From the Guidelines
Simple cysts are typically caused by abnormal foetal ductal plate maturation, leading to the formation of fluid-filled lesions lined by a single cell layer, as stated in the EASL clinical practice guidelines on the management of cystic liver diseases 1. The pathogenesis of cysts involves ductal plate malformation, where the ductal plate disconnects from the biliary tree and progresses into cystic structures. Some key points about simple cysts include:
- They are fluid-filled sacs that can develop in various parts of the body
- They are typically benign and may form when normal fluid drainage is obstructed, causing fluid to accumulate within a membrane-lined cavity
- Treatment for simple cysts depends on their location, size, and whether they cause symptoms
- Many asymptomatic cysts require no treatment and may be monitored with regular follow-up imaging
- For symptomatic cysts, treatment options include aspiration (draining the fluid with a needle), which may be combined with sclerotherapy where an irritating substance is injected to prevent recurrence
- Symptomatic simple hepatic cysts without biliary communication should be treated with the best locally available volume-reducing therapy, as recommended by the EASL clinical practice guidelines 1. Some treatment options for simple cysts include:
- Aspiration sclerotherapy, which involves draining the cyst and temporarily exposing it to a sclerosing agent
- Cyst fenestration, which entails a laparoscopy, followed by drainage and resection of the extrahepatic cyst wall
- Surgical removal, which is recommended for larger cysts, those that recur after aspiration, or when there's uncertainty about whether the cyst is benign
- Cyst fenestration, also called deroofing, can be considered in patients with superficial large cysts, as stated in the EASL clinical practice guidelines 1.
From the Research
Causes of Simple Cysts
- The exact cause of simple cysts is not well understood, but they are thought to be related to the normal aging process and may be influenced by genetic and environmental factors.
- Simple cysts can occur in various parts of the body, including the kidneys, liver, and ovaries.
Treatment of Simple Cysts
- Treatment options for simple cysts depend on the size, location, and symptoms of the cyst, as well as the patient's overall health.
- Possible treatments include:
- Aspiration with sclerotherapy: a procedure in which the cyst is drained and a sclerosing agent is injected to help prevent recurrence 2, 3, 4.
- Laparoscopic deroofing: a minimally invasive surgical procedure in which the cyst is drained and the lining of the cyst is removed 3, 5, 4.
- Percutaneous endoscopic ablation: a procedure in which the cyst is drained and ablated using an endoscope 4.
- Ureteroscopic marsupialization: a procedure in which the cyst is drained and a hole is created in the cyst to allow it to communicate with the urinary tract 4.
- The choice of treatment depends on various factors, including the size and location of the cyst, the presence of symptoms or complications, and the patient's preferences and overall health.
Comparison of Treatment Options
- Studies have compared the efficacy and safety of different treatment options for simple cysts, including aspiration with sclerotherapy and laparoscopic deroofing 3, 6.
- Aspiration with sclerotherapy has been shown to be effective in relieving symptoms and preventing recurrence, but may have a higher risk of complications compared to laparoscopic deroofing 3.
- Laparoscopic deroofing has been shown to be effective in relieving symptoms and preventing recurrence, but may have a higher risk of complications and longer recovery time compared to aspiration with sclerotherapy 3, 6.
- The choice of treatment should be individualized based on the patient's specific needs and circumstances.