Diseases

Cysts - causes, symptoms and therapy

Cysts - causes, symptoms and therapy


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The word cyst comes from the Greek. The cysts presented here should not be confused with the excretory organ, despite the fact that they have the same name, although there are morphological similarities. To put it simply, they consist of a cavity in which there is liquid. They are surrounded on the outside by a capsule made of epithelial tissue. This type of tissue forms the surface tissue that covers the organs and delimits them from the environment.

Cysts are self-contained structures. They do not have an outlet, so that the liquid they contain cannot run off. Their size can vary significantly. It ranges from a few millimeters to the size of a fist. In rare cases, diameters of 20 centimeters and more are possible. They occur as a single structure, but can also be divided into several chambers. The liquid content can be composed of different substances and can contain urine, blood, pus and sebum in addition to tissue fluid. Depending on the composition, the consistency of the content ranges from liquid to solid.

As a rule, cysts are harmless and only represent a cosmetic problem. However, if you are uncertain about the origin and type of tumors, a doctor should definitely be consulted for clarification.

Types of cysts

Medically, cysts are divided into two main groups. The "real cysts" are - as already described above - surrounded by an epithelium. They can be found anywhere in the body and can be classified into different types of cysts. They include the so-called epidermal or follicular cysts, which are widespread. Almost everyone has already met these one to three centimeters large, spherical structures in the skin.

Many also know milia. These are tiny, one to three millimeter large structures that nest on the cheeks and temples as whitish-yellow granules. They often occur in young children and adolescents, but can also affect adults. You have no pathogenic potential. Due to their exposed location, however, they can pose a considerable cosmetic problem for those affected. In addition, real cysts in a wide variety of sizes, shapes and variants can occur almost anywhere. The most common types can be seen in the following list:

  • Kidney cysts,
  • Liver cysts,
  • Ovarian cysts (ovarian cysts),
  • Cysts in the back of the knee (Baker's cyst),
  • Thyroid cysts,
  • Cysts in the glands on the eyelid,
  • Sebaceous cysts of the skin,
  • Cysts in the chest,
  • Bone cysts,
  • Tooth root cysts.

The so-called pseudocysts must be distinguished from the real cysts. They are not surrounded by epithelial cell tissue, but by a thin layer of connective tissue. They mostly arise as a result of degenerative or inflammatory processes. A typical example of this are pancreatic cysts that develop due to pancreatitis.

The mucocele (mucosal cyst) also belongs to this type. It forms when salivary glands are injured and can no longer release their fluid. Due to the fluid retention, the salivary gland develops a cyst as a kind of overflow basin. This mechanism often affects the oral mucosa when a careless bite damages the glands. Pseudocysts can also be caused by parasites or infections. The following chapters deal exclusively with real cysts.

Causes that lead to the formation of a cyst

The formation of cysts can have various causes. They often arise because fluid accumulations in the tissues cannot drain or can only drain insufficiently. This happens quite often in the skin when the sebaceous glands are blocked. Breast cysts also belong to this category. They are caused by a blockage in the milk ducts.

Cysts can also form as a result of illness, such as cystic fibrosis. This is a rare inherited disorder in which the secretion metabolism in all glands that produce mucus is disturbed. The secretions contain too little water and become viscous. The result is very severe functional restrictions in a wide variety of organs, especially in the lungs. There, the viscous mucus forms cysts in the lung tissue.

Ovarian, testicular and some breast cysts have a hormonal cause. This connection can be observed very impressively in ovarian cysts. The mostly cherry-sized structures arise in the context of hormonal changes in puberty and in the menopause. With the end of the hormone change, they disappear again. Obesity can promote their emergence.

So-called chocolate cysts arise as a result of endometriosis. This is a condition in which butter-like tissue occurs outside the uterine cavity. Mixed with clotted blood, it can collect in a cavity called a chocolate cyst because of its brown color.

Liver cysts can have two different causes. In our latitudes, developmental disorders of certain tissues in the womb are mostly to blame for their development. They are more rarely the result of infestation with the fox tapeworm, which can trigger a dangerous worm disease, echinococcosis. It affects the liver, but can also affect other organs. If left untreated, it can lead to death.

Individual cysts in the liver are mostly harmless. However, the situation is different with the so-called cyst liver (polycystic liver disease). It usually arises on the basis of the autosomal dominant inherited polycystic kidney disease. In 75 percent of cases, this also affects the liver. A cyst liver is a serious disease because of the large amount of space caused by the numerous cysts. The same applies accordingly to the cyst kidney (polycystic kidney disease).

Another disease associated with increased cyst formation is polycystic ovary syndrome (PCOS). It arises from hormonal disorders, in which the increase in the level of androgens (male sex hormones) is particularly noticeable. This results in the increase in body hair. Another characteristic of the disease, as the name suggests, is the presence of many cysts. With at least eight cysts with a maximum diameter of ten millimeters and an increase in the supporting tissue, doctors speak of PCOS.

The disease mainly affects young women of childbearing age. Their causes have not yet been fully clarified. Doctors assume that it is inherited because of family clusters. Being overweight increases the risk of illness. PCOS is often associated with insulin resistance. The receptors that are responsible for the absorption of glucose from the blood do not work properly. A diabetic situation arises that can make the symptoms of polycystic ovarian syndrome worse.

Symptoms

Single cysts are usually harmless and do not cause symptoms. This is also the reason why they often go undetected. In the internal organs, they are usually only discovered by chance during routine medical examinations. Cysts are found even less frequently in the brain when they are asymptomatic. They can be noticed in the context of diagnostics using MRI (magnetic resonance imaging). However, this examination is not part of routine controls and is only used for certain indications. In this way, cysts in the brain often go undetected. The situation is similar when the teeth or jaw are affected. Cysts in this area are usually only identified if the dentist takes an X-ray as part of his diagnosis.

Whether a cyst causes symptoms depends on where it is, how big it is, and how it behaves in the tissue. Ovarian cysts tend to burst and can then cause bleeding and cause acute abdominal pain and abdominal pain. Most of the time, these symptoms go away very quickly. Some ovarian cysts also produce estrogens, which can lead to spotting.

Very large cysts can take up so much space that they affect the surrounding tissue, which, depending on the location, can have serious consequences. Visual and speech disorders can occur in the brain. Motor impairments are also possible. In an unfavorable situation, cysts can block the ducts of organs. This can be observed, for example, in the paranasal sinus, but also in the pancreas. The liquid build-up increases the risk that germs can accumulate and infections can be caused. The Baker's cyst in the back of the knee can be very full of fluid, which often limits mobility and causes pain.

While individual cysts rarely cause problems, the cystic kidney and the cystic liver are serious symptoms. They are characterized by a large number of cysts that severely impair the functioning of the two organs. The first symptoms of a cystic kidney are high blood pressure, blood in the urine and recurrent urinary tract infections. In addition, the abdominal girth increases and there is pain and pulling in the abdomen.

With some forms of the course, the system can compensate for the malfunctions for a long time. There are no symptoms, often until shortly before the organ finally fails. The reduced kidney function means that waste products are no longer completely disposed of. They gradually poison the body and cause other symptoms. These can be general signs of illness such as malaise, tiredness, nausea and reduced performance, but also specific symptoms such as the following:

  • Yellowing of the skin,
  • constant itching,
  • Sleep and concentration disorders,
  • Calf cramps,
  • Nausea and vomiting,
  • Diarrhea,
  • Irregular heartbeat,
  • Inflammation of the heart,
  • Anemia,
  • Coagulation disorders,
  • increased susceptibility to infections,
  • cerebral susceptibility to bleeding
  • and bone softening due to vitamin D deficiency

The increased size of the polycystic kidneys can also cause permanent or intermittent pain, which is usually located on the side of the upper body or abdomen.

The cyst liver shows a similarly dramatic clinical picture. The course differs, however, since the liver can compensate for the loss of function due to the mass of space for longer than the kidney. If the enlargement reaches a critical level, symptoms such as feeling of pressure and pain in the upper abdomen can appear. The liver can grow enormously and gradually displaces the stomach, intestines, heart and lungs. This can cause the following symptoms:

  • Loss of appetite,
  • early feeling of satiety,
  • Weight loss,
  • Shortness of breath
  • and irregular heartbeat.

In polycystic ovarian syndrome, the numerous cysts and the increased support tissue cause an enlargement of the entire organ. The disrupted hormonal balance with the high androgen levels is symptomatic by the following signs:

  • increased body hair,
  • lower pitch,
  • Masculinity of the body stature,
  • Enlargement of the clitoris,
  • Breast reduction
  • and blemishes.

In addition, the women affected often suffer from infertility and the resulting psychological stress.

Diagnosis

Since the cysts usually go undetected, diagnosis is often difficult. Complaints that arise are often not associated with them. Therefore, if anything is unclear, you should always go to the doctor to determine whether the symptoms come from a cyst or have another cause. Depending on the severity of the symptoms, the doctor can consider whether further diagnostic measures are necessary.

If there is suspicion of a serious impairment of organ functions, imaging methods can be used to clarify the facts. The first means of choice is ultrasound. It allows a quick overview of the condition of the organs in the abdominal cavity and in the thorax, but is not suitable for examining the brain. MRI and CT (computed tomography) can be used there. In the end, all diagnostic procedures are about two things: More serious causes of the symptoms should be excluded as far as possible and existing cysts should be assessed precisely according to their position, size and impairment of the environment. The result of the examinations largely determines whether therapy is necessary and, if so, which one is indicated.

Therapy

From a medical point of view, cysts that do not cause discomfort do not need to be treated. They are only checked regularly to detect any malicious changes in good time. However, there are various criteria that make medical intervention necessary. From a medical point of view, these are complaints that arise in the cyst itself; for example when it bursts. However, symptoms that are caused by the increasing mass in the surrounding tissue or in the neighboring organs are more common. In some situations, cosmetic considerations may also require medical intervention, for example in milia. In any case, the procedure should be coordinated with the doctor. The doctors have the following therapy options available.

Depending on the appearance of the cyst, the symptoms and the causative factors, anti-inflammatory, cortisone-containing drugs and hormonal preparations can be used.

In the case of large, bulky cysts, the doctor can puncture the liquid with a hollow needle. This reduces the pressure load on the environment for a certain time. However, the basic problem is not solved because the cavity subsequently fills with liquid again. The alternative is surgical removal of the cyst. This procedure has a longer-lasting effect than the puncture, but is often not successful in the long term. Some cysts have a high rate of recurrence. This indicates that there is a close connection to the processes that cause it. If these are not removed, the cysts form again and again.

A prime example of this are Baker's cysts on the knee. They always occur in connection with stability problems in the knee, which lead to constant additional stress. This can be caused by poorly healed cruciate ligament tears or degenerative changes (arthrosis) in the joint. If these causes are not eliminated, the Baker cysts will always return despite the surgical removal. The same applies to cysts that have a hormonal cause, for example in the breast or in the ovaries.

Persistent symptoms and discomfort cause stress, strain the psyche and weaken the immune system. Therefore, measures that activate the self-healing powers are very useful to support medical therapy. Relaxation methods are very suitable for relieving stress and getting back into balance. So far, they have proven particularly effective in women with cysts in the breast or ovaries to regulate hormonal fluctuations.

Another therapy option is acupuncture from traditional Chinese medicine. Together with herbs from Chinese medicine, it can help to restore the energetic balance and strengthen the body's resistance.

Treating patients with a cystic kidney is very difficult. There is no causal therapy. The course of the disease cannot be stopped and inevitably leads to kidney replacement therapy at some point. This consists initially in regular dialysis and finally ends in kidney transplantation. Until then, the therapy is purely symptomatic with the aim of maintaining kidney function for as long as possible. One focus is the adjustment of the hypertension induced by the kidney. In addition to drug regulation, the change in diet to low-salt diet can also help.

The course and prognosis of cyst liver are not as dramatic as that of cystic kidney. Despite extensive infestation, the disease can go on for a long time without symptoms and without any health impairment. This is related to the enormous biological potential of the liver, which we normally only use to a small fraction. Despite the large-scale infestation, there are still power reserves. In rare cases, surgical interventions are still necessary because the mass of the liver affects other organs.

The consequences of polycystic ovarian syndrome can also be influenced by the women concerned. With an adapted diet and regular exercise, they can counteract obesity and the development of diabetes. In terms of medication, the focus in this disease is on the administration of hormone preparations with which the androgenic changes and infertility can be eliminated. (fp)

Author and source information

This text corresponds to the requirements of the medical literature, medical guidelines and current studies and has been checked by medical doctors.

Dipl. Geogr. Fabian Peters

Swell:

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  • Trinh, Tony W .; Kennedy, Anne M .; "Fetal Ovarian Cysts: Review of Imaging Spectum, Differential Diagnosis, Management, and Outcome", in: Radiographics, Volume 35 Issue 2, 2015, NCBI
  • American College of Obstetricians and Gynecologists' Committee on Practice Bulletins-Gynecology's (ed.): "Practice Bulletin No. 174: Evaluation and Management of Adnexal Masses", in: Obstetrics & Gynecology, Volume 128 Issue 5, November 2016, NCBI
  • Weyerstahl, Thomas; Stauber, Manfred: Dual series gynecology and obstetrics, Georg Thieme Verlag, 2013
  • Staubach, Karl-Hermann: Short textbook, four-volume small operative subjects: urology, ophthalmology, ENT, orthopedics, urban & Fischer in Elsevier, 2007


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