management of pancreatic cysts.This review synthesizes the evidence from studies published on the field in the last years,focusing on the accuracy and clinical utility of biomarkers such as carcinoembryonic antigen,intracystic glucose,and novel genetic markers including DNA mutation analysis.Our findings indicate that elevated carcinoembryonic antigen levels and decreased intra-cystic glucose levels are strongly associated with mucinous cysts which carry a higher malignancy risk,while DNA mutation analysis has shown increased predictive accuracy for identifying malignant transformations.Integrating these biomarkers with imaging techniques enhances risk stratification and can significantly influence therapeutic decisions.The review highlights the need for standardization of biomarker assays and further validation of biomarker panels to refine their prognostic value in clinical settings,ultimately aiding in the tailored management of patients with pancreatic cysts.展开更多
Introduction Choledochal cysts(CCs)are cystic dilatations of the intrahepatic and/or extrahepatic biliary ducts that affect primarily female infants[1-3].CCs vary markedly in incidence worldwide:the incidence is appro...Introduction Choledochal cysts(CCs)are cystic dilatations of the intrahepatic and/or extrahepatic biliary ducts that affect primarily female infants[1-3].CCs vary markedly in incidence worldwide:the incidence is approximately 1 in 100,000 to 1 in 150,000 live births in Western countries and 1 in 1,000 people in Asian countries[4].展开更多
BACKGROUND Liver hydatid cysts(LHC)liver requires effective surgical treatment.Open closed total pericystectomy removes the entire echinococcus cyst while preserving healthy liver tissue.AIM To evaluate the outcomes o...BACKGROUND Liver hydatid cysts(LHC)liver requires effective surgical treatment.Open closed total pericystectomy removes the entire echinococcus cyst while preserving healthy liver tissue.AIM To evaluate the outcomes of pericystectomy and its efficacy as a treatment modality for cystic echinococcosis(CE).METHODS Thirty-eight patients were analyzed after open total pericystectomy at the University Hospital of Cologne between January 2006 and January 2024.Demographic,clinical,and laboratory parameters were collected retrospectively.Intraoperative data and postoperative complications were documented and classified using the Clavien-Dindo classification.Throughout the follow-up period,patients underwent regular clinical,serological,and sonographic evaluations both at the outpatient department and by their general physicians.RESULTS Fifty-four cysts were treated with open total pericystectomy.Multiple cysts were found in 42.2%of cases.Singular cysts occurred in 57.8%.The right hepatic lobe was affected in 66.7%.Ectopic cysts occurred in 4 patients in the lung(n=3)and spleen(n=1).Median cyst size was 6.78 cm×5.92 cm(range:1.4-20.0 cm).The median surgical time of pericystectomy was 189 minutes(range:78-455 minutes)with a median blood loss of 400 mL(range:100-1400 mL).The complication rate(Clavien-Dindo>III)was 21.1%.The average hospital stay was 12.5 days.No recurrent disease could be detected after a median follow-up time of 97 months(range:4-216 months).No recurrent cyst manifestation,postoperative liver failure or death was observed.CONCLUSION The presented surgical procedure known as open total pericystectomy is a safe surgical technique in treatment of cystic echinococcosis.展开更多
BACKGROUND Pancreatic cystic neoplasms(PCNs)are increasingly detected due to advancements in radiographic techniques,with a prevalence of approximately 15%in the general population.These lesions range from benign to p...BACKGROUND Pancreatic cystic neoplasms(PCNs)are increasingly detected due to advancements in radiographic techniques,with a prevalence of approximately 15%in the general population.These lesions range from benign to premalignant and malignant,posing a diagnostic challenge.Accurate differentiation is critical,as premalignant and malignant PCNs often require surgical intervention,while benign cysts may only need monitoring unless symptomatic.Current diagnostic methods,including cross-sectional imaging,endoscopic ultrasonography,and endoscopic ultrasonography-guided fine-needle aspiration/biopsy,are specialized,not universally available,and have variable accuracy.Clinical and laboratory parameters such as carbohydrate antigen 19-9(CA 19-9),neutrophillymphocyte ratio,platelet-lymphocyte ratio,and red cell distribution width(RDW)have been associated with malignancy risk,though only CA 19-9 is guideline-supported.AIM To assess the malignancy risk of PCNs using preoperative clinical and routine laboratory parameters.METHODS A retrospective cohort study analyzed 70 patients who underwent surgery for PCNs at Ankara Bilkent City Hospital between February 2019 and March 2023.Patients were categorized into group A(benign or low-grade dysplasia,n=40)and group B(malignancy or high-grade dysplasia,n=30)based on postoperative pathology.Preoperative demographic and laboratory parameters,including age,RDW,albumin,and CA 19-9,were compared.Univariate and multivariate logistic regression analyses identified independent predictors of malignancy.Receiver operating characteristic curve analysis evaluated predictive performance,with internal validation using bootstrapping.RESULTS Group B patients were older(69.86±9.58 years vs 52.74±16.85 years,P<0.001)and had a higher incidence of diabetes mellitus(57.1%vs 21.4%,P=0.002).RDW(16.2%vs 13.7%,P<0.001),platelet-lymphocyte ratio(178 vs 126,P=0.008),and CA 19-9(21.7 U/mL vs 9.3 U/mL,P=0.009)were significantly higher in group B,while albumin was lower(41 g/L vs 45 g/L,P=0.008).Multivariate analysis identified age[odds ratio=1.067,95%confidence interval(CI):1.014-1.122,P=0.012]and RDW(odds ratio=1.784,95%CI:1.172-2.715,P=0.007)as independent predictors.The area under the curve for age,RDW,and their combination was 0.798(95%CI:0.695-0.900),0.801(95%CI:0.692-0.911),and 0.858(95%CI:0.771-0.944),respectively,with bootstrapped validation confirming stability.Cut-off values of age≥60 years and RDW≥15.5%balanced sensitivity and specificity,increasing malignancy risk 15.3-fold and 22.6-fold,respectively.CONCLUSION Age and RDW are independent predictors of malignancy in PCNs,aiding in patient selection for advanced diagnostics and surgery.Larger,multicenter studies are needed to validate these findings.展开更多
Biliary cyst tumors(cystadenoma and cystadeno-carcinoma) are an indication for liver resection. They account for only 5% of all solitary cystic lesions of the liver,but differential diagnosis with multiloculated or co...Biliary cyst tumors(cystadenoma and cystadeno-carcinoma) are an indication for liver resection. They account for only 5% of all solitary cystic lesions of the liver,but differential diagnosis with multiloculated or complicated biliary cysts,atypical hemangiomas,hamartomas and lymphangiomas may be difficult. The most frequent challenge is to differentiate biliary cyst tumors from hemorrhagic cysts. Computerized tomography(CT) and magnetic resonance imaging(MRI) are often not diagnostic and in these cases fine needle aspiration(FNA) is used to confirm the presence of atypical biliary cells. FNA,however,lacks adequate sensitivity and specificity and should always be used in conjunction with imaging. Pre-operative differentiation of cystadenoma from cystadenocarcinoma is impossible and surgery must be performed if a biliary cyst tumor is suspected. When multiple cystic lesions are observed throughout the liver parenchyma,it is important to exclude liver metastasis,of which colonic cancer is the most common primary site. Multiple biliary hamartomas(von Meyenburg complex) can appear as a mixture of solid and cystic lesions and can be confused with cystic metastasis. Strong and uniform T2 hyperintensity on MRI is usually diagnostic,but occasionally a percutaneous biopsy may be required.展开更多
Cystic formations within the liver are a frequent finding among populations.Besides the common cystic lesions,like simple liver cysts,rare cystic liver lesions like cystadenocarcinoma should also be considered in the ...Cystic formations within the liver are a frequent finding among populations.Besides the common cystic lesions,like simple liver cysts,rare cystic liver lesions like cystadenocarcinoma should also be considered in the differential diagnosis.Thorough knowledge of each entity’s nature and course are key elements to successful treatment.Detailed search in PubMed,Cochrane Database,and international published literature regarding rare cystic liver lesions was carried out.In our research are included not only primary rare lesions like cystadenoma,hydatid cyst,and polycystic liver disease,but also secondary ones like metastasis from gastrointestinal stromal tumors lesions.Up-to date knowledge regarding diagnosis and management of rare cystic liver lesions is provided.A diagnostic and therapeutic algorithm is also proposed.The need for a multidisciplinary approach by a team including radiologists and surgeons familiar with liver cystic entities,diagnostic tools,and treatment modalities is stressed.Patients with cystic liver lesions must be carefully evaluated by a multidisciplinary team,in order to receive the most appropriate treatment,since many cystic liver lesions have a malignant potential and evolution.展开更多
Recently, a novel and distinct pancreatic cystic tumor termed 'mudnous nonneoplastic' cyst was described in the literature. We report our experience with a 71-year-old female with a cystic tumor in the body of...Recently, a novel and distinct pancreatic cystic tumor termed 'mudnous nonneoplastic' cyst was described in the literature. We report our experience with a 71-year-old female with a cystic tumor in the body of the pancreas demonstrating features suggestive of this diagnosis. We also review the literature regarding this 'novel' pathological entity and discuss critically its existence and its differential diagnoses.展开更多
Cystic lesions of the anterior mediastinum in children suggest a well-known group of benign lesions that are comparatively frequent.Thymic cysts(TCs)are mostly positioned in the anterior mediastinum and some patients ...Cystic lesions of the anterior mediastinum in children suggest a well-known group of benign lesions that are comparatively frequent.Thymic cysts(TCs)are mostly positioned in the anterior mediastinum and some patients in the neck.Benign TCs classified as congenital intra-thoracic mesothelial cysts are commonly asymptomatic and have slight clinical significance.Multilocular TC,which can mimic another anterior mediastinal cystic tumor and is seen in adults,is more clinically important.It is a sporadic mediastinal lesion thought to arise in the course of acquired inflammation.Congenital mediastinal cysts represent 3%-6%of all mediastinal tumors and 10%-18%of radiologically reported mediastinal masses.Mediastinal TCs are uncommon and it is hard to know their true incidence.About 60%of cases with mediastinal TCs are asymptomatic,and the remainder of patients complains of nonspecific symptoms(e.g.,chest pain,dyspnea,or cough).The literature suggests that most cysts are benign,but an indefinite percentage may have a neoplastic process and result in significant compressive symptoms over time.Clinical symptoms of TCs vary depending on the location.In addition,frequent symptoms at the appearance of enlarged benign thymic and mediastinal cysts generally contain compressive symptoms(e.g.,respiratory distress,thymic pain,and symptoms related to Horner syndrome,hoarseness,dysphonia,dyspnea,orthopnea,wheezing,and fever).Many TCs have cystic density and a neat border and are simple to diagnose with radiological imaging.However,some TCs are hard to identify before surgery and may be misidentified as thymomas depending on their site and computed tomography results.Excision by thoracotomy,median sternotomy,or video-assisted techniques is essential for conclusive diagnosis,management,and abolition of relapse of anterior mediastinal masses and TCs.Histopathologic examination may be required after surgery.Considering the extent of the mass and the preliminary inability to make a definitive diagnosis,en bloc excision of the cyst was thought to be preferred to circumvent likely complications(e.g.,perforation,spillage of the contents,or incomplete excision).展开更多
Harmful algal blooms(HABs)of dinoflagellates pose significant threats to aquaculture,marine ecosystems,and human health.While resting cysts have been well known for their vital roles in initiating HABs of dinoflagella...Harmful algal blooms(HABs)of dinoflagellates pose significant threats to aquaculture,marine ecosystems,and human health.While resting cysts have been well known for their vital roles in initiating HABs of dinoflagellates,mapping results of the cyst abundance and distribution in marine sediments have been also well documented to be a highly valuable predictor,and thus can be used as a basis to assess the risk of HABs.We attempted to establish a framework for the risk assessment of dinoflagellate HABs based mainly on cyst-mapping of marine sediments and a case application of it to the risk assessment of HABs in the Yellow Sea.In the framework,firstly,the targeted marine area subjected to the assessment was determined and gridded into different assessment units according to their geography,administration,and ecological or economic function.Secondly,the dinoflagellate cyst abundance from the surface sediment,HABs records,and the monitoring results of vegetative cells for all or particular species of concern were collected experimentally or by literature search,as three main indicators scored and weighted respectively with different values.The scoring and weighting process was based on scientific reasoning and empirical consideration as detailed in the text.Thirdly,the risk of HABs occurrences for all or any particular species of concern at each site was ranked with five levels according to the calculated risk values.Finally,the final evaluation results were presented with tables,matrix diagrams,and color-coded textual annotations on nautical charts.As a case application,we performed a risk assessment for HABs of target species in the Yellow Sea,which warned high risks of HABs for Karlodinium veneficum,Gymnodinium catenatum,and others.This assessment framework provides a practical and testable tool for all involved stakeholders,and subject to improvement along with the advancement of ecology of HABs.展开更多
INTRODUCTION Pericardial cysts are usually discovered inci-dentally,with an estimated incidence of approx-imately 1 in 100,000,and are more often locat-ed at the right cardiac diaphragmatic angle 1.
Objective:To consolidate the scarce and scattered evidence on oral cysticercosis,a rare and often overlooked manifestation of Taenia solium infection.Methods:A comprehensive literature search was conducted in three ma...Objective:To consolidate the scarce and scattered evidence on oral cysticercosis,a rare and often overlooked manifestation of Taenia solium infection.Methods:A comprehensive literature search was conducted in three major databases:PubMed,Scopus,and Embase.A total of 75 records were initially identified(PubMed:n=23;Scopus:n=29;Embase:n=23).After screening and eligibility assessment,22 studies meeting inclusion criteria were selected for final analysis.Results:Oral cysticercosis primarily involved the tongue,typically presenting as a painless swelling.The majority of reported cases were from India.Clinically,it was most often misdiagnosed as a mucocele or fibroma,with cysticercosis rarely considered due to its uncommon occurrence.Among the muscles affected,the masseter,mentalis,and buccinator were most frequently involved.Diagnosis was primarily made through histopathological examination.Treatment commonly included surgical excision,and albendazole was the most frequently used antiparasitic medication.Recurrence was uncommon,except in cases with disseminated or deep muscular involvement.Conclusions:Oral cysticercosis should be considered a potential differential diagnosis,particularly in regions where pork consumption is common.Given that most reported cases originated from India,pathologists in this region should maintain a high index of suspicion.Oral pathologists,in particular,should be well-acquainted with its histopathological features to ensure accurate diagnosis and avoid diagnostic pitfalls.展开更多
BACKGROUND Choledochal cysts(CC)and cystic biliary atresia(CBA)present similarly in early infancy but require different treatment approaches.While CC surgery can be delayed until 3-6 months of age in asymptomatic pati...BACKGROUND Choledochal cysts(CC)and cystic biliary atresia(CBA)present similarly in early infancy but require different treatment approaches.While CC surgery can be delayed until 3-6 months of age in asymptomatic patients,CBA requires intervention within 60 days to prevent cirrhosis.AIM To develop a diagnostic model for early differentiation between these conditions.METHODS A total of 319 patients with hepatic hilar cysts(<60 days old at surgery)were retrospectively analyzed;these patients were treated at three hospitals between 2011 and 2022.Clinical features including biochemical markers and ultrasonographic measurements were compared between CC(n=274)and CBA(n=45)groups.Least absolute shrinkage and selection operator regression identified key diagnostic features,and 11 machine learning models were developed and compared.RESULTS The CBA group showed higher levels of total bile acid,total bilirubin,γ-glutamyl transferase,aspartate aminotransferase,and alanine aminotransferase,and direct bilirubin,while longitudinal diameter of the cysts and transverse diameter of the cysts were larger in the CC group.The multilayer perceptron model demonstrated optimal performance with 95.8% accuracy,92.9% sensitivity,96.3% specificity,and an area under the curve of 0.990.Decision curve analysis confirmed its clinical utility.Based on the model,we developed user-friendly diagnostic software for clinical implementation.CONCLUSION Our machine learning approach differentiates CC from CBA in early infancy using routinely available clinical parameters.Early accurate diagnosis facilitates timely surgical intervention for CBA cases,potentially improving patient outcomes.展开更多
Background:Parathyroid cysts(PCs)are rare lesions that often resemble other cervical cystic conditions,making preoperative diagnosis challenging,especially in resource-limited settings.Methods:We report a case of a pa...Background:Parathyroid cysts(PCs)are rare lesions that often resemble other cervical cystic conditions,making preoperative diagnosis challenging,especially in resource-limited settings.Methods:We report a case of a parathyroid cyst diagnosed and treated at Chongqing University Fuling Hospital in 2020.Clinical presentation,imaging,cytological features,pathological fi ndings,diff erential diagnosis and management strategies were analyzed in conjunction with an updated review of the literature.Conclusion:PCs represent a rare subset of parathyroid lesions and are most often non-functioning.Their imaging and cytological characteristics frequently resemble those of thyroid cysts,which may lead to misdiagnosis.Mea-surement of parathyroid hormone levels in aspirated cyst fl uid is essential when a PC is suspected.Surgical excision remains the defi nitive treatment.This case underscores the diagnostic challenges and highlights the importance of heightened clinical awareness,particularly in primary and rural healthcare settings.展开更多
Nonparasitic hepatic cysts consist of a heterogeneous group of disorders, which differ in etiology, prevalence,and manifestations. With improving diagnostic techniques, hepatic cysts are becoming more common.Recent ad...Nonparasitic hepatic cysts consist of a heterogeneous group of disorders, which differ in etiology, prevalence,and manifestations. With improving diagnostic techniques, hepatic cysts are becoming more common.Recent advancements in minimally invasive technology created a new Era in the management of hepatic cystic disease. Herein, the most current recommendations for management of noninfectious hepatic cysts are described, thereby discussing differential diagnosis, new therapeutic modalities and outcomes.展开更多
Objective:Radicular cyst(RC),dentigerous cyst(DC),and odontogenic keratocyst(OKC)are most common odontogenic jaw cysts(OJC).Methods:In order to compare their clinical features,a retrospective study of 669 cases of OJC...Objective:Radicular cyst(RC),dentigerous cyst(DC),and odontogenic keratocyst(OKC)are most common odontogenic jaw cysts(OJC).Methods:In order to compare their clinical features,a retrospective study of 669 cases of OJC was designed including the gender composition,age distribution,localization,and clinical presentation of OKC,RC,and DC,and the results were statistically analyzed with chi-square test.Results:The male:female ratio of OKC was 1.6∶1,RC 1.4∶1,and DC 4.1∶1(P<0.005).The incidence of OJC was seen in almost all age groups except that DC was not seen in 70+years group.The age distribution had a significant difference among the three kinds of OJC or in each cyst group(P<0.005).The incidence rate of OKC or RC in the third decade was the highest among that of all age groups(OKC,27%;RC,20%);the incidence rate of DC in the second decade was the highest(29%).The three kinds of OJC were seen in all areas of the jaw with a different frequency,and the involved locations had significant differences among the three kinds of OJC or in each cyst group(P<0.005).137 cases of OKC,48cases of RC,and 18 cases of DC were secondarily infected(infection rate:OKC,39%;RC,24%;DC,16%)(P<0.005).Conclusions:These results suggest that(1)male predilection appears in OJC;(2)the peak incidence of OKC or RC is the third decade,and that of DC is the second decade;(3)a different location of the jaw has a different susceptibility for OKC,RC,or DC-the predilection localization of OKC is mandibular molar-premolar region,and that of RC or DC is maxillary anterior region;(4)the symptom of infection is helpful for the differential diagnosis among OKC,RC and DC.展开更多
Percutaneous or endoscopic drainage is the initial choice for the treatment of peripancreatic fluid collection in symptomatic patients.Endoscopic transgastric fenestration(ETGF)was first reported for the management of...Percutaneous or endoscopic drainage is the initial choice for the treatment of peripancreatic fluid collection in symptomatic patients.Endoscopic transgastric fenestration(ETGF)was first reported for the management of pancreatic pseu-docysts of 20 patients in 2008.From a surgeon’s viewpoint,ETGF is a similar procedure to cystogastrostomy in that they both produce a wide outlet orifice for the drainage of fluid and necrotic debris.ETGF can be performed at least 4 wk after the initial onset of acute pancreatitis and it has a high priority over the surgical approach.However,the surgical approach usually has a better success rate because surgical cystogastrostomy has a wider outlet(>6 cm vs 2 cm)than ETGF.However,percutaneous or endoscopic drainage,ETGF,and surgical approach offer various treatment options for peripancreatic fluid collection patients based on their conditions.展开更多
A recent case report provided a patient scenario,wherein,a 39-year-old male patient presented with occasional palpitations,headache,and fever.Evaluation of tumor markers did not show any abnormal results.Subsequently,...A recent case report provided a patient scenario,wherein,a 39-year-old male patient presented with occasional palpitations,headache,and fever.Evaluation of tumor markers did not show any abnormal results.Subsequently,a computed tomography(CT)scan was undertaken,and its findings were affirmative of thymic cancer.Finally,the postoperative histopathological assessment of the mass,after its resection,confirmed it as an anterior mediastinal multilocular thymic cyst(MTC),with concurrent acute upper respiratory tract infection and acute myocarditis.Accordingly,this case report advocates the need for a preoperative histopathological examination with CT imaging to minimize the risk of confusing an MTC with a malignant thymic tumor.展开更多
Keloid scars and epidermoid cysts present unique challenges in plastic surgery,often requiring distinct diagnostic and therapeutic approaches.Keloid scars result from dysregulated wound healing characterized by collag...Keloid scars and epidermoid cysts present unique challenges in plastic surgery,often requiring distinct diagnostic and therapeutic approaches.Keloid scars result from dysregulated wound healing characterized by collagen overproduction and inflammatory states.In contrast,epidermoid cysts are cutaneous lesions lined with keratinized epithelium,with the rare complication of development into squamous cell carcinoma.A rare clinical dilemma is when epidermoid cysts arise within keloidal scar tissue.In this case,effective management involves meticulous diagnostic approaches,including ultrasonography and histopathological examination,to identify coexisting cysts within scar tissue.In the few studies reporting this rare occurrence,various treatment protocols exist consisting of various combinations of surgical excision,intralesional corticosteroid injections,chemotherapeutic agents,laser therapy,radiotherapy,isotretinoin,and tranilast.As advancements in the comprehension and treatment of epidermoid cysts within keloid scars progress,customized therapeutic approaches provide promise for enhancing patient outcomes and quality of life.展开更多
BACKGROUND Renal cysts,especially the cortical type,are a prevalent renal pathology.Most cases are asymptomatic and detected incidentally during abdominal imaging examination for unrelated complaints.They are often be...BACKGROUND Renal cysts,especially the cortical type,are a prevalent renal pathology.Most cases are asymptomatic and detected incidentally during abdominal imaging examination for unrelated complaints.They are often benign,but they can rarely transform into cystic renal malignancies.When huge or complicated,especially with an abscess,it may become symptomatic from the renal capsular stretch or inflammation.The open surgical,endoscopic,laparoscopic,and robotic appro-aches are available for symptomatic renal cyst treatment.This paper aims to report our experience in the management of a case of a giant renal cyst abscess.CASE SUMMARY This is a 26-year-old housewife who was referred to the urology outpatient clinic with a history of left flank pain and swelling for 5 months,with the transabdo-minal ultrasound scan and computerized tomography scan findings of a huge left renal cortical cyst(Bosniak I).She had associated anorexia,weight loss,nausea,and intermittent fever,which on one occasion was severe and high-grade with chills and rigors.This warranted hospital admission,analgesic and antibiotic therapy.The physical examination was unremarkable at presentation except for a ballotable and mildly tender left lumbar cystic mass.Her vital signs were stable.There was leukocytosis with relative neutrophilia.Further review of the imaging films confirmed the diagnosis of a left giant renal cortical cyst abscess.She was counselled and had open surgical exploration,drainage of 300 mL of pus,cyst unroofing with marsupialization,and was discharged home on the 10th postoperative day.CONCLUSION Treatment of giant simple renal cortical cyst abscesses should be individualized depending on the pathology in question,the surgeon’s experience,patient preference and availability of facilities for endoscopic,laparoscopic or robotic modalities.Notwithstanding open surgical exploration,cyst unroofing and marsupialization are useful modalities in giant renal cortical cyst abscesses and are associated with patient satisfaction.展开更多
BACKGROUND Esophageal bronchogenic cysts(EBCs)are usually discovered incidentally during radiologic or endoscopic examinations.They are rare and prone to misdiagnosis or mistreatment.As a submucosal lesion,the endosco...BACKGROUND Esophageal bronchogenic cysts(EBCs)are usually discovered incidentally during radiologic or endoscopic examinations.They are rare and prone to misdiagnosis or mistreatment.As a submucosal lesion,the endoscopic ultrasonography(EUS)characteristics of EBCs are unclear.AIM To analyze the clinicopathological and EUS characteristics of EBCs.METHODS A total of 22 patients with a histological diagnosis of EBCs who underwent EUS examination were retrospectively included.The clinicopathological and EUS features were collected and analyzed.RESULTS Most of the EBCs were asymptomatic,and no malignant transformation or precancerous changes was found histologically.Most of the EBCs were located in the lower esophagus(72.7%,16/22).A total of 90.9%(20/22)of the EBCs originated from the muscularis propria,and 9.1%(2/22)originated from the submucosa.All of the lesions had clear boundaries.In terms of echo,77.3%(17/22)had a hypoechoic pattern,and 22.7%(5/22)had an anechoic pattern.We found floating echoes inside the lesion,which presented as a punctiform hyperecho in 45.5%(10/22)and a flocculent hypoecho in 36.4%(8/22)of the patients.A total of 45.5%(10/22)displayed posterior wall enhancement.Fourteen patients underwent color doppler,and no blood flow signal was identified.On EUS elastography,the EBCs presented a yellow-green or green pattern(100%,6/6).When contrast-enhanced EUS was used,the EBCs showed no enhancement(100%,5/5).CONCLUSION When a submucosal lesion located at the lower esophagus originates from the intrinsic muscle layer,the possibility of EBCs should be noted,the EUS characteristics of which include a hypoecho with a clear boundary and a posterior wall enhancement,a floating echo inside and no blood flow signal,a yellow-green or green pattern on elastography,and no enhancement on contrast EUS.展开更多
文摘Evaluating the prognostic significance of biomarkers in pancreatic cyst fluid,accessed through endoscopic ultrasound-guided fine-needle aspiration,is essential for improving the clinical management of pancreatic cysts.This review synthesizes the evidence from studies published on the field in the last years,focusing on the accuracy and clinical utility of biomarkers such as carcinoembryonic antigen,intracystic glucose,and novel genetic markers including DNA mutation analysis.Our findings indicate that elevated carcinoembryonic antigen levels and decreased intra-cystic glucose levels are strongly associated with mucinous cysts which carry a higher malignancy risk,while DNA mutation analysis has shown increased predictive accuracy for identifying malignant transformations.Integrating these biomarkers with imaging techniques enhances risk stratification and can significantly influence therapeutic decisions.The review highlights the need for standardization of biomarker assays and further validation of biomarker panels to refine their prognostic value in clinical settings,ultimately aiding in the tailored management of patients with pancreatic cysts.
基金Funding support for this article was provided by the Key R&D Program of Zhejiang(2023C03029).
文摘Introduction Choledochal cysts(CCs)are cystic dilatations of the intrahepatic and/or extrahepatic biliary ducts that affect primarily female infants[1-3].CCs vary markedly in incidence worldwide:the incidence is approximately 1 in 100,000 to 1 in 150,000 live births in Western countries and 1 in 1,000 people in Asian countries[4].
文摘BACKGROUND Liver hydatid cysts(LHC)liver requires effective surgical treatment.Open closed total pericystectomy removes the entire echinococcus cyst while preserving healthy liver tissue.AIM To evaluate the outcomes of pericystectomy and its efficacy as a treatment modality for cystic echinococcosis(CE).METHODS Thirty-eight patients were analyzed after open total pericystectomy at the University Hospital of Cologne between January 2006 and January 2024.Demographic,clinical,and laboratory parameters were collected retrospectively.Intraoperative data and postoperative complications were documented and classified using the Clavien-Dindo classification.Throughout the follow-up period,patients underwent regular clinical,serological,and sonographic evaluations both at the outpatient department and by their general physicians.RESULTS Fifty-four cysts were treated with open total pericystectomy.Multiple cysts were found in 42.2%of cases.Singular cysts occurred in 57.8%.The right hepatic lobe was affected in 66.7%.Ectopic cysts occurred in 4 patients in the lung(n=3)and spleen(n=1).Median cyst size was 6.78 cm×5.92 cm(range:1.4-20.0 cm).The median surgical time of pericystectomy was 189 minutes(range:78-455 minutes)with a median blood loss of 400 mL(range:100-1400 mL).The complication rate(Clavien-Dindo>III)was 21.1%.The average hospital stay was 12.5 days.No recurrent disease could be detected after a median follow-up time of 97 months(range:4-216 months).No recurrent cyst manifestation,postoperative liver failure or death was observed.CONCLUSION The presented surgical procedure known as open total pericystectomy is a safe surgical technique in treatment of cystic echinococcosis.
文摘BACKGROUND Pancreatic cystic neoplasms(PCNs)are increasingly detected due to advancements in radiographic techniques,with a prevalence of approximately 15%in the general population.These lesions range from benign to premalignant and malignant,posing a diagnostic challenge.Accurate differentiation is critical,as premalignant and malignant PCNs often require surgical intervention,while benign cysts may only need monitoring unless symptomatic.Current diagnostic methods,including cross-sectional imaging,endoscopic ultrasonography,and endoscopic ultrasonography-guided fine-needle aspiration/biopsy,are specialized,not universally available,and have variable accuracy.Clinical and laboratory parameters such as carbohydrate antigen 19-9(CA 19-9),neutrophillymphocyte ratio,platelet-lymphocyte ratio,and red cell distribution width(RDW)have been associated with malignancy risk,though only CA 19-9 is guideline-supported.AIM To assess the malignancy risk of PCNs using preoperative clinical and routine laboratory parameters.METHODS A retrospective cohort study analyzed 70 patients who underwent surgery for PCNs at Ankara Bilkent City Hospital between February 2019 and March 2023.Patients were categorized into group A(benign or low-grade dysplasia,n=40)and group B(malignancy or high-grade dysplasia,n=30)based on postoperative pathology.Preoperative demographic and laboratory parameters,including age,RDW,albumin,and CA 19-9,were compared.Univariate and multivariate logistic regression analyses identified independent predictors of malignancy.Receiver operating characteristic curve analysis evaluated predictive performance,with internal validation using bootstrapping.RESULTS Group B patients were older(69.86±9.58 years vs 52.74±16.85 years,P<0.001)and had a higher incidence of diabetes mellitus(57.1%vs 21.4%,P=0.002).RDW(16.2%vs 13.7%,P<0.001),platelet-lymphocyte ratio(178 vs 126,P=0.008),and CA 19-9(21.7 U/mL vs 9.3 U/mL,P=0.009)were significantly higher in group B,while albumin was lower(41 g/L vs 45 g/L,P=0.008).Multivariate analysis identified age[odds ratio=1.067,95%confidence interval(CI):1.014-1.122,P=0.012]and RDW(odds ratio=1.784,95%CI:1.172-2.715,P=0.007)as independent predictors.The area under the curve for age,RDW,and their combination was 0.798(95%CI:0.695-0.900),0.801(95%CI:0.692-0.911),and 0.858(95%CI:0.771-0.944),respectively,with bootstrapped validation confirming stability.Cut-off values of age≥60 years and RDW≥15.5%balanced sensitivity and specificity,increasing malignancy risk 15.3-fold and 22.6-fold,respectively.CONCLUSION Age and RDW are independent predictors of malignancy in PCNs,aiding in patient selection for advanced diagnostics and surgery.Larger,multicenter studies are needed to validate these findings.
文摘Biliary cyst tumors(cystadenoma and cystadeno-carcinoma) are an indication for liver resection. They account for only 5% of all solitary cystic lesions of the liver,but differential diagnosis with multiloculated or complicated biliary cysts,atypical hemangiomas,hamartomas and lymphangiomas may be difficult. The most frequent challenge is to differentiate biliary cyst tumors from hemorrhagic cysts. Computerized tomography(CT) and magnetic resonance imaging(MRI) are often not diagnostic and in these cases fine needle aspiration(FNA) is used to confirm the presence of atypical biliary cells. FNA,however,lacks adequate sensitivity and specificity and should always be used in conjunction with imaging. Pre-operative differentiation of cystadenoma from cystadenocarcinoma is impossible and surgery must be performed if a biliary cyst tumor is suspected. When multiple cystic lesions are observed throughout the liver parenchyma,it is important to exclude liver metastasis,of which colonic cancer is the most common primary site. Multiple biliary hamartomas(von Meyenburg complex) can appear as a mixture of solid and cystic lesions and can be confused with cystic metastasis. Strong and uniform T2 hyperintensity on MRI is usually diagnostic,but occasionally a percutaneous biopsy may be required.
文摘Cystic formations within the liver are a frequent finding among populations.Besides the common cystic lesions,like simple liver cysts,rare cystic liver lesions like cystadenocarcinoma should also be considered in the differential diagnosis.Thorough knowledge of each entity’s nature and course are key elements to successful treatment.Detailed search in PubMed,Cochrane Database,and international published literature regarding rare cystic liver lesions was carried out.In our research are included not only primary rare lesions like cystadenoma,hydatid cyst,and polycystic liver disease,but also secondary ones like metastasis from gastrointestinal stromal tumors lesions.Up-to date knowledge regarding diagnosis and management of rare cystic liver lesions is provided.A diagnostic and therapeutic algorithm is also proposed.The need for a multidisciplinary approach by a team including radiologists and surgeons familiar with liver cystic entities,diagnostic tools,and treatment modalities is stressed.Patients with cystic liver lesions must be carefully evaluated by a multidisciplinary team,in order to receive the most appropriate treatment,since many cystic liver lesions have a malignant potential and evolution.
文摘Recently, a novel and distinct pancreatic cystic tumor termed 'mudnous nonneoplastic' cyst was described in the literature. We report our experience with a 71-year-old female with a cystic tumor in the body of the pancreas demonstrating features suggestive of this diagnosis. We also review the literature regarding this 'novel' pathological entity and discuss critically its existence and its differential diagnoses.
文摘Cystic lesions of the anterior mediastinum in children suggest a well-known group of benign lesions that are comparatively frequent.Thymic cysts(TCs)are mostly positioned in the anterior mediastinum and some patients in the neck.Benign TCs classified as congenital intra-thoracic mesothelial cysts are commonly asymptomatic and have slight clinical significance.Multilocular TC,which can mimic another anterior mediastinal cystic tumor and is seen in adults,is more clinically important.It is a sporadic mediastinal lesion thought to arise in the course of acquired inflammation.Congenital mediastinal cysts represent 3%-6%of all mediastinal tumors and 10%-18%of radiologically reported mediastinal masses.Mediastinal TCs are uncommon and it is hard to know their true incidence.About 60%of cases with mediastinal TCs are asymptomatic,and the remainder of patients complains of nonspecific symptoms(e.g.,chest pain,dyspnea,or cough).The literature suggests that most cysts are benign,but an indefinite percentage may have a neoplastic process and result in significant compressive symptoms over time.Clinical symptoms of TCs vary depending on the location.In addition,frequent symptoms at the appearance of enlarged benign thymic and mediastinal cysts generally contain compressive symptoms(e.g.,respiratory distress,thymic pain,and symptoms related to Horner syndrome,hoarseness,dysphonia,dyspnea,orthopnea,wheezing,and fever).Many TCs have cystic density and a neat border and are simple to diagnose with radiological imaging.However,some TCs are hard to identify before surgery and may be misidentified as thymomas depending on their site and computed tomography results.Excision by thoracotomy,median sternotomy,or video-assisted techniques is essential for conclusive diagnosis,management,and abolition of relapse of anterior mediastinal masses and TCs.Histopathologic examination may be required after surgery.Considering the extent of the mass and the preliminary inability to make a definitive diagnosis,en bloc excision of the cyst was thought to be preferred to circumvent likely complications(e.g.,perforation,spillage of the contents,or incomplete excision).
基金Supported by the National Key Research and Development Program of China(No.2022 YFC 3105201)the Science and Technology Innovation Project of Laoshan Laboratory(No.LSKJ 202203700)the Shandong Province Natural Science Foundation(No.ZR 2021 QD 025)。
文摘Harmful algal blooms(HABs)of dinoflagellates pose significant threats to aquaculture,marine ecosystems,and human health.While resting cysts have been well known for their vital roles in initiating HABs of dinoflagellates,mapping results of the cyst abundance and distribution in marine sediments have been also well documented to be a highly valuable predictor,and thus can be used as a basis to assess the risk of HABs.We attempted to establish a framework for the risk assessment of dinoflagellate HABs based mainly on cyst-mapping of marine sediments and a case application of it to the risk assessment of HABs in the Yellow Sea.In the framework,firstly,the targeted marine area subjected to the assessment was determined and gridded into different assessment units according to their geography,administration,and ecological or economic function.Secondly,the dinoflagellate cyst abundance from the surface sediment,HABs records,and the monitoring results of vegetative cells for all or particular species of concern were collected experimentally or by literature search,as three main indicators scored and weighted respectively with different values.The scoring and weighting process was based on scientific reasoning and empirical consideration as detailed in the text.Thirdly,the risk of HABs occurrences for all or any particular species of concern at each site was ranked with five levels according to the calculated risk values.Finally,the final evaluation results were presented with tables,matrix diagrams,and color-coded textual annotations on nautical charts.As a case application,we performed a risk assessment for HABs of target species in the Yellow Sea,which warned high risks of HABs for Karlodinium veneficum,Gymnodinium catenatum,and others.This assessment framework provides a practical and testable tool for all involved stakeholders,and subject to improvement along with the advancement of ecology of HABs.
文摘INTRODUCTION Pericardial cysts are usually discovered inci-dentally,with an estimated incidence of approx-imately 1 in 100,000,and are more often locat-ed at the right cardiac diaphragmatic angle 1.
文摘Objective:To consolidate the scarce and scattered evidence on oral cysticercosis,a rare and often overlooked manifestation of Taenia solium infection.Methods:A comprehensive literature search was conducted in three major databases:PubMed,Scopus,and Embase.A total of 75 records were initially identified(PubMed:n=23;Scopus:n=29;Embase:n=23).After screening and eligibility assessment,22 studies meeting inclusion criteria were selected for final analysis.Results:Oral cysticercosis primarily involved the tongue,typically presenting as a painless swelling.The majority of reported cases were from India.Clinically,it was most often misdiagnosed as a mucocele or fibroma,with cysticercosis rarely considered due to its uncommon occurrence.Among the muscles affected,the masseter,mentalis,and buccinator were most frequently involved.Diagnosis was primarily made through histopathological examination.Treatment commonly included surgical excision,and albendazole was the most frequently used antiparasitic medication.Recurrence was uncommon,except in cases with disseminated or deep muscular involvement.Conclusions:Oral cysticercosis should be considered a potential differential diagnosis,particularly in regions where pork consumption is common.Given that most reported cases originated from India,pathologists in this region should maintain a high index of suspicion.Oral pathologists,in particular,should be well-acquainted with its histopathological features to ensure accurate diagnosis and avoid diagnostic pitfalls.
基金Supported by the Beijing Municipal Science and Technology Commission,No.Z191100006619002Haiyou Health High-Caliber Talent Project,No.202412the Research Unit of Minimally Invasive Pediatric Surgery on Diagnosis and Treatment,Chinese Academy of Medical Sciences,No.2021RU015.
文摘BACKGROUND Choledochal cysts(CC)and cystic biliary atresia(CBA)present similarly in early infancy but require different treatment approaches.While CC surgery can be delayed until 3-6 months of age in asymptomatic patients,CBA requires intervention within 60 days to prevent cirrhosis.AIM To develop a diagnostic model for early differentiation between these conditions.METHODS A total of 319 patients with hepatic hilar cysts(<60 days old at surgery)were retrospectively analyzed;these patients were treated at three hospitals between 2011 and 2022.Clinical features including biochemical markers and ultrasonographic measurements were compared between CC(n=274)and CBA(n=45)groups.Least absolute shrinkage and selection operator regression identified key diagnostic features,and 11 machine learning models were developed and compared.RESULTS The CBA group showed higher levels of total bile acid,total bilirubin,γ-glutamyl transferase,aspartate aminotransferase,and alanine aminotransferase,and direct bilirubin,while longitudinal diameter of the cysts and transverse diameter of the cysts were larger in the CC group.The multilayer perceptron model demonstrated optimal performance with 95.8% accuracy,92.9% sensitivity,96.3% specificity,and an area under the curve of 0.990.Decision curve analysis confirmed its clinical utility.Based on the model,we developed user-friendly diagnostic software for clinical implementation.CONCLUSION Our machine learning approach differentiates CC from CBA in early infancy using routinely available clinical parameters.Early accurate diagnosis facilitates timely surgical intervention for CBA cases,potentially improving patient outcomes.
基金supported by the Fuling District Science and Technology and Health Joint Medical Research Program(Chongqing)(grant number 2024KWLH008)the Fuling District Research Project(Chongqing)(grant number FLKJ,2024AAN3046).
文摘Background:Parathyroid cysts(PCs)are rare lesions that often resemble other cervical cystic conditions,making preoperative diagnosis challenging,especially in resource-limited settings.Methods:We report a case of a parathyroid cyst diagnosed and treated at Chongqing University Fuling Hospital in 2020.Clinical presentation,imaging,cytological features,pathological fi ndings,diff erential diagnosis and management strategies were analyzed in conjunction with an updated review of the literature.Conclusion:PCs represent a rare subset of parathyroid lesions and are most often non-functioning.Their imaging and cytological characteristics frequently resemble those of thyroid cysts,which may lead to misdiagnosis.Mea-surement of parathyroid hormone levels in aspirated cyst fl uid is essential when a PC is suspected.Surgical excision remains the defi nitive treatment.This case underscores the diagnostic challenges and highlights the importance of heightened clinical awareness,particularly in primary and rural healthcare settings.
文摘Nonparasitic hepatic cysts consist of a heterogeneous group of disorders, which differ in etiology, prevalence,and manifestations. With improving diagnostic techniques, hepatic cysts are becoming more common.Recent advancements in minimally invasive technology created a new Era in the management of hepatic cystic disease. Herein, the most current recommendations for management of noninfectious hepatic cysts are described, thereby discussing differential diagnosis, new therapeutic modalities and outcomes.
文摘Objective:Radicular cyst(RC),dentigerous cyst(DC),and odontogenic keratocyst(OKC)are most common odontogenic jaw cysts(OJC).Methods:In order to compare their clinical features,a retrospective study of 669 cases of OJC was designed including the gender composition,age distribution,localization,and clinical presentation of OKC,RC,and DC,and the results were statistically analyzed with chi-square test.Results:The male:female ratio of OKC was 1.6∶1,RC 1.4∶1,and DC 4.1∶1(P<0.005).The incidence of OJC was seen in almost all age groups except that DC was not seen in 70+years group.The age distribution had a significant difference among the three kinds of OJC or in each cyst group(P<0.005).The incidence rate of OKC or RC in the third decade was the highest among that of all age groups(OKC,27%;RC,20%);the incidence rate of DC in the second decade was the highest(29%).The three kinds of OJC were seen in all areas of the jaw with a different frequency,and the involved locations had significant differences among the three kinds of OJC or in each cyst group(P<0.005).137 cases of OKC,48cases of RC,and 18 cases of DC were secondarily infected(infection rate:OKC,39%;RC,24%;DC,16%)(P<0.005).Conclusions:These results suggest that(1)male predilection appears in OJC;(2)the peak incidence of OKC or RC is the third decade,and that of DC is the second decade;(3)a different location of the jaw has a different susceptibility for OKC,RC,or DC-the predilection localization of OKC is mandibular molar-premolar region,and that of RC or DC is maxillary anterior region;(4)the symptom of infection is helpful for the differential diagnosis among OKC,RC and DC.
文摘Percutaneous or endoscopic drainage is the initial choice for the treatment of peripancreatic fluid collection in symptomatic patients.Endoscopic transgastric fenestration(ETGF)was first reported for the management of pancreatic pseu-docysts of 20 patients in 2008.From a surgeon’s viewpoint,ETGF is a similar procedure to cystogastrostomy in that they both produce a wide outlet orifice for the drainage of fluid and necrotic debris.ETGF can be performed at least 4 wk after the initial onset of acute pancreatitis and it has a high priority over the surgical approach.However,the surgical approach usually has a better success rate because surgical cystogastrostomy has a wider outlet(>6 cm vs 2 cm)than ETGF.However,percutaneous or endoscopic drainage,ETGF,and surgical approach offer various treatment options for peripancreatic fluid collection patients based on their conditions.
文摘A recent case report provided a patient scenario,wherein,a 39-year-old male patient presented with occasional palpitations,headache,and fever.Evaluation of tumor markers did not show any abnormal results.Subsequently,a computed tomography(CT)scan was undertaken,and its findings were affirmative of thymic cancer.Finally,the postoperative histopathological assessment of the mass,after its resection,confirmed it as an anterior mediastinal multilocular thymic cyst(MTC),with concurrent acute upper respiratory tract infection and acute myocarditis.Accordingly,this case report advocates the need for a preoperative histopathological examination with CT imaging to minimize the risk of confusing an MTC with a malignant thymic tumor.
文摘Keloid scars and epidermoid cysts present unique challenges in plastic surgery,often requiring distinct diagnostic and therapeutic approaches.Keloid scars result from dysregulated wound healing characterized by collagen overproduction and inflammatory states.In contrast,epidermoid cysts are cutaneous lesions lined with keratinized epithelium,with the rare complication of development into squamous cell carcinoma.A rare clinical dilemma is when epidermoid cysts arise within keloidal scar tissue.In this case,effective management involves meticulous diagnostic approaches,including ultrasonography and histopathological examination,to identify coexisting cysts within scar tissue.In the few studies reporting this rare occurrence,various treatment protocols exist consisting of various combinations of surgical excision,intralesional corticosteroid injections,chemotherapeutic agents,laser therapy,radiotherapy,isotretinoin,and tranilast.As advancements in the comprehension and treatment of epidermoid cysts within keloid scars progress,customized therapeutic approaches provide promise for enhancing patient outcomes and quality of life.
文摘BACKGROUND Renal cysts,especially the cortical type,are a prevalent renal pathology.Most cases are asymptomatic and detected incidentally during abdominal imaging examination for unrelated complaints.They are often benign,but they can rarely transform into cystic renal malignancies.When huge or complicated,especially with an abscess,it may become symptomatic from the renal capsular stretch or inflammation.The open surgical,endoscopic,laparoscopic,and robotic appro-aches are available for symptomatic renal cyst treatment.This paper aims to report our experience in the management of a case of a giant renal cyst abscess.CASE SUMMARY This is a 26-year-old housewife who was referred to the urology outpatient clinic with a history of left flank pain and swelling for 5 months,with the transabdo-minal ultrasound scan and computerized tomography scan findings of a huge left renal cortical cyst(Bosniak I).She had associated anorexia,weight loss,nausea,and intermittent fever,which on one occasion was severe and high-grade with chills and rigors.This warranted hospital admission,analgesic and antibiotic therapy.The physical examination was unremarkable at presentation except for a ballotable and mildly tender left lumbar cystic mass.Her vital signs were stable.There was leukocytosis with relative neutrophilia.Further review of the imaging films confirmed the diagnosis of a left giant renal cortical cyst abscess.She was counselled and had open surgical exploration,drainage of 300 mL of pus,cyst unroofing with marsupialization,and was discharged home on the 10th postoperative day.CONCLUSION Treatment of giant simple renal cortical cyst abscesses should be individualized depending on the pathology in question,the surgeon’s experience,patient preference and availability of facilities for endoscopic,laparoscopic or robotic modalities.Notwithstanding open surgical exploration,cyst unroofing and marsupialization are useful modalities in giant renal cortical cyst abscesses and are associated with patient satisfaction.
基金Supported by Zhejiang Provincial Medical and Health Science and Technology Project,No.2022-KY1-001-198.
文摘BACKGROUND Esophageal bronchogenic cysts(EBCs)are usually discovered incidentally during radiologic or endoscopic examinations.They are rare and prone to misdiagnosis or mistreatment.As a submucosal lesion,the endoscopic ultrasonography(EUS)characteristics of EBCs are unclear.AIM To analyze the clinicopathological and EUS characteristics of EBCs.METHODS A total of 22 patients with a histological diagnosis of EBCs who underwent EUS examination were retrospectively included.The clinicopathological and EUS features were collected and analyzed.RESULTS Most of the EBCs were asymptomatic,and no malignant transformation or precancerous changes was found histologically.Most of the EBCs were located in the lower esophagus(72.7%,16/22).A total of 90.9%(20/22)of the EBCs originated from the muscularis propria,and 9.1%(2/22)originated from the submucosa.All of the lesions had clear boundaries.In terms of echo,77.3%(17/22)had a hypoechoic pattern,and 22.7%(5/22)had an anechoic pattern.We found floating echoes inside the lesion,which presented as a punctiform hyperecho in 45.5%(10/22)and a flocculent hypoecho in 36.4%(8/22)of the patients.A total of 45.5%(10/22)displayed posterior wall enhancement.Fourteen patients underwent color doppler,and no blood flow signal was identified.On EUS elastography,the EBCs presented a yellow-green or green pattern(100%,6/6).When contrast-enhanced EUS was used,the EBCs showed no enhancement(100%,5/5).CONCLUSION When a submucosal lesion located at the lower esophagus originates from the intrinsic muscle layer,the possibility of EBCs should be noted,the EUS characteristics of which include a hypoecho with a clear boundary and a posterior wall enhancement,a floating echo inside and no blood flow signal,a yellow-green or green pattern on elastography,and no enhancement on contrast EUS.
