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Treatment for dermoid cyst is complete surgical removal, preferably in one piece and without any spillage of cyst contents. Marsupialization, a surgical technique often used to treat pilonidal cyst, is inappropriate for dermoid cyst due to the risk of malignancy.
The association of dermoid cysts with pregnancy has been increasingly reported. They usually present the dilemma of weighing the risks of surgery and anesthesia versus the risks of untreated adnexal mass. Most references state that it is more feasible to treat bilateral dermoid cysts of the ovaries discovered during pregnancy if they grow beyond 6 cm in diameter.
A cyst is a closed sac, having a distinct membrane and division compared with the nearby tissue. Hence, it is a cluster of cells that has grouped together to form a sac (not unlike the manner in which water molecules group together, forming a bubble); however, the distinguishing aspect of a cyst is that the cells forming the "shell" of such a sac are distinctly abnormal (in both appearance and behaviour) when compared with all surrounding cells for that given location. It may contain air, fluids, or semi-solid material. A collection of pus is called an abscess, not a cyst. Once formed, sometimes a cyst may resolve on its own. When a cyst fails to resolve, it may need to be removed surgically, but that would depend upon its type and location.
Cancer-related cysts are formed as a defense mechanism for the body, following the development of mutations that lead to an uncontrolled cellular division. Once that mutation has occurred, the affected cells divide incessantly (and become known as cancerous), forming a tumour. The body encapsulates those cells to try to prevent them from continuing their division and to try to contain the tumour, which becomes known as a cyst. That said, the cancerous cells still may mutate further and gain the ability to form their own blood vessels, from which they received nourishment before being contained. Once that happens, the capsule becomes useless and the tumour may advance from benign to a cancer.
Some cysts are neoplastic and thus, are called cystic tumors; many types are not neoplastic. Some are dysplastic or metaplastic. Pseudocysts are similar to cysts (having a sac filled with fluid), but lack an epithelial lining.
Cysts derived from CNS tissues are very common in America. They are a subtype of cerebrovascular diseases, which are the third leading cause of death in America. Generally, CNS cysts are present in all geographic regions, races, ages, and sexes. However, certain types of CNS cysts are more prevalent in certain types of individuals than others. Some examples of incidence rates in specific types of cysts include:
- Arachnoid cysts are more prevalent in males than females
- Colloid cysts are more prevalent in adults
- Dermoid cysts are more prevalent in children under 10 years of age
- Epidermoid cysts are more prevalent in middle-aged adults
Treatment ranges from simple enucleation of the cyst to curettage to resection. There are cysts—e.g., buccal bifurcation cyst—that resolve on their own, in which just close observation may be employed, unless it is infected and symptomatic.
Dermoid cysts can appear in young children, often near the lateral aspect of the eyebrow (right part of the right eyebrow or left part of the left eyebrow). Depending on the perceived amount of risk, these are sometimes excised or simply kept under observation.
An inflammatory reaction can occur if a dermoid cyst is disrupted, and the cyst can recur if it is not completely excised. Sometimes complete excision is not practical if the cyst is in a dumbbell configuration, whereby it extends through a suture line in the skull.
If dermoid cysts appear on the medial aspect, the possibility of an encephalocele becomes greater and should be considered among the differential diagnoses.
Dermoid cysts develop during pregnancy. They occur when skin cells and things like hair, sweat glands, oil glands or fatty tissue get trapped in the skin as a baby grows in the womb.Dermoid cysts are present at birth (congenital) and are common. It can be months or years before a dermoid cyst is noticed on a child because the cysts grow slowly.
Dermoid cyst symptoms are minor and the cysts are usually painless. They are not harmful to a child’s health. If they become infected, the infection must be treated and the cyst should be removed. It is easier to remove cysts and prevent scars if the cyst is removed before it gets infected.
Many CNS cysts form in the womb during the first few weeks of development as a result of congenital defects. In adults cysts may also form due to a head injury or trauma, resulting in necrotic tissues (dead tissue), and can sometimes be associated with cancerous tumors or infection in the brain. However, the underlying reasons for cyst formation are still unknown.
It is estimated that 7% of women in the western world develop palpable breast cysts.
There is preliminary evidence that women with breast cysts may be at an increased risk of breast cancer, especially at younger ages.
In males, the occurrence of breast cysts is rare and may (but need not) be an indication of malignancy.
Theca lutein cyst is a type of bilateral functional ovarian cyst filled with clear, straw-colored fluid. To be classified a functional cyst, the mass must reach a diameter of at least three centimeters.
These cysts result from exaggerated physiological stimulation (hyperreactio luteinalis) and are usually associated with markedly elevated levels of beta-human chorionic gonadotropin (beta-hCG). They are thus associated with gestational trophoblastic disease (molar pregnancy), diabetes mellitus, alloimmunisation to Rh-D, and multiple gestations. They have rarely been associated with chronic kidney disease (secondary to reduced hCG clearance) and hyperthyroidism (given the structural homology with TSH). These cysts resolve after pregnancy. Rarely, when the theca-lutein cysts are stimulated by gonadotropins, massive ascites can result. In most cases however, abdominal symptoms are minimal and restricted to peritoneal irritation from cyst hemorrhage. Surgical intervention may be required to remove ruptured or infarcted tissue.
Women who smoke have a twofold increase for functional cysts.
While Bartholin cysts can be quite painful, they are not life-threatening. New cysts cannot absolutely be prevented from forming, but surgical or laser removal of a cyst makes it less likely that a new one will form at the same site. Those with a cyst are more likely than those without a cyst to get one in the future. They can recur every few years or more frequently. Many women who have marsupialization done find that the recurrences may slow, but do not actually stop.
The clinical management of a cyst of Montgomery depends upon the symptoms of the patient.
If there are no signs of infection, a cyst of Montgomery can be observed, because more than 80% resolve spontaneously, over only a few months. However, in some cases, spontaneous resolution may take up two years. In such cases, a repeat ultrasonography may become necessary. If, however, the patient has signs of an infection, for example reddening (erythema), warmth, pain and tenderness, a treatment for mastitis can be initiated, which may include antibiotics and non-steroidal anti-inflammatory drugs (NSAIDs). With treatment, inflammatory changes usually disappear quickly. In rare cases, drainage may become necessary. A surgical treatment of a cyst of Montgomery, i.e. a resection, may become necessary only if a cyst of Montgomery persists, or the diagnosis is questioned clinically.
The prognosis seems to be excellent. In one series, all adolescent patients with a cyst of Montgomery had a favourable outcome.
Blocked sebaceous glands, swollen hair follicles, high levels of testosterone and the use of androgenic anabolic steroids will cause such cysts.
A case has been reported of a sebaceous cyst being caused by the human botfly.
Hereditary causes of sebaceous cysts include Gardner's syndrome and basal cell nevus syndrome.
Two percent of women will have a Bartholin's gland cyst at some point in their lives. They occur at a rate of 0.55 per 1000 person-years and in women aged 35–50 years at a rate of 1.21 per 1000 person-years. The incidence of Bartholin duct cysts increases with age until menopause, and decreases thereafter. Hispanic women may be more often affected than white women and black women. The risk of developing a Bartholin's gland cyst increases with the number of childbirths.
Radicular cysts are by far the most common cyst occurring in the jaws.
The prognosis depends upon the type, size and location of a cyst. Most cysts are entirely benign, and some may require no treatment. Rarely, some cystic lesions represent locally aggressive tumors that may cause destruction of surrounding bone if left untreated. This type of cyst are usually removed with a margin of healthy bone to prevent recurrence of new cysts. If a cyst expands to a very large size, the mandible may be weakened such that a pathologic fracture occurs.
A cyst of Montgomery is a benign breast mass, usually found in adolescent girls. Typically, it resolves spontaneously by itself.
Epidermoid cysts commonly result from implantation of epidermis into the dermis, as in trauma or surgery. They can also be caused by a blocked pore adjacent to a body piercing. They are also seen in Gardner's syndrome and Nevoid Basal Cell Carcinoma Syndrome on the head and neck. They can be infected by bacteria and form a pimple-like shape.
About 90% of pilar cysts occur on the scalp, with the remaining sometimes occurring on the face, trunk and extremities. Pilar cysts are significantly more common in females, and a tendency to develop these cysts is often inherited in an autosomal dominant pattern. In most cases, multiple pilar cysts appear at once.
The epidermoid cyst may have no symptoms, or it may hurt when touched. It can release pus. It is very common for women on the major or minor labia. In contrast to pilar cysts, epidermoid cysts are usually present on parts of the body with relatively little hair.
Occasionally, an epidermoid cyst will present with Trigeminal neuralgia.
Although they are not malignant, there are rare cases of malignant tumors arising from an epidermoid cyst.
The thyroglossal tract arises from the foramen cecum at the junction of the anterior two-thirds and posterior one-third of the tongue. Any part of the tract can persist, causing a sinus, fistula or cyst. Most fistulae are acquired following rupture or incision of the infected thyroglossal cyst. A thyroglossal cyst is lined by pseudostratified, ciliated columnar epithelium while a thyroglossal fistula is lined by columnar epithelium.
Odontogenic cyst are a group of jaw cysts that are formed from tissues involved in odontogenesis (tooth development). Odontogenic cysts are closed sacs, and have a distinct membrane derived from rests of odontogenic epithelium. It may contain air, fluids, or semi-solid material. Intra-bony cysts are most common in the jaws, because the mandible and maxilla are the only bones with epithelial components. That odontogenic epithelium is critical in normal tooth development. However, epithelial rests may be the origin for the cyst lining later.
Not all oral cysts are odontogenic cyst. For example, mucous cyst of the oral mucosa and nasolabial duct cyst are not of odontogenic origin.
In addition, there are several conditions with so-called (radiographic) 'pseudocystic appearance' in jaws; ranging from anatomic variants such as Stafne static bone cyst, to the aggressive aneurysmal bone cyst.
Treatment ranges from simple enucleation of the cyst to curettage to resection. For example, small radicular cyst may resolved after successful endodontic ("root-canal") treatment. Because of high recurrence potential and aggressive behaviour, curettage is recommended for keratocyst. However, the conservative enucleation is the treatment of choice for most odontogenic cysts. The removed cyst must be evaluated by pathologist to confirm the diagnosis, and to rule out other neoplastic lesions with similar clinical or radiographic features (e.g., cystic or solid ameloblastoma, central mucoepidermoid carcinoma). There are cysts, e.g. buccal bifurcation cyst with self-resolation nature, in which close observation can be employed unless the cyst is infected and symptomatic.
Rarely, cancer may be present in a thyroglossal duct cyst. These tumors usually arise from the ectopic thyroid tissue within the cyst.
A colloid cyst is a tumor containing gelatinous material in the brain. It is almost always found just posterior to the foramen of Monro in the anterior aspect of the third ventricle, originating from the roof of the ventricle. Because of its location, it can cause obstructive hydrocephalus and increased intracranial pressure. Colloid cysts represent 0.5–1% of intracranial tumors.
Symptoms can include headache, vertigo, memory deficits, diplopia, behavioral disturbances and in extreme cases, sudden death. Intermittency of symptoms is characteristic of this lesion. Untreated pressure caused by these cysts can result in brain herniation. Colloid cyst symptoms have been associated with 4 variables: cyst size, cyst imaging characteristics, ventricular size, and patient age. The developmental origin is unclear, though they may be of endodermal origin, which would explain the mucin-producing, ciliated cell type. These cysts can be surgically resected, and opinion is divided about the advisability of this.
Arachnoid cysts are seen in up to 1.1% of the population with a gender distribution of 2:1 male:female Only 20% of these have symptoms, usually from secondary hydrocephalus.
A study that looked at 2,536 healthy young males found a prevalence of 1.7% (95% CI 1.2 to 2.3%). Only a small percentage of the detected abnormalities require urgent medical attention.
Patients with third ventricular colloid cysts become symptomatic when the tumor enlarges rapidly, causing CSF obstruction, ventriculomegaly, and increased intracranial pressure. Some cysts enlarge more gradually, however, allowing the patient to accommodate the enlarging mass without disruption of CSF flow, and the patient remains asymptomatic. In these cases, if the cyst stops growing, the patient can maintain a steady state between CSF production and absorption and may not require neurosurgical intervention.