Cystic lymphangioma of the lesser omentum in an adult patient.

INTRODUCTION: Lymphangiomas belong to the group of benign vascular tumors that originate in the lymphatic tissue. Up to 90% of cases manifest in children before the second year of life. In adults, their presence is very rare. In most cases, they are located in the head, neck and axilla. Intra-abdominal lymphangiomas are very rare and represent less than 1% of all cases. CASE REPORT: The authors present the case of a 64-year-old female patient diagnosed with an intra-abdominal cystic lesion following a routine examination. A CT scan of the abdomen confirmed a cystic lesion located in the lesser omentum between the left lobe of the liver and the lesser curvature of the stomach. The patient was scheduled for laparoscopic exstirpation of the lesion. Histological examination confirmed the clinical diagnosis of cystic lymphangioma of the lesser omentum. CONCLUSION: The etiopathogenesis of lymphangiomas remains unclear. Despite the fact that they are benign tumors, lymphangiomas tend to have an infiltrative pattern of growth, invading surrounding structures. The majority of cases are asymptomatic and the diagnosis is incidental. The gold standard in treatment remains complete surgical extirpation with microscopically negative margins.

Adrenal cysts less than 10 cm can be safely observed.

BACKGROUND: Adrenal cysts are rare and appropriate management is unclear due to a lack of data on their natural history. Understanding adrenal cyst growth patterns would assist in clinical management. METHODS: This single-institution study included all adult patients diagnosed with simple adrenal cysts between 2004 and 2021. Baseline characteristics and outcomes of those who underwent resection (ADX) or observation (OBS) were compared using the chi-squared test, student's t-test, and Wilcoxon rank-sum test. Growth curves and sensitivity analysis were plotted for all patients who had follow-up imaging. RESULTS: We identified 77 patients with imaging-confirmed adrenal cysts. The majority were female (75.3%) and more than half were white (55.8%). One-third of patients underwent ADX, and the remaining were observed. ADX patients were younger (median age [IQR]: 55.5 y [45.0-68.2 y] vs. 44.2 y [38.7-55.0 y], p = 0.01) and more likely to be Hispanic (12% vs. 0%, p = 0.05). ADX patients presented with larger cysts (5.6 vs. 2.6 cm, p = 0.002). The median time from diagnosis to last follow-up was 1.1 y for ADX and 4.1 y for OBS. Average growth for OBS was 0.3 cm/y, while average growth for ADX was 3.9 cm/y. In ADX patients, cysts >10 cm grew significantly faster than cysts <10 cm (median growth rate 13.2 cm/y vs. 0.3 cm/y, p < 0.05). There was no adrenal malignancy diagnosis, hyperfunctionality, or observation-related complications (e.g., rupture). CONCLUSION: While size >4-6 cm has guided surgical referral for solid adrenal masses, this study demonstrates a size threshold of 10 cm, below which asymptomatic, simple adrenal cysts can safely be observed.

Leukoencephalopathy with cerebral calcifications and cysts: the neurosurgical perspective. Literature review.

PURPOSE: Labrune syndrome is a rare white matter disease characterised by angiomatous leukoencephalopathy, diffuse intracranial calcifications and supra- and infra-tentorial parenchymal cysts. The clinical worsening is often related to cyst expansion, and surgery may be advocated for symptomatic management in about one-third of cases. However, no consensus exists on surgical timing, the most effective procedure, and long-term results. MATERIAL AND METHODS: Electronic databases, such as PubMed/ MEDLINE and Google Scholar, were analysed for studies published to April 2022 using the search term "Labrune syndrome OR leukoencephalopathy with calcifications and cysts OR brain calcifications OR brain cysts AND therapy OR surgery RESULTS: We found 28 studies reported in the literature, and we added a new case we treated at our Institution, reaching a series of 37 patients. All the patients in this series underwent surgical intervention. We aimed to review all the pertinent literature to discuss clinical-radiological features and etiopathogenetic insights, addressing the specific issue of the surgical options, clinical results and prognosis. CONCLUSION: LCC is a rare neurodegenerative disorder without effective medical treatment. Surgery remains the only therapeutic option to control the disease to reduce the mass effect of growing cystic lesions. Almost half of the patients who underwent surgery required further approaches, with great concern for the associated disabilities. Several procedures have been described, with no evidence of the most effective. Individual-based surgical planning must be advocated, tailoring the approach to limit side effects. Mini-invasive neuroendoscopic approaches may be considered to achieve those satisfactory results.

Peribiliary cysts: uncommon mimickers of hepatic and biliary cystic lesions.

Peribiliary cysts (PC) are dilatations of the extramural peribiliary glands, with a very characteristic imaging pattern in the contexts of hepatobiliary diseases, idiopathic portal hypertension, adult-type polycystic disease of the liver and kidneys, solitary nonparasitic cysts, and systemic infections. The clinical relevance of PC is related to the fact that their presence may indicate underlying pathologies (such as those mentioned above) and may be considered as a potential marker of liver disease progression. Although imaging findings are quite characteristic, recognizing their main differential diagnoses, including malignancies, can be challenging but are essential to avoiding diagnostic errors.

Tubular adenoma arising in tubular colonic duplication: a case report.

Colonic duplication constitutes a rare congenital anomaly, characterized by the presence of hollow cystic or tubular structures exhibiting an epithelial-lined intestinal wall. Diagnostic challenges persist due to its low incidence and manifestation of nonspecific symptoms such as abdominal pain or constipation, resulting in a reluctance to pursue surgical resection. As associated malignancies in colonic duplication are rare, the inherent malignant potential of these anomalies remains undetermined. Additionally, despite reported instances of associated malignancies in colonic duplication, there is an absence of reports in the literature detailing tubular adenoma within these cases. The histologic features of the presented case are particularly noteworthy, situated at the precancerous stage, intimating potential progression towards adenocarcinoma within colonic duplication.

Congenital orbital respiratory epithelial cyst with anomalous maxillary antrum in the absence of bony defect.

A 23-year-old female symptomatic with unilateral proptosis with superior globe displacement and hypertropia was found to have a multiloculated cystic lesion with bony lining arising from the inferomedial orbit. The adjacent maxillary sinus was markedly smaller on the affected side, with no defect of the wall on radiographic or intraoperative examination. Surgical excision and histological analysis of the lesion demonstrated an orbital respiratory epithelial cyst. A literature review of congenital orbital respiratory epithelial cysts is presented. To our knowledge, this is the first published case of choristomatous orbital respiratory epithelial cyst associated with ossification, and a primary or secondary anomaly of the adjacent sinus without bony defect.

Fine-needle aspiration technique under endoscopic ultrasound guidance: A technical approach for RNA profiling of pancreatic neoplasms.

BACKGROUND: Early diagnosis of pancreatic ductal adenocarcinoma (PDAC) has been a longstanding challenge. The prognosis of patients with PDAC depends on the stage at diagnosis. It is necessary to identify biomarkers for the detection and differentiation of pancreatic tumors and optimize PDAC sample preparation procedures for DNA and RNA analysis. Most molecular studies are done using paraffin-embedded blocks; however, the integrity of DNA and RNA is often compromised in this format. Moreover, RNA isolated from human pancreatic tissue samples is generally of low quality, in part, because of the high concentration of endogenous pancreatic RNAse activity present. AIM: To assess the potential of endoscopic ultrasound-guided fine-needle aspiration (EUS-FNA) to obtain specimens from pancreatic neoplasms for subsequent RNA molecular profiling, including next-generation sequencing (NGS). METHODS: Thirty-four EUS-FNA samples were included in this study: PDAC (n = 15), chronic pancreatitis (n = 5), pancreatic cysts (n = 14), mucinous cysts (mucinous cystic neoplasia/intraductal papillary mucinous neoplasia) n = 7, serous cystic neoplasms n = 5, and pseudocysts n = 2. Cyst material consisted of cyst fluid and cyst wall samples obtained by through-the-needle biopsy (TTNB). Samples were stored at -80 °C until analysis. RNA purity (A260/230, A260/280 ratios), concentration, and integrity (RIN) were assessed. Real-time polymerase chain reaction was conducted on all samples, and small RNA libraries were prepared from solid mass samples. RESULTS: RNA was successfully extracted from 29/34 (85%) EUS-FNA samples: 100% pancreatic adenocarcinoma samples, 100% chronic pancreatitis samples, 70% pancreatic fluid cyst samples, and 50% TTNB samples. The relative expression of GAPDH and HPRT were obtained for all successfully extracted RNA samples (n = 29) including low-quality RNA specimens. Low concentration and nonoptimal RIN values (no less than 3) of RNA extracted from EUS-FNA samples did not prevent NGS library preparation. The suitability of cyst fluid samples for RNA profiling varied. The quality of RNA extracted from mucinous cyst fluid had a median RIN of 7.7 (5.0-8.2), which was compatible with that from solid neoplasms [6.2 (0-7.8)], whereas the quality of the RNA extracted from all fluids of serous cystic neoplasms and TTNB samples had a RIN of 0. CONCLUSION: The results demonstrate the high potential of EUS-FNA material for RNA profiling of various pancreatic lesions, including low-quality RNA specimens.

Cysts of the ligamentum flavum are often linked to ischemic conditions: A morphological study.

"Cysts of the ligamentum flavum (cysts-LF)" is the term for non-neoplastic cystic lesion involving LF. The aim of the present study was to elucidate the histopathological characteristics and pathogenesis of "cysts-LF". Herein, we defined cysts-LF as spinal cysts containing degenerative LF components. From archival cases, we investigated 18 symptomatic cysts-LF surgically removed from 18 patients (13 males and five females; median age 68.5 years [range, 42-86 years]). The elastic fibers of LF components in the wall were separated and/or torn, and cyst walls were accompanied by chondroid metaplasia (17 cases), myxoid changes (13 cases), ossification (11 cases), amyloid deposits (14 cases), hemosiderosis (six cases), granular/smudgy calcification (four cases), synovial cell linings (three cases), and severe inflammatory infiltrates (one case). These histologic features of our cysts-LF were shared by previously reported "cysts-LF." Fourteen cysts-LF demonstrated vascular stenosis/occlusion, and eight showed thick hyalinized vessels, suggesting local circulatory insufficiency. Eight cases (44%) exhibited lipomembranous fat necrosis, accompanied by hyalinized vascular changes (p = 0.003). Ischemic conditions were observed in nearly half of the present cysts-LF, and may be one of the main contributing factors for the formation of cysts-LF, via degeneration and cystic changes in the LF.

Large nasopalatine duct cyst in a child patient: a case report.

Introduction and importance: Nasopalatine duct cyst (NPDC) is one of the most common non-odontogenic cysts of the oral cavity, which it can arise at any age but is seen rarely in children. These cysts are usually asymptomatic, and are detected by routine radiographs. Case presentation: This case report presents the management of a large nasopalatine duct cyst in an 11-year-old pediatric patient. The patient presented with symptoms such severe mobility in central incisors and swelling in the anterior part of the palate. Diagnostic imaging confirmed the presence of a large cyst in the nasopalatine region. Surgical intervention was performed to excise the cyst, and the central incisors were splinted with a rigid splint for 4 weeks. Clinical discussion: The case of a large nasopalatine duct cyst in a child patient poses several important clinical considerations. Nasopalatine duct cysts are relatively rare, especially in pediatric patients, making this case particularly noteworthy. The presentation of a large cyst in a child raises questions about the etiology, diagnosis, and treatment options for such cases. Conclusions: This case report highlights the importance of considering nasopalatine duct cysts as a differential diagnosis in pediatric patients presenting with maxillary swelling and associated symptoms. Early recognition and appropriate management are essential to prevent potential complications and ensure optimal outcomes for the patient. The nasopalatine duct cyst that occurs at children may be aggressive and led to severe loss in the supporting alveolar bone with teeth mobility.

Unraveling Labrune Syndrome: A Case Report on the Neurological Phenotype in SNORD118-Negative Patients.

Labrune syndrome is a rare neurogenetic disorder with varied presentations. Here, we report the case of a 53-year-old male who presented with seizures, gait imbalance, and upper limb tremors for two years. Imaging studies revealed extensive leukodystrophy, multiple cerebral calcifications, and cystic lesions characteristic of Labrune syndrome. However, whole exome sequencing did not detect the SNORD118 mutation, typically associated with Labrune syndrome. Although the SNORD118 mutation is commonly found in Labrune syndrome, a few cases of the syndrome without this mutation have also been reported. This suggests the possibility that other yet undiscovered mutations may cause the same phenotype.

Three-dimensional evaluation of dentigerous cysts in the Turkish subpopulation.

BACKGROUND: To investigate the radiological and demographic features, types, distribution, and treatment methods of dentigerous cysts (DC). METHODS: Panoramic radiographs and cone beam computed tomography (CBCT) images of patients diagnosed with DC based on biopsy results between January 2020 and December 2023 were examined. In patients from different age groups, the numbers, types and locations, and radiological features of DCs, associated changes in surrounding tissues, and treatment methods used were reviewed. RESULTS: Among 95 patients with DC (66 males, 29 females), sex and age distributions were comparable between those with a single cyst (n = 86) and those with two cysts (n = 9). Of 104 DCs, 44 were central, 38 were lateral, and 22 were circumferential. DC types were not significantly affected by sex, age group, or anatomical location. Circumferential DCs often caused displacement of the mandibular canal inferiorly. While enucleation was preferred for the treatment of central DCs, circumferential DCs were treated with marsupialization. CONCLUSIONS: In this study, which is the first to evaluate the DC types on CBCT images, the central type was the most common. Circumferential DCs were mostly treated with marsupialization. CBCT imaging can assist in determining DC types, and may provide guidance for treatment planning.

Successful treatment of nasopalatine duct cyst after maxillary anterior implant surgery: a case report.

BACKGROUND: Sporadic studies have reported the occurrence of nasopalatine duct cysts after maxillary anterior implant surgery, and the treatment methods still have clinical uncertainty. PURPOSE: We report a potential therapy method that successfully treated a nasopalatine duct cyst that developed and expanded one year after maxillary anterior implant placement following periodontally hopeless teeth extraction. MATERIALS AND METHODS: The nasopalatine cyst was treated surgically without removing implants. During flap surgery, the cyst was removed intact, and the exposed implant's surface was debrided thoroughly by hydrogen peroxide (H2O2) rinsing, glycine air polishing, and saline rinsing. To deal with the significant bone defect caused by the cyst, a bovine porous bone mineral injected platelet-rich fibrin (BPBM-i-PRF) complex was applied to fill the defect, following a resorbable collagen membrane to cover. RESULTS: 7 years after surgery, no cyst recurrence was observed, and bone regeneration in the bone graft area was stable. The implants functioned well without mobility. CONCLUSIONS: For nasopalatine duct cysts associated with dental implant placement, complete surgical debridement and longitudinal stable bone regeneration are possibly accessible by regenerative surgery without implant removal.

Unusual giant plunging sublingual epidermoid cyst: A case report and review of literature.

Key Clinical Message: When treating a painless or asymptomatic mass in the submental or floor of the mouth, sublingual epidermoid cyst should be considered. Despite its irregularity, preventing malignant transformation is essential for a successful outcome. Abstract: Dermoid and epidermoid cysts are rarely found in the head and neck region. They account for less than 0.01% of all oral cavity cysts. This is a rare case of a sublingual epidermoid cyst of the oral cavity in a 25-year-old male. The patient presented with a painless sublingual swelling for a duration of 1 month. The clinical examination revealed a non-tender swelling in the sublingual region extending to the submental triangle. Magnetic resonance imaging confirmed a 6.2 × 7.7 × 3.2 cm cystic lesion in the sublingual space. Fine needle aspiration cytology confirmed dermoid cyst contents. Intra-oral surgical excision under general anesthesia was performed successfully. Histopathological analysis revealed that the cyst wall was lined by stratified squamous epithelium. The presence of a prominent granular layer and keratin flakes confirmed the diagnosis of an epidermoid cyst. Postoperative recovery was good, and no recurrence was observed during follow-up. This case emphasizes the infrequent and unusual presentation of a case of a giant plunging sublingual epidermoid cyst and promotes awareness and potential studies in the enhancement of patient care in this area.

Transport and preservation of calcareous and organic-walled dinoflagellate cysts off Cape Blanc (NW africa) in relation to nepheloid layers.

Our understanding of dinoflagellates' present-day and past ecology is limited due to the scarcity of data on the transport of dinoflagellate cysts in oceanic environments. Previous studies have shown that lateral transport affects the source-to-sink trajectory of cysts in the very productive region off Cape Blanc (NW Africa). Unsolved questions remain, such as: how far these cysts can be advected, whether the cyst sources vary over time and whether lateral transport is a permanent feature or restricted to individual events. To fill these gaps and assess the role of nepheloid layers on the lateral transport and preservation of dinoflagellate cysts, new data on dinoflagellate cyst distributions in the water column and sediments along a land-sea transect were obtained. Samples were collected in November 2018 along a shelf break-offshore transect during intense upwelling, notably, within and between the nepheloid layers. The composition and abundance of cysts with organic walls in the water column and surface sediments were studied. Moreover, the distribution of calcareous cysts was also analysed in the water samples, using non-destructive acid-free preparation methods. The records were dominated by empty cysts, but no clear indications that these originated from local resuspension of older sediments were observed. Clustering, principal component analysis and redundant discriminant analysis were used to compare cyst assemblages in the water column and surface sediments, and environmental conditions in the upper water column. The strong similarity in species composition of water samples collected in the active upwelling region to those collected from the more onshore parts of the Benthic Nepheloid Layer (BNL), upper Intermediate Nepheloid Layer (INL) (∼1000 m depth) and lower INL (∼2200 m depth) indicated that lateral transport of cysts within these NLs occurred until about ∼110 km from the shelf break. Cyst assemblages from above and below these NLs showed significantly different taxa composition reinforcing the role of NLs in the lateral advection of cysts. In the more offshore stations, vertically similar cyst assemblages were observed in the same station, independent of the sample depth, within or between the NLs, which supported that at these stations vertical transport was the dominant process influencing cyst assemblages. Consequently, the cyst signal in sediments off Cape Blanc may be affected both by horizontal transport of allochthonous cysts and vertical deposition of locally-produced cysts, particularly in the more offshore stations (>2000 m depth). Despite lateral transport and possible species-specific preservation effects, horizontal distributions of most cyst taxa in the water column and the surface sediments could be explained to a great extent by the main environmental gradients in the upper water column. This agrees with observations made in other regions, and reinforces that dinoflagellate cysts as good proxies to reconstruct past environmental conditions in offshore environments. New data on dinoflagellate cyst distribution, transport and accumulation patterns in deep environments off Cape Blanc may be useful for interpreting past environmental signals in the region. This is particularly relevant regarding calcareous cysts, as information on their distribution and ecology is very scarce. The present work contributes to a better understanding of the dispersal patterns of dinoflagellate cysts in the deep ocean, highlighting the significant role played by nepheloid layers in this process and thus on the dinoflagellate cyst signature in deep-sea sediments.

Automatic Classification and Segmentation of Multiclass Jaw Lesions in Cone-Beam Computed Tomography using Deep Learning.

OBJECTIVES: To develop and validate a modified deep learning (DL) model based on nnU-net for classifying and segmenting five-class jaw lesions using cone-beam computed tomography (CBCT). METHODS: A total of 368 CBCT scans (37 168 slices) were used to train a multi-class segmentation model. The data underwent manual annotation by two oral and maxillofacial surgeons (OMSs) to serve as ground truth. Sensitivity, specificity, precision, F1-score, and accuracy were used to evaluate the classification ability of the model and doctors, with or without artificial intelligence assistance. The dice similarity coefficient (DSC), average symmetric surface distance (ASSD) and segmentation time were used to evaluate the segmentation effect of the model. RESULTS: The model achieved the dual task of classifying and segmenting jaw lesions in CBCT. For classification, the sensitivity, specificity, precision, and accuracy of the model were 0.871, 0.974, 0.874 and 0.891, respectively, surpassing oral and maxillofacial radiologists (OMFRs) and OMSs, approaching the specialist. With the model's assistance, the classification performance of OMFRs and OMSs improved, particularly for odontogenic keratocyst (OKC) and ameloblastoma (AM), with F1-score improvements ranging from 6.2% to 12.7%. For segmentation, the DSC was 87.2% and the ASSD was 1.359 mm. The model's average segmentation time was 40 ± 9.9 s, contrasting with 25 ± 7.2 min for OMSs. CONCLUSIONS: The proposed DL model accurately and efficiently classified and segmented five classes of jaw lesions using CBCT. In addition, it could assist doctors in improving classification accuracy and segmentation efficiency, particularly in distinguishing confusing lesions (e.g., AM and OKC).

[Differential diagnosis of cystic and nodular lung diseases]. / Differenzialdiagnose zystischer und nodulärer Lungenkrankheiten.

BACKGROUND: Cystic and nodular lung diseases encompass a broad spectrum of diseases with different etiologies and clinicoradiological presentations. Their differentiation is crucial for patient management but can be complex due to diseases with features of both categories and overlapping radiological patterns. OBJECTIVE: This study aims to describe the imaging features of cystic and nodular lung diseases in high-resolution computed tomography (CT) in detail-primarily based on their etiology-in order to allow a more accurate differential diagnosis of these diseases. MATERIALS AND METHODS: A narrative review based on current literature on the topic was conducted from a clinicoradiological perspective. RESULTS: This paper systematically categorizes the differential diagnosis of cystic and nodular lung disease and provides insights into their radiological patterns and etiologies. It highlights the role of CT in the diagnosis of these diseases and emphasizes the importance of multidisciplinary panels combining expertise from radiology, pulmonology, rheumatology, and pathology. CONCLUSION: Reliable differential diagnosis of cystic and nodular lung diseases, particularly based on their radiological features alone, remains difficult due to their overlapping and dynamic nature. Multidisciplinary boards should be the clinical standard for accurate work-up of these diseases, as they combine the medical history, symptoms, radiological findings, and, if necessary, histopathological examinations, thus providing a more robust framework for diagnosis and management.

Evaluation of the Local and Peripheral Immune Responses in Patients with Cystic Echinococcosis.

BACKGROUND: Cystic echinococcosis (CE) cysts may persist for decades because of immune modulation mechanisms. Here, we characterize the cysts and the blood immune responses in patients with CE. METHODS: We enrolled 61 patients with CE and 19 control subjects. We received tissue samples from seven patients with CE and a control subject requiring liver cystectomy. The immunohistochemistry evaluation of the immune cell subtypes and cytokines in the pericysts and surrounding liver and the antigen B (AgB)-specific response analysis of whole blood were performed. RESULTS: In CE, the pericyst and the surrounding liver parenchyma showed aggregates of CD3+ T lymphocytes, mainly CD4+. B lymphocyte aggregates were present in the liver tissue. Monocytes/granulocytes were rarely observed. Th2 cytokine expression was scarce, whereas IFN-γ expression was present in the CE tissues. The control subject did not show an inflammatory infiltrate. The IL-4-specific response to AgB was increased in the patients with CE compared to the control, and this result was confirmed in a larger cohort (p = 0.003), whereas the IFN-γ-response was similar between the two groups (p = 0.5570). CONCLUSION: In patients with CE, CD4+ lymphocytes infiltrate the pericyst and the surrounding liver tissue with a low IL-4/IL-13 expression level and a moderate IFN-γ expression level; moreover, an IL-4 parasite-specific response is detected in the periphery. These results support adventitia involvement in CE immunopathogenesis.

Naturally and Anthropogenically Induced Lingulodinium polyedra Dinoflagellate Red Tides in the Galician Rias (NW Iberian Peninsula).

Despite the fact that the first red tide reported on the coasts of the Iberian Peninsula was due to Lingulodinium polyedra, knowledge about their frequency and, particularly, about the environmental conditions contributing to bloom initiation is still scarce. For this reason, L. polyedra bloom episodes were observed and studied in three Galician rias during the summer season based on the 1993-2008 record database period; additionally, samples were collected in summer 2008. Proliferations of L. polyedra occurred in the rias of Ares and Barqueiro in June and August, respectively, while in the Ria of Coruña, they persisted from the end of June to early September. Red tides developed when the surface temperature reached 17 °C, with "seasonal thermal window" conditions, and when salinities were ≥30, i.e., an "optimal salinity window"; when these parameters were lower than these thresholds, cyst germination decreased. A cyst transport mechanism from sediments to the surface must also exist; this mechanism was found to be natural (tidal currents) in the ria of Barqueiro or anthropogenic (dredging) in the rias of Ares and Coruña. Surface temperatures during summer were usually favorable for cyst germination (85 to 100%) during the 1993-2008 period; however, water temperatures below 10 m depth only rarely reached the 17 °C threshold (2 to 18%). During this 16-year period, dredging activities could explain 71% (Coruña) and 44% (Ares) of the recorded bloom events. When a bloom episode developed in early summer, favorable conditions did not lead to a new red tide, probably due to the lag period required by cysts for germination. Moreover, blooms did not develop when high densities of diatoms (>1,000,000 cells·L-1) remained in the water column as a result of summer upwelling pulses occurring in specific years. The temperature-sediment disturbance pattern found in this study provides a useful tool for the prevention of eventual risks resulting from red tides of this dinoflagellate.

Immunohistochemical Analysis of Dentigerous Cysts and Odontogenic Keratocysts Associated with Impacted Third Molars-A Systematic Review.

OBJECTIVE: This systematic review investigates the diagnostic, prognostic, and therapeutic implications of immunohistochemical markers in dentigerous cysts (DCs) and odontogenic keratocysts (OKCs) associated with impacted third molars. MATERIALS AND METHODS: A comprehensive search strategy was employed across major databases including MEDLINE/PubMed, EMBASE, and Web of Science, from the inception of the databases to March 2024. Keywords and Medical Subject Heading (MeSH) terms such as "dentigerous cysts", "odontogenic keratocysts", "immunohistochemistry", "Ki-67", and "p53" were used. The PRISMA 2020 guidelines were followed to ensure methodological rigor. Inclusion criteria encompassed studies on humans and animals providing definitive diagnoses or specific signs and symptoms related to DCs and OKCs, with results on protein expression derived from immunohistochemistry, immune antibody, proteomics, or protein expression methods. RESULTS: Of the 159 studies initially identified, 138 met the inclusion criteria. Our analysis highlighted significantly higher expressions of Ki-67 (22.1% ± 4.7 vs. 10.5% ± 3.2, p < 0.001), p53 (15.3% ± 3.6 vs. 5.2% ± 1.9, p < 0.001), and Bcl-2 (18.4% ± 3.2 vs. 8.7% ± 2.4, p < 0.001) in OKCs compared to DCs, indicating a higher proliferative index, increased cellular stress, and enhanced anti-apoptotic mechanisms in OKCs. Additionally, PCNA levels were higher in OKCs (25.6% ± 4.5 vs. 12.3% ± 3.1, p < 0.001). Genetic mutations, particularly in the PTCH1 gene, were frequently observed in OKCs, underscoring their aggressive behavior and potential malignancy. CONCLUSIONS: The findings emphasize the significant role of immunohistochemical markers in distinguishing between DCs and OKCs, with elevated levels of Ki-67, p53, Bcl-2, and PCNA in OKCs suggesting a higher potential for growth and recurrence. Genetic insights, including PTCH1 mutations, further support the need for personalized treatment approaches. These markers enhance diagnostic accuracy and inform targeted therapeutic strategies, potentially transforming patient management in oral and maxillofacial surgery.