CYSTS

Dr Mbayah J. Etabale
Anatomical Pathologist and Lecturer of Pathology
Department of Pathology
Maseno University
 2

OUTLINE
• Introduction
• Pathogenesis of cysts
• Classification of cysts
• Clinical manifestations of cysts
• Management of cysts

Cysts
 3

OBJECTIVES
• Define a cyst
• State the components of a cyst
• Classify cysts giving an example of each
• Describe the possible managements of various cysts

Cysts
 4

INTRODUCTION
• An abnormal tissue pocket with enclosed matter
• Two main parts
• Cyst wall
• Composed of connective tissue
• Supports the cyst
• May have specialised lining cells on the luminal aspect
• Lumen
• Aka locule
• Cavity containing cyst contents
• Cyst contents may be gaseous, liquid, semisolid or solid
• A cyst may have several locules (multiloculated)

Cysts
 5

INTRODUCTION

Cysts
 6

PATHOGENESIS
1. Persistence of embryonal visci in which material accumulates
2. Obstruction / obliteration of ducts or duct-like communications
3. Tissue degeneration with residual cavity spaces
4. Infections
5. Necrotising inflammation
6. Neoplastic proliferation of lining cells, especially glandular epithelia

Cysts
 7

CLASSIFICATION OF CYSTS
• Cysts may be classified in many ways:
1. Nature of cyst contents
2. Developmental vs acquired
3. True cysts vs pseudocysts
4. Neoplastic vs non-neoplastic
5. Benign vs malignant

Cysts
 8

NATURE OF CYST CONTENTS

• A cyst may be characterised by the
nature of its contents
• Haemorrhagic cyst
• Serous cyst
• Mucus / mucinous cyst
• Colloid cyst
• Complex cyst

Endometriotic Cyst

Cysts
 9

DEVELOPMENTAL CYSTS
• These cysts arise from aberrant embryogenesis
• Examples include:
• Thyroglossal duct cyst
• Duplication cysts of the gastrointestinal and respiratory tracts

Cysts Source: osmosis.org Source: healthjade.net

 10

TRUE CYSTS VS PSEUDOCYST

• Cysts can be classified based on the type of cell that lines the lumen
• Cysts containing specialised lining cells are true cysts
• These cells may be epithelial or mesenchymal
• An example is cutaneous epidermoid cyst
• Cysts that lack specialised lining cells are false cysts / pseudocysts
• The lining surface is a continuation of the connective tissue wall
• An example ganglion cyst

Cysts
 11

TRUE CYSTS VS PSEUDOCYST

Epidermoid Cyst Ganglion Cyst

Source: Rosai and Ackerman’s Surgical Pathology, 11e

Cysts
 12

TRUE CYSTS VS PSEUDOCYST

Echinococcus granulosus

Source: radiologykey.com Source: britannica.com Source: mcdinternational.org

Cysts
 13

NEOPLASTIC CYSTS
• These cysts are caused by neoplastic proliferation of the lining cells, usually glandular
epithelial cells
• Ovarian cystic neoplasms are good examples
• Benign cystic neoplasms
• Lined by non-atypical and non-invasive neoplastic cells
• Examples: cystic teratoma, serous cystadenoma
• Malignant cystic neoplasms
• Lined by invasive malignant cells
• Example: serous cystadenocarcinoma, mucinous cystadenocarcinoma
• Borderline cystic neoplasms
• Typically seen in the ovary and pancreas
• Lining cells exhibit mild-to-moderate cytologic atypia and stratification but lack evidence
of stromal invasion
• Example: borderline mucinous tumour

Cysts
 14

CLINICAL MANIFESTATIONS
• Clinical manifestations depend on:
• Size of the cyst
• Location of the cyst
• Secondary events such as torsion, rupture
• Whether benign or malignant
• Clinical features include:
• Asymptomatic
• Swellings
• Feeling of pressure
• Pain
• Others

Cysts
 15

MANAGEMENT
• Investigations
• Imaging studies – sonogram, radiograph, MRI, CT scan
• Fine needle aspiration cytology
• Serum tumour markers, if applicable
• Treatment
• Observation
• Surgical excision
• Chemotherapy/radiotherapy for some malignancies

Cysts
 16

THE END

Cysts