What are the treatment options for a cyst?

Treatment Options for Cysts

The treatment approach for cysts depends on the cyst type, location, size, and whether it is symptomatic, with symptomatic cysts typically requiring intervention while asymptomatic cysts often need no treatment. 1

Simple Hepatic Cysts

Asymptomatic Cysts

• No treatment or follow-up is indicated for asymptomatic simple hepatic cysts regardless of size 1
• Routine imaging follow-up is not recommended for asymptomatic simple cysts 1

Symptomatic Cysts

• Ultrasound should be the first diagnostic modality when symptoms occur 1
• Treatment options include:
  • Percutaneous aspiration with or without sclerotherapy 1, 2
  • Surgical intervention (laparoscopic or open fenestration/decortication) for recurrent or very large symptomatic cysts 3, 2
• Treatment success is defined by symptom relief, not by volume reduction 1
• Routine follow-up imaging after aspiration sclerotherapy or surgical procedures is not recommended 1

Complicated Hepatic Cysts

Hemorrhagic Cysts

• Intracystic hemorrhage within a hepatic cyst typically resolves spontaneously and does not require treatment 1

Infected Cysts

• Infected hepatic cysts require active management 1
• Imaging with contrast-enhanced CT, MRI, or PET-CT may be needed 1
• Treatment options include percutaneous catheter drainage with antibiotics 1
• For hepatic abscesses >3 cm, percutaneous catheter drainage with antibiotics has shown success rates of 83% 1

Hydatid Cysts (Echinococcosis)

• Treatment depends on cyst size, location, and stage 1
• For simple liver cysts <5 cm: Albendazole alone (400 mg twice daily) 1
• For cysts >5 cm: Puncture, aspiration, injection, and re-aspiration (PAIR) with drug therapy 1
• Medical treatment includes albendazole (400 mg twice daily) with the addition of praziquantel (20 mg/kg twice daily) for 2 weeks before and after aspiration or surgery 1
• Surgery may be indicated for larger, extrahepatic, or multiple cysts 1
• Treatment should only be carried out in specialist centers due to risk of anaphylaxis if cyst contents spill 1

Renal Cysts

• Simple renal cysts (Bosniak type I & II) are managed only if symptomatic or if complications arise (hemorrhage, infection, hydronephrosis, hypertension) 3
• Treatment options include:
  • Percutaneous aspiration alone or with sclerotherapy as first-line treatment 3, 4
  • Surgical decortication for recurrent or very large symptomatic cysts 3
  • Laparoscopic surgery (retroperitoneal approach preferred, especially for infected cysts) 3

Ovarian Cysts

• Management depends on cyst characteristics and patient age 1
• Simple paraovarian cysts generally need no follow-up 1
• Nonsimple unilocular smooth cysts:
  • Premenopausal women: No management needed if ≤3 cm; follow-up ultrasound in 8-12 weeks if >3 cm and <10 cm 1
  • Postmenopausal women: Follow-up in 1 year is an option if ≤3 cm; additional characterization recommended regardless of size 1

Ganglion Cysts

• 50% of ganglion cysts will spontaneously resolve without treatment 5
• Treatment options include:
  • Watchful waiting 5
  • Nonoperative aspiration/injection (high recurrence rate) 5
  • Surgical removal (lower recurrence rate but higher complication rate) 5

Colloid Cysts (Third Ventricle)

• Typically located in the third ventricle of the brain 6
• May cause increased intracranial pressure and hydrocephalus 6
• Treatment requires an interdisciplinary approach with temporizing measures to relieve symptoms followed by definitive removal 6

Common Pitfalls and Caveats

• Simple aspiration without sclerotherapy has a high recurrence rate 3, 5, 2
• It's essential to rule out cystadenoma, malignancy, biliary communication, and infection before treating hepatic cysts 2
• For hydatid cysts, rupture or spillage of cyst contents can result in anaphylaxis 1
• Cyst aspiration/injection is associated with higher recurrence rates compared to surgery, though surgery has a higher incidence of complications 5
• For complex cysts or when malignancy is suspected, surgical intervention is preferred over aspiration 2