[3] Cysts which form in relation to new-growths have been considered with tumours.
Cysts are rounded sacs, the wall being composed of fibrous tissue lined by epithelium or endothelium; the contents are fluid or semi-solid, and vary in character according to the tissue in which the cyst has originated.
Retention and Exudation Cysts.—Retention cysts develop when the duct of a secreting gland is partly obstructed; the secretion accumulates, and the gland and its duct become distended into a cyst. They are met with in the mamma and in the salivary glands. Sebaceous cysts or wens are described with diseases of the skin. Exudation cysts arise from the distension of cavities which are not provided with excretory ducts, such as those in the thyreoid.
Implantation cysts are caused by the accidental transference of portions of the epidermis into the underlying connective tissue, as may occur in wounds by needles, awls, forks, or thorns. The implanted epidermis proliferates and forms a small cyst. They are met with chiefly on the palmar aspect of the fingers, and vary in size from a split pea to a cherry. The treatment consists in removing them by dissection.
Parasitic cysts are produced by the growth within the tissues of cyst-forming parasites, the best known being the tænia echinococcus, which gives rise to the hydatid cyst. The liver is by far the most common site of hydatid cysts in the human subject.
With regard to the further life-history of hydatids, the living elements of the cyst may die and degenerate, or the cyst may increase in size until it ruptures. As a result of pyogenic infection the cyst may be converted into an abscess.
The clinical features of hydatids vary so much with their situation and size, that they are best discussed with the individual organs. In general it may be said that there is a slow formation of a globular, elastic, fluctuating, painless swelling. Fluctuation is detected when the cyst approaches the surface, and it is then also that percussion may elicit the “hydatid thrill” or fremitus. This thrill is not often obtainable, and in any case is not pathognomonic of hydatids, as it may be elicited in ascites and in other abdominal cysts. Pressure of the cyst upon adjacent structures, and the occurrence of suppuration, are attended with characteristic clinical features.
The diagnosis of hydatids will be considered with the individual organs. The disease is more common in certain parts of Australia and in Shetland and Iceland than in countries where the association of dogs in the domestic life of the inhabitants is less intimate. Pfeiler, who has worked at the serum diagnosis of hydatid disease, regards the complement deviation method as the most reliable; he believes that a positive reaction may almost be regarded as absolutely diagnostic of an echinococcal lesion.
The treatment is to excise the cyst completely, or to inject into it a 1 per cent. solution of formalin. In operating upon hydatids the utmost care must be taken to avoid leakage of the contents of the cyst, as these may readily disseminate the infection.
A blood cyst or hæmatoma results from the encapsulation of extravasated blood in the tissues, from hæmorrhage taking place into a preformed cyst, or from the saccular pouching of a varicose vein.
A lymph cyst usually results from a contusion in which the skin is forcibly displaced from the subjacent tissues, and lymph vessels are thereby torn across. The cyst is usually situated between the skin and fascia, and contains clear or blood-stained serum. At first it is lax and fluctuates readily, later it becomes larger and more tense. The treatment consists in drawing off the contents through a hollow needle and applying firm pressure. Apart from injury, lymph cysts are met with as the result of the distension of lymph spaces and vessels (lymphangiectasis); and in lymphangiomas, of which the best-known example is the cystic hygroma or hydrocele of the neck.