Cysts – causes, manifestations, types and treatment

Causes of cysts

In most cases, tissue changes cystically and forms a cyst without an obvious cause. Some cysts are caused by developmental defects. For example, a dermoid cyst, which is a skin growth associated with a defect in prenatal development, forms because some skin cells are trapped in the skin during development and do not travel to the surface. Fluid then forms in the subcutaneous tissue and a cyst is thus formed.

In the case of polycystic kidneys, not all of the renal tubules are connected to the collecting ducts of the kidneys. They accumulate urine, become enlarged and form cysts. In some cases, cysts are a reaction to the presence of a parasite in the body. They can also be a symptom of a more serious injury caused by a powerful impact. Cysts on the ovaries or in the breast result from a hormonal imbalance, when there is a lower level of progesterone and a higher level of oestrogen.

Cysts can thus occur practically anywhere and most commonly form from blocked sebaceous glands. In summary, the possible causes or bases for the formation of cysts include the following:

• blocked glands or ducts in various organs of the human body
• genetic disorders
• embryotic developmental disorders
• defects in cells
• chronic or persistent inflammation
• parasitic infection
• trauma or injury with damage to lymph ducts or blood vessels
• tumours

How cysts manifest

Symptoms depend on the type of cyst and its location. Some subcutaneous cysts (e.g. ganglion) may form a visible lump on the skin detectable by the patient.

Cysts on internal organs (e.g. the liver or kidneys) are often detected incidentally in the course of an imaging examination. Cysts in the brain may manifest with headaches and other symptoms such as confusion, impaired mobility or speech difficulties. Cysts in the breast also often manifest with pain, as they put pressure on the surrounding tissue.

Though most cysts are benign, they should not be underestimated – it is always necessary to perform a tissue analysis. A problem arises when a cyst is infected (abscess), as it can cause inflammation. In this case, it is necessary to lance the cyst and drain it. Patients are commonly afflicted with the following types of cysts:

• ovarian cyst
• uterine cyst
• breast cyst
• Baker cyst (knee)
• testicular cyst
• kidney cyst
• liver cyst

pancreatic cyst, liver cyst

• neck cyst
• eye cyst (Meibomian cyst)
• brain cyst
• pilonidal cyst (fistula) in the area of the coccyx and sacrum

Types of cysts

 Ovarian cyst

Ovarian cysts most commonly appear in adulthood or after childbirth. The dimensions of ovarian cysts vary – from the size of a pea to the size of an orange. In addition to ovarian cysts, uterine cysts also occur in women.

Ovarian cysts most commonly form during ovulation, when the ovarian follicle does not rupture, but fills with fluid, or ruptures and refills with fluid – this is a follicular cyst. The resulting cyst is usually not limiting and disappears spontaneously over time. In the case of larger cysts, however, discomfort may occur and the patient’s fertility and health may be put at risk. In such a case, it is appropriate to surgically puncture the cyst.

Ovarian cysts are usually benign, and small ones are often asymptomatic. They are usually detected incidentally during a preventive gynaecological examination. Depending on the size of the cyst, the following symptoms may occur:

• irregular menstrual cycle
• abdominal pressure
• pain during sex
• pain when at rest (only in the case of larger cysts).

Another type of ovarian cyst is endometrial cysts, or endometriomas. These can form on the ovaries of women suffering from endometriosis.

• Ruptured ovarian cyst
  A ruptured (large) cyst can cause inflammation in the lower abdomen. Such inflammation manifests as severe pain, nausea, vomiting and fever. In such a condition, it is necessary to seek medical care immediately– there is a risk of damage to the blood vessels and bleeding into the abdominal cavity. If bleeding occurs, surgical (laparoscopic) treatment is performed.

Breast cyst

Breast cysts occur especially in women and, though they can be painful, they usually do not require treatment. In women, they most often occur in connection with the menstrual cycle. They may disappear spontaneously or change in size. If breast cysts cause pain, tension, pressure in the breast, etc., the treatment option is drainage of the cyst.

Some studies indicate that so-called simple breast cysts do not increase the risk of breast cancer. However, multilocular and large cysts can become malignant and cause a cancerous growth.

Therefore, it is necessary to monitor breast cysts and regularly undergo an ultrasound examination (e.g. mammograph).

A Baker cyst (cyst in the knee) appears in the popliteal area. These cysts often occur after knee injuries or if the patient has gout, arthrosis or rheumatoid arthritis. However, Baker cysts are not uncommon in athletes who regularly put excessive strain on their knee joints.

Typical symptoms of a Baker cyst mainly include swelling in the popliteal fossa, which may spread to the entire knee.

Kidney cyst

We divide kidney (renal) cysts into two basic types – cortical cysts (simple) in the renal cortex and parapelvic or intrarenal cysts in the area of the renal pelvis.

Kidney cysts can be congenital (polycystic kidney disease). Though they are usually benign, it is always necessary to monitor them. In terms of their malignant potential, kidney cysts are divided into several classes according to the Bosniak classification. If the risk of malignancy is exceedingly high, it is necessary to surgically remove the cyst.

Testicular cyst

Epididymal cysts or spermatoceles occur in the epididymis. These are generally common cysts that usually do not require treatment and do not affect male fertility in any way. However, if such a cyst causes difficulties, surgical removal may be recommended.

Liver cyst

Liver cysts are usually detected incidentally during an imaging examination. They can be solitary or multiple, in which case the patient may already have polycystic liver disease, which can lead to the necessity of a liver transplant. Symptoms include, in particular, pressure pain in the epigastrium. Treatment involves surgery and is usually performed laparoscopically.

Brain cyst

Brain cysts grow and cause symptoms only exceptionally. They are usually detected incidentally during a brain imaging examination. The most common brain cysts are arachnoid and pineal cysts.

Here it is crucial to rule out the connection of a brain cyst with a possible more serious disease, as some brain tumours can also form cysts. A doctor can usually determine the severity of a cyst during the initial MRI scan.

Retention cyst

Retention cysts occur due to post-foetal closure of a glandule duct (hyperplasia of the duct lining, thickening of the secretion, concrement, pressure of a tumour growing in the vicinity of the duct, etc.). The gland’s secretion accumulates in front of the obstruction and dilates the duct or the gland itself until the hydrostatic pressure of the secretion equalises with the secretory pressure of the gland – the lining of the cyst then succumbs to pressure atrophy and atrophy due to inactivity; further enlargement is possible due to the decay of the contents of the cyst (increase in osmolarity) or by exudation in the case of inflammation of the cyst wall. Examples:

• comedo – retention of horny scales and thickened secretion of the sebaceous gland in the mouth of the hair follicle – there is a black cap.
• atheroma – retention cyst of the sebaceous gland, the contents are sebum and scales of the epidermis.
• ranula – retention cyst of the sublingual salivary gland with serous content, called a “frog’s belly” (which it resembles).
• mucocele – retention cyst of the minor salivary gland, often on the cheek mucosa, lower lip, soft palate, floor of the oral cavity, base of the tongue; it is necessary to distinguish these cysts from tumours of the minor salivary glands.
• ovum Nabothi– retention cyst on the cervix uteriarising from the overgrowth of the squamous epithelium over the mouth of the cervical mucous glands.

Implantation cyst

These cysts occur due to the the introduction of epithelium into connective tissue during trauma or inflammation, epithelium lining the wall of the cavity in which it is found (thigmotaxis – the tendency of epithelia to cover unoccupied surfaces).

Examples:

• horny cysts in skin.
• serous cysts in peritoneal
• apical dental cysts from enamel-forming epithelium that has entered the apical granuloma and grown through its wall.

Hyperplastic cyst

Hyperplastic cysts occur in organs whose epithelium is subject to hormonal regulation – these cysts are represented by dilatation of the gland or its duct caused by hyperplasia of the lining (which, however, remains predominantly monolayer, is not atrophic and its proliferation leads to an increase in surface area – a prerequisite is low consistency of the surrounding area, enabling dilatation of the epithelial formation).

Examples:

• cystic mastopathy – in the mammary glands(influenced by FSH)
• glandular cystic hyperplasia of the endometrium – excess FSH
• follicular cysts of the ovary – cysts arise due to excessively growing follicles in which ovulation does not occur (however, the lining of the cyst originates in the ovarian stroma and not in the epithelium – this is rather a case of a pseudocyst).

Foetal cyst

Foetal cysts are caused by a developmental disorder, e.g. defective connection of tubular structures (renal cystosis – non-connection of the proximal and distal bases of the nephron – the proximal section is dilated by stagnation of the fluid produced by the epithelium), imperfect closure of embryonic clefts (cervical cysts – medial ductus thyreoglossus (from the root of the tongue to the thyroid gland → moves during swallowing and movement of the tongue) and lateral from the branchial protrusions – branchiogenic cysts), the persistence of epithelial islets in the interstitium (Walthard cysts in the area of the ovary arising from cleaved nests of its surface epithelium – a variant of implantation cysts) or from embryonically based organs, which vanish in the course of further development (cysts from the remnants of the urachus, omphaloenteric duct, etc.).

Parasitic cyst

A parasitic cyst is formed by the body of a parasite, e.g. a tapeworm or echinococcus.

Neoplastic cyst

Neoplastic cysts are true tumours and occur due to the tumorous growth of tissue that retains the glandular cystic character of the initial epithelium with serous or mucinous secretion (macroscopically, the cystic character of the formation prevails over the growth of solid sections of the tumorous parenchyma), e.g. cystadenomas of the ovary.

“A true cyst is always bordered by an epithelial membrane, the structure of which usually depends on the structure of the organ in which the cyst arose. Cysts can occur in practically all organs and tissues of the body (e.g. breasts, ovaries, kidneys, liver). Baker pseudocysts – protrusions in the popliteal fossa – often occur in the knee joints. Cysts vary in size, from microscopic to massive cystic formations that can put pressure on internal organs,” says MUDr. Jaroslav Kalina, general practitioner for adults and doctor of occupational medical services at EUC PLS.

The most common shape of a cyst is spherical or oval; multilocular cysts composed of several interconnected spheres occur more rarely. Most cysts are benign (non-malignant), though some can become cancerous or be a direct component of both malignant and benign tumours. Therefore, this problem should not be underestimated and it is always necessary to seek medical attention without delay.

Treatment of cysts

How to get rid of a cyst? Treatment depends on many factors, particularly the type and size of the cyst and the severity of the difficulty it causes. Large symptomatic cysts can be removed surgically or the fluid can be drained from them by inserting a needle or catheter. Such a procedure is called aspiration or drainage.

If it is suspected that the cyst is malignant, drainage cannot be performed because there is a risk that cancer cells could be introduced into the surrounding area. Therefore, it is necessary to perform surgical resection, or removal, and sometimes it is necessary to remove part of the affected organ.

If the cyst is caused by a chronic or other disease (e.g. fibrocystic breast disease or polycystic ovary syndrome), it is absolutely necessary to treat the underlying causes and not only remove the cyst itself.

Cysts in a nutshell

A cyst is a cavity with an epithelial lining filled with fluid or, more rarely, solid substances or gases. Cysts can affect any organ or tissue. Most types of cysts are benign, though there are also cysts that can develop into malignant tumours. The most common cause of a cyst is blockage of the ducts of the sebaceous or sweat glands, followed by infectious diseases, trauma, parasites and certain types of tumours.

Cysts on internal organs are usually discovered incidentally during imaging examinations. Cysts in the subcutaneous tissue and in the area of joints are often palpable or visible. If cysts do not cause problems, they usually do not require treatment. In the case of symptomatic cysts, treatment usually consists in removal or drainage. If you find a cyst anywhere on your body, visit a doctor without delay. You can also contact the specialists at the EUC clinics.