Cysts: causes and forms
Cysts can develop in a wide variety of body sites and at any age. There are many different causes.
Some cysts develop when drainage is obstructed from a cavity that produces or contains fluid. For example, if the outflow duct of a sebaceous gland in the skin is blocked, a sebaceous gland cyst (a type of blackhead) may form.
In other cases, cysts develop due to chronic diseases (for example, lung cysts in cystic fibrosis), hereditary diseases (such as cystic kidneys or cystic liver), tumors, or as part of developmental disorders in the embryo.
Infections with parasites (such as the dog or fox tapeworm: echinococcosis) can also cause organ cysts. In addition, cysts can form under the influence of hormones, for example in the female breast, ovaries or testicles.
More common cysts include:
- Kidney cysts
- Liver cysts
- Ovarian cysts (ovarian cysts)
- Water hernia of the testis (hydrocele)
- Thyroid cysts
- Cysts in the glands of the eyelid
- Sebaceous gland cyst of the skin (atheroma)
- cysts in the breast
- Bone cysts
- Tooth root cysts
A “true cyst” is one that is lined by cells. A pseudocyst, on the other hand, is surrounded by connective tissue.
Cysts: symptoms and examinations
Symptoms
The symptoms caused by cysts depend, among other things, on the type of cyst, its place of origin and its size. Some cysts are noticeable by a visible or palpable swelling, for example a cyst in the breast. A Baker’s cyst in the back of the knee may also be palpable once it reaches a certain size. In addition, it can cause a vague feeling of pressure, pain and even numbness in the lower leg.
Other cysts are not noticed for a long time because they are located on internal organs (such as kidney, liver).
Whether a cyst causes discomfort or not says nothing about whether it is benign or malignant (most cysts are benign!).
Examinations
Sometimes further testing is necessary to more accurately determine the size and cause of the cyst. These include such things as:
- Computer tomography (CT)
- Magnetic resonance imaging (MRI)
- X-rays
- Blood tests
- Cyst puncture (in this procedure, the doctor removes some fluid from inside the cyst with a fine hollow needle in order to have it examined more closely in the laboratory)
Kidney cysts
Kidney cysts can occur singly or in multiples on one or both kidneys. They usually do not cause any symptoms and are therefore usually discovered only by chance. Large cysts, however, may be noticeable by pain in the back or abdomen.
Kidney cysts are rare in people under 30 years of age. With increasing age, they occur more frequently. More than 20 percent of people over 60 have one or more cysts on their kidneys.
A cyst on the kidney that does not cause problems does not necessarily need to be treated. Large cysts that are associated with pain or complications can be lanced by the doctor with a needle to draw in the fluid they contain (puncture). He may have the fluid from the cyst examined under a microscope. He may be able to sclerose or remove the cyst in surgery.
Cystic kidneys
However, the disease does not only affect the kidneys. Cysts can also form in other organs (for example, pancreas, liver, lungs, spleen, ovaries, uterus, testicles or thyroid). Some affected individuals also develop bulges in the wall of the aorta (aortic aneurysm) or the intestinal wall (diverticulosis).
Polycystic kidney disease can lead to various complications and is currently incurable. Treatment is only required when symptoms such as urinary retention or urinary tract infections occur.
Currently, there is no drug that can treat cystic kidneys causally. Therapy is aimed at alleviating symptoms.
Liver cysts
Treatment is usually not necessary for liver cysts – unless a cyst causes discomfort. In that case, the doctor can pierce it through the skin with a fine needle, aspirate its contents and inject an alcohol solution to sclerose the cyst. Rarely, the affected person must have the cyst removed in surgery (cyst resection).
Liver cysts in echinococcosis
Not all liver cysts are harmless. Infection with the dog or fox tapeworm can also cause cysts in the liver. Echinococcosis is a serious disease that is fatal without treatment!
Cystic liver
Cystic liver is a hereditary disease. It is caused by changes in the genetic material (mutations), more precisely in the genes PKD-1 and PKD-2. The liver of the affected person is occupied with cysts from birth. However, it can still do its job for a long time.
The symptoms can be relieved in the short term if the doctor punctures the cysts and sucks out the fluid. After a while, however, fluid usually flows back – the cysts fill up again. It is also possible to surgically remove part of the liver (partial liver resection). In some cases, only a liver transplant helps.
There are no medications that causally cure a cystic liver.
Ovarian cysts (ovarian cysts)
Ovarian cysts can be congenital – they form as a result of maldevelopment during the embryonic period. This happens, for example, with the so-called dermoid cysts. They can contain other types of tissue, for example hair or teeth.
Most often, however, ovarian cysts are acquired and develop due to normal hormonal fluctuations during the female cycle. Some ovarian cysts also form as a result of taking hormone supplements.
Treatment depends on the symptoms and the size of the cyst or cysts. In many cases, it is possible to wait and see. Some women are helped by medications that suppress ovulation (for example, the pill). If the cysts do not regress, the doctor can surgically remove them during a laparoscopy (laparoscopic cyst extirpation).
Polycystic ovarian syndrome
Eight or more cysts in one ovary may indicate polycystic ovary syndrome (PCO syndrome). In this disease, the ovaries produce more male sex hormones. Women gain weight, get acne, voice becomes deeper, and body hair becomes thicker.
Endometriosis
Water hernia of the testis (hydrocele)
A hydrocele describes an accumulation of fluid in the testicular sheaths. It may be congenital or acquired during life.
The scrotum is usually enlarged and bulging in the case of a hydrocele. On ultrasound, the doctor can easily identify the hydrocele and distinguish it from other changes in the testicle (for example, a tumor).
In the case of a congenital hydrocele that does not cause any symptoms, it is possible to wait for the boy’s first year of life – sometimes the hydrocele regresses spontaneously during this time. Older children with a congenital hydrocele will be operated on by the doctor, because otherwise they may later develop an inguinal hernia (groin hernia).
In the case of acquired hydrocele, the doctor first treats the underlying disease (e.g. inflammation of the testicle and epididymis) and then removes the hydrocele in an operation.
Cyst in the back of the knee (Baker’s cyst)
A prallelastic swelling is palpable in the back of the affected person’s knee. In addition, it may hurt when the knee is bent. In rheumatic diseases, the cyst may become so large that it continues into the lower leg. Such large cysts can compress blood vessels, causing circulatory problems. This manifests itself in numbness in the lower leg or foot and perhaps even paralysis.
Small cysts, on the other hand, cause little discomfort and may remain untreated. Often, a Baker cyst even regresses spontaneously if the doctor successfully treats the underlying disease. Large cysts that cause symptoms can be removed surgically.
