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Cystic hepatic lesions are a group of heterogeneous entities commonly encountered in clinical practice. The prevalence of cystic hepatic lesions has been reported to be as high as 15%-18% in the United States. Recent advances in imaging have led to the early incidental detection of hepatic cysts. Most of them are benign with no clinical significance. However, a few malignant and potentially lethal conditions can also cause cystic lesions in the liver. Clinical, radiological, and pathological correlation is crucial in accurate diagnosis and treatment. Treatment modalities for hepatic cysts range from simple fenestration to aspiration sclerotherapy, to surgical resection. In the current review, we classified the hepatic cystic lesions as developmental, neoplastic, inflammatory, post-traumatic, and miscellaneous. The unique clinical features, radiological, and histological findings, and treatment modalities of various cystic hepatic lesions are discussed in detail in the review.
This study evaluated the therapeutic potential of lupeol (LUP), a naturally occurring pentacyclic triterpenoid isolated from Ochrosia elliptica (Labill)., in a rat model of letrozole-induced polycystic ovary syndrome (PCOS). Thirty-five adults female Wistar rats were randomly allocated into five groups: normal control, PCOS model, clomiphene citrate-treated (1 mg/kg), and two LUP-treated groups (10 and 20 mg/kg). Following PCOS induction, treatments were administered orally for 28 consecutive days. PCOS rats exhibited significantly elevated MDA levels and reduced SOD and CAT activities, indicating severe oxidative stress. Lupeol treatment significantly attenuated lipid peroxidation and enhanced SOD activity. However, the increase in CAT activity did not reach statistical significance compared with the PCOS group. Hormonal analysis showed that both lupeol and clomiphene citrate significantly reduced the high LH and testosterone levels in the PCOS group. Lupeol demonstrated a dose-dependent response, lowering testosterone by 22% at 15 mg/kg and 27.9% at 30 mg/kg At the molecular level, quantitative real-time PCR analysis showed that PCOS was associated with upregulation of steroiFdogenic genes (Cyp17a1 and Hsp3β) and downregulation of the antioxidant regulator Nrf2 and aromatase gene Cyp19a1. These dysregulated gene expression patterns were markedly ameliorated by LUP treatment. Histopathological evaluation revealed multiple enlarged cystic follicles with diminished corpora lutea in PCOS ovaries, whereas LUP administration substantially improved folliculogenesis and luteal development. Immunohistochemical analysis further demonstrated elevated caspase-3 expression in granulosa cells of PCOS ovaries, which was significantly suppressed by LUP in a dose-dependent manner. Collectively, these findings indicate that lupeol exerts potent antioxidant, anti-apoptotic, and hormone-modulatory effects, highlighting its promise as a novel phytotherapeutic candidate for the management of polycystic ovary syndrome.
This narrative review summarizes the current concept, CT imaging features, pathologic basis, and the correlation between imaging and pathology in lung cancer associated with cystic airspaces (LCCAs). Lung cancer associated with cystic airspaces is a distinct subtype of lung cancer with unique imaging and pathological features. Lung cancer screening can identify patients with cystic lesions on imaging, but distinguishing benign from malignant lesions remains challenging. The pathologic types of LCCAs vary, and early diagnosis and accurate identification are of great clinical value for patient management and improved prognosis. Clinicians should pay more attention to LCCAs to promote early diagnosis, improve the timing of interventions, and achieve better survival benefits for patients.
Ultrashort echo time (UTE) MRI overcomes the low signal intensity and short T2* of pulmonary tissues, improving image quality. Abnormally low UTE signal intensities are associated with hallmarks of cystic fibrosis (CF), including gas trapping and lung hyperexpansion. To explore short-term repeatability and sensitivity to treatment of low signal volume (LSV) from UTE MRI in pediatric CF. Single-site, retrospective, longitudinal. Thirteen participants with stable CF (6M/7F, median age = 15 years old) were scanned at baseline and 1-month to evaluate short-term repeatability. Subsequently, 14 CF participants (7M/7F median age = 16 years old) were scanned pre- and 1-month post-initiation of elexacaftor/tezacaftor/ivacaftor (ETI). Three-dimensional stack-of-spirals for UTE, 2-dimensional gradient-echo for hyperpolarized xenon (Xe-MRI), 3-dimensional gradient-echo for thoracic cavity estimation at 3 T. LSV was analyzed from UTE MRI. Same-day spirometry, multiple-breath washout, and Xe-MRI were also performed to compare to LSV. Differences were assessed with the Wilcoxon matched-pairs signed-rank test. Bland-Altman analysis and the Intraclass Correlation Coefficient (ICC) were used to assess 1-month repeatability in stable CF. Relationships between measures were assessed with Spearman correlation. p < 0.05 was considered significant. Baseline LSV was correlated with forced expiratory volume in 1 s (FEV1), FEV1 to forced vital capacity ratio (FEV1/FVC), lung clearance index (LCI), and ventilation defect percent (VDP) (all |ρ| ≥ 0.50). LSV was not significantly different after 1-month (20.1 [10.9-25.5]% vs. 21.7 [12.7-28.2]%, p = 0.4548) in stable pediatric CF with Bland-Altman bias < 1% and ICC = 0.93. LSV was significantly reduced from 18.8 [12.0-30.3]% to 16.4 [7.8-19.6]% after 1-month of ETI and correlated with absolute differences in FEV1, FEV1/FVC, LCI, and VDP (all |ρ| ≥ 0.59). LSV analysis was feasible and repeatable in pediatric CF over a 1-month period. LSV was significantly reduced 1-month after ETI treatment, indicating sensitivity to reduced gas trapping, hyperexpansion, and obstruction. 4. 1. Ultrashort echo time MRI has advanced for detailed structural imaging of the lungs and assessment of chronic lung diseases such as cystic fibrosis (CF). This study explores the quantification of regions of abnormally low UTE MRI signals for investigation of gas trapping, hyperinflation, and loss of lung tissue density in children with CF. We demonstrate this is feasible and agrees with pulmonary function testing and Xenon MRI. Improvements after initiation of elexacaftor/tezacaftor/ivacaftor were also observed, highlighting sensitivity to treatment. This work demonstrates the potential for automated and quantitative analysis of UTE MRI to study chronic lung disease in children.
 : Cystic fibrosis (CF) is likely underdiagnosed in Caribbean populations due to non-representative cystic fibrosis transmembrane conductance regulator (CFTR) variant screening panels, limited newborn screening programs, and structural healthcare barriers. Data from 2022 indicate substantial populations with European ancestry in Puerto Rico (1.4 M, 42.7%) and the Dominican Republic (1.4 M, 57.9%), yet the true burden of CF in the broader Caribbean remains largely undocumented. Current diagnostic frameworks, largely based on European-derived CFTR variant distributions, fail to capture the true burden of CF in Caribbean populations, leading to underestimated prevalence and delayed or missed diagnoses. To synthesize registry, clinical, and published data to identify barriers to accurately assessing CF prevalence in Caribbean populations. This narrative literature review integrates CF registries, published data on CFTR variant distribution, population ancestry data, and clinical observations from CF centers in Puerto Rico and the Dominican Republic. Clinical insights were derived from pediatric patients evaluated at the Pediatric Rare Lung and Asthma Institute in Puerto Rico and the CF Clinic at Robert Reid Cabral Children's Hospital in the Dominican Republic. CFTR variant patterns differ from those in the United States, with higher frequencies of rare variants such as p.Ala559Thr. Standard screening panels may miss these variants, contributing to underdiagnosis. Limited newborn screening, misdiagnosis, and restricted access to CFTR modulator therapies further exacerbate disparities. Structural, diagnostic, and genetic factors hinder accurate CF prevalence estimates in the Caribbean, highlighting the need for region-specific research, improved screening, and expanded access to therapies.
In people with cystic fibrosis (pwCF), identification of exocrine pancreatic insufficiency (EPI) is essential to prevent steatorrhea and, if not managed actively, can lead to catastrophic consequences. Fecal elastase-1 (FE-1) is a widely used test to screen for EPI in cystic fibrosis (CF). Once thought permanent, some patients with EPI on CF transmembrane conductance regulator (CFTR)-directed therapies (modulators) have been noted to show improvement in EPI. Here, we evaluated the utility of FE-1 in pwCF. We performed a scoping review and searched several databases for the terms/concepts of "cystic fibrosis" and "fecal elastase-1" and their synonyms. The search period was from 1-1-2003 to 7-31-2025. We included all age groups and used a web-based platform for compiling and sorting out the articles. We combined the eligible studies to synthesize information on four questions: Utilization of FE-1 in CF (when to screen for EPI, how often to screen); Comparison of diagnostic accuracy of FE-1 versus other tests; Definition of ideal cut-off for FE-1 in evaluating EPI in CF; Utilization of FE-1 in pwCF managed on CFTR-directed therapies. All pwCF should have EPI evaluated at diagnosis. Among various tests, FE-1 is the most commonly utilized test for screening EPI. A value of < 200 μg/g of stool is consistent with EPI and is highly sensitive for EPI diagnosis. A value of < 100 μg/g is highly specific for severe EPI. Repeating FE-1 should be considered in the current era of modulators, especially with a change in clinical status.
Mutations in the cystic fibrosis transmembrane conductance regulator (CFTR) cause cystic fibrosis (CF), an autosomal recessive multiorgan disorder. In addition to respiratory, digestive, and reproductive pathologies, patients with CF also exhibit higher rates of enamel defects. CFTR is an anion channel expressed in maturation-stage ameloblasts and is known for its role in chloride and bicarbonate conductance, a function thought to promote enamel mineralization through the neutralization of protons released during hydroxyapatite formation. Previous studies of CFTR global knockout mice have shown hypomineralization and acidification of the maturation-stage enamel matrix. However, the systemic nature of CF and the contribution of extrinsic factors may contribute to these findings. To determine how CFTR specifically contributes to amelogenesis, we generated a conditional knockout mouse in which CFTR loss-of-function is driven by Cre expression under the promoter of the maturation-stage ameloblast marker, Odam. CFTR loss-of-function resulted in the formation of hypomineralized enamel. The enamel matrix was acidified, and loss of matrix pH cycling coincided with arrested ameloblast modulation as indicated by failed re-localization of tight/ gap junctions and ion transporters to the ameloblast distal membrane. Amelogenin hydrolysis was reduced and retained in the maturing enamel matrix, which was associated with reduced Klk4 expression and activity. Transcriptional analyses of incisor ameloblasts showed reduced expression of acid-base regulators, consistent with dysregulation of both intracellular and extracellular pH. Together, these findings show multiple functions of CFTR in incisor enamel maturation, including regulation of intra/ extracellular pH, ameloblast modulation, and extracellular matrix remodeling.
Oxidative stress is considered to be a significant factor in the complex disorder known as polycystic ovarian syndrome (PCOS). In this study, we investigated whether using the traditional medicinal plant Tribulus terrestris L. to lower oxidative stress could help alleviate the symptoms of PCOS. In this randomized controlled trial, rats were given oral estradiol (4 mg/kg/bw) to induce PCOS, and they were split into four groups: treatment (T. terrestris L. extract, 7 mg/kg/bw), standard control (metformin, 300 mg/kg/bw), positive control, and negative control. Blood and ovarian tissues were taken for histological, hormonal, molecular, and biochemical examinations after 21 days. Treatment with T. terrestris L. extract resulted in decreased levels of FSH, LH, estrogen, insulin, TOS, and MDA, as well as downregulated expression of IL-6, IL-1, IGF-1, and CYP-19, in comparison to the positive control. Histological examination revealed healthier ovarian morphology with more corpus luteum and fewer cystic follicles, and TAC levels rose. The results imply that T. terrestris may help combat hormonal disruption and oxidative stress in PCOS, but human studies are still required for confirmation.
We aimed to identify the main factors influencing the achievement of high efficacy or negative outcomes for ethanol ablation (EA) of cystic thyroid nodules. We conducted a retrospective cohort study on consecutive patients treated with EA for cytologically benign and symptomatic CTNs at the Vanvitelli University Hospital in Naples (Italy) over a period of four years. Data was analyzed using multivariable logistic regression and Fisher's exact test. All tests were performed at the significant level of 0.05. We included 118 nodules undergoing EA with one year follow-up [median volume 16.2 (7.0-32.8) mL], with important cervical symptomatology [overall visual analogue scale (VAS) score 26.0 (22.0-30.0) and cosmetic score (CS) 4.0 (3.0-4.0)]. At 12 months follow-up (T12), median VRR was 88.9 (77.2-97.6) %, overall VAS score and CS were 0 (0.0-1.5) and 1.0 (1.0-1.0), respectively. The classical EA was the only predictor of VRR > 75% (OR = 3.27; 95% CI 1.01-10.57; p = 0.048). Monolocular aspect was the only predictor (OR = 5.719; 95% CI 1.664-19.652; p = 0.006) of VAS = 0 and CS = 1. EA for CTNs is usually associated with high efficacy and rarely (one out of ten patients) with negative outcomes at one-year follow-up. The classical EA procedure (when the cystic content can be initially aspirated) and the monolocular aspect thyroid nodules seem to be factors that positively influence the high efficacy of EA, regardless of baseline nodule volume, ultrasound composition, number of EA sessions, and total ethanol amount.
Cystic fibrosis (CF) is a common genetic disease caused by a defective CF-transmembrane conductance regulator (CFTR). People with CF (pwCF) are prone to develop infections by opportunistic pathogens, including Burkholderia cenocepacia, leading to chronic inflammation. Neutrophils release granular proteins and oxidative products that contribute to tissue damage. CFTR modulators are a new treatment for pwCF aiming to correct the subcellular location and function of the CFTR ion channel. The triple modulator combination of Elexacaftor, Tezacaftor, and Ivacaftor (ETI) or Trikafta® has significantly improved clinical symptoms and overall provided a better quality of life for pwCF. The mechanism by which CFTR modulators help to restore the antimicrobial functions of neutrophils is unknown. The present study demonstrated that neutrophils functionally express CFTR and revealed how ETI modifies subcellular CFTR trafficking in CF neutrophils. In addition, ETI treatment reduced intracellular chloride levels in human neutrophils, indicating activation of CFTR-dependent chloride efflux. Finally, ETI treatment also re-established the intracellular antimicrobial killing of CF neutrophils by potentiating NADPH oxidase activity and improved trapping microbes by enhancing the production of Neutrophil Extracellular Traps (NETs). Together, our findings suggest that CFTR has an essential role in controlling neutrophil functions and CFTR modulators help restore the antimicrobial functions of neutrophils from pwCF.
Advances in cystic fibrosis (CF) treatment have seen more people with CF starting a family. Females with CF (FwCF) have expressed a need for improved reproductive health-related shared decision-making (SDM) with health care providers. This study explored perspectives of FwCF and clinicians on the role and implementation of SDM tools in CF reproductive health care. We conducted qualitative semi-structured interviews with FwCF and clinicians. We recruited clinicians through professional networks and FwCF via a previous study and social media. Interviews explored experiences of SDM related to reproductive health. Participants were given examples of SDM tools and asked to consider their utility within CF care. We analyzed interview transcripts using an inductive approach, identifying key themes. Six FwCF and 23 clinicians participated. Four themes were identified: Perceived usefulness of an SDM approach for CF reproductive health, Role of tools in facilitating SDM, Considerations for SDM tool development, and Implementation of SDM in routine CF care. Participants saw information provision as key to SDM, enhancing patient confidence to initiate and engage in conversations. Participants considered SDM tools helpful at three stages: preparing for consultations, facilitating in-consultation communication, and supporting post-consultation reflection and discussion. Trustworthy content was key to engagement. Participants felt reproductive health conversations should start in adolescence and recur throughout the life course. Clinicians highlighted the need for a service-wide culture supporting SDM. Both groups supported early and ongoing reproductive health-related SDM. Further research should evaluate CF-specific reproductive health SDM interventions that build confidence, skills, and foster a health-service culture supportive of SDM.
The COVID-19 pandemic disrupted healthcare utilization and access for many, with persons living with pre-existing pulmonary conditions like cystic fibrosis (pwCF) having been the most impacted. PwCF appeared to have improvements in lung function and reduction in pulmonary exacerbations during the pandemic. However, it is not clear if general healthcare utilization beyond CF centers were also reduced and whether there existed any sex-based differences in health outcomes during the pandemic. Our objective was to use population-level administrative data to gain a comprehensive understanding of healthcare utilization and outcomes for pwCF pre- compared to post-COVID. A retrospective provincial-level analysis was conducted using linked administrative datasets from a single-payer health jurisdiction in Alberta, Canada. We measured hospitalization, emergency department and outpatient visits in pwCF 18 months before and after March 12, 2020. Subgroup analysis was undertaken to differences between sexes. Acute care encounters (including general emergency department [ED] visits and hospitalizations) for pwCF declined during the pandemic. There was a trend towards an increase in outpatient primary care and specialist clinics (both virtual and in-person) in the post-COVID period. Mortality rate was largely unchanged during the pandemic. CF females and males experienced the same relative change in healthcare utilization during the pandemic with a greater reduction in ED visits by CF females. PwCF accessed acute care resources less but females experienced a greater drop in ED visits despite similar hospitalization rates as males, raising the possibility that females with CF experienced a disproportionate barrier to accessing acute care.
Polycystic ovary syndrome (PCOS) is a common endocrine disorder among women of reproductive age. This study aimed to determine self-reported prevalence of physician-diagnosed PCOS among young medical students at King Saud University and to compare it with reported rates from Western and international populations of similar age. In addition, it assessed the awareness among female medical students at King Saud University. A cross-sectional study was conducted using a structured self-administered questionnaire distributed to female medical students at King Saud University between December 2024 and March 2025. The survey contained sociodemographic data, PCOS-related signs and symptoms, past medical history, lifestyle factors, knowledge about PCOS and its complications. Statistical analyses included bivariate analysis and multivariable logistic regression. We collected 303 responses. The self-reported prevalence of physician-diagnosed PCOS was 18.5%. Common symptoms included hair loss (60.7%), acne (49.8%), and weight gain (32%). PCOS diagnosis was significantly associated with age group (p = 0.015), BMI (p = 0.038), menstrual irregularities (p < 0.001), hirsutism (p < 0.001), weight gain (p = 0.004), diabetes mellitus (p < 0.001), and family history (p < 0.001). Multivariable logistic regression identified hirsutism (OR = 4.36, p = 0.005) to be significantly associated with self-reported physician-diagnosed PCOS. The observed prevalence in young medical students in this study was higher than that reported in several Western populations of similar age. Recognition of contributing factors such as genetic susceptibility and lifestyle patterns is essential. Greater emphasis on early screening and targeted health education is recommended.
Background Knee joint disorders are a major cause of musculoskeletal morbidity and functional disability worldwide, involving a broad spectrum of traumatic, degenerative, cystic, and neoplastic pathologies. Accurate evaluation of these conditions is essential for appropriate clinical assessment. MRI provides detailed visualization of intra-articular and periarticular structures due to its superior soft tissue contrast and multiplanar capability. However, there remains a need for region-specific observational data describing the spectrum of MRI findings in routine clinical practice. Materials and methods This retrospective observational study was conducted in the Department of Radiodiagnosis at Hi-Tech Medical College and Hospital, Rourkela, India, following institutional ethics approval. A total of 236 patients who underwent MRI of the knee between August 2024 and July 2025 were included. Patients referred with clinical suspicion of knee joint pathology were evaluated. MRI findings were analyzed to determine the distribution of knee joint pathologies and their association with demographic variables. Results Of the 236 patients, 149 (63.13%) were males, and 87 (36.87%) were females. Ligamentous and meniscal injuries were the most common findings, observed in 134 patients (56.78%), with a predominance among younger male patients. Anterior cruciate ligament tears were the most frequent ligamentous injury, followed by medial meniscus tears. Osteoarthritis was identified in 47 cases (19.92%) and was more frequently observed in older female patients. Baker's cysts were observed in 25 cases (10.59%), fractures in 20 cases (8.47%), and malignant neoplasms in 10 cases (4.24%). Among fractures, patellar fractures were the most common pattern. Among malignant lesions, synovial sarcoma was the most frequently identified tumor. Conclusions Knee joint pathologies demonstrated a distinct distribution pattern, with ligamentous and meniscal injuries predominating in younger males and degenerative changes more frequent in older females. Within the framework of this observational study, MRI facilitated detailed characterization of a wide spectrum of knee abnormalities; however, in the absence of comparative or outcome-based data, conclusions regarding diagnostic accuracy or clinical impact cannot be established. These findings provide context-specific insights into the epidemiological and imaging profile of knee joint pathologies and may serve as a foundation for future prospective and comparative studies.
To characterize anterior segment structural alterations in adults with cystic fibrosis (CF), with emphasis on conjunctival and corneal epithelial parameters, and to compare them with healthy controls. This cross-sectional study included 33 adults with CF and 33 age- and sex-matched controls. Swept-source OCT was used to quantify bulbar conjunctival thickness (BCT) and bulbar conjunctival epithelial thickness (BCEpT) in four quadrants, as well as central corneal epithelial thickness (CEpT) and central corneal thickness (CCT). Keratometry and non-invasive TBUT (N-TBUT) were assessed using the Topcon MYAH multifunctional device. Endothelial parameters were evaluated with specular microscopy, and symptoms were recorded with the OSDI questionnaire. CF patients exhibited significant BCEpT thinning across all quadrants (all p < 0.001) and selective temporal BCT thinning (p < 0.05). CEpT was significantly reduced (p < 0.010), while CCT remained comparable between groups (p > 0.100). Keratometric values (K1, K2) were steeper in CF (p < 0.05). N-TBUT was preserved mainly, although CF individuals reported higher OSDI scores (p < 0.01). Endothelial cell density and morphology showed no between-group differences (all p > 0.100). No significant correlations were found between ocular structural parameters and lung function indices. CF is associated with a distinct epithelial phenotype characterized by thinning of both conjunctival and corneal epithelium and steeper anterior corneal curvature, while stromal and endothelial layers remain preserved. These findings indicate preferential involvement of CFTR-dependent epithelial tissues and suggest early, subclinical ocular surface alterations in CF.
Adenoid cystic carcinoma (ACC) is a rare salivary gland malignancy with no FDA-approved systemic therapies and limited benefit from conventional treatments. Proteogenomic profiling has revealed consistent overexpression of AXL, providing a compelling rationale to pursue AXL as a novel therapeutic target. We investigated mipasetamab uzoptirine (ADCT-601), an AXL-targeting antibody-drug conjugate (ADC) with pyrrolobenzodiazepine dimer payload, in preclinical models of ACC. In vitro cytotoxicity was assessed in AXL-positive cell lines, and in vivo efficacy was evaluated using cell line xenograft and patient-derived xenograft (PDX) models. ADCT-601 demonstrated potent and selective cytotoxicity in AXL-expressing ACC cell lines. In xenograft models, a single administration at 0.5 or 1.0 mg/kg induced significant tumor regression, with complete tumor eradication observed at 1.0 mg/kg. Across a panel of ACC PDX models, ADCT-601 produced strong yet variable anti-tumor activity, with therapeutic response correlating with AXL expression levels. ADCT-601 demonstrates robust AXL expression linked to anti-tumor activity in preclinical models of ACC, establishing a proof-of-concept for targeting AXL in this rare cancer. These findings support clinical translation of AXL-targeting ADC as a novel biomarker-driven therapy for patients in ACC.
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Cystic lymphangioma is a rare benign tumor of lymphatic origin, characterized by slow growth and variable clinical presentation. The presence of a peritoneal diverticulum is exceedingly rare in adults and often poses a diagnostic challenge owing to nonspecific symptoms and imaging findings. A 22-year-old previously healthy male presented with abdominal fullness and flatulence without other relevant symptoms. On physical examination, a firm, palpable abdominal mass was identified. Laboratory tests revealed mild elevations in alanine aminotransferase and alkaline phosphatase levels. Abdominal computed tomography (CT) revealed a cystic lesion in the epigastric and right hypochondriac regions adjacent to the liver, pancreas, and stomach. Magnetic resonance imaging (MRI) revealed a cystic mass suggestive of lymphangioma, measuring 21 cm × 20 cm × 16 cm. The patient underwent open retroperitoneal lymphadenectomy with complete excision of the lesion and additional foci located above the superior mesenteric vein. Histopathological examination confirmed the diagnosis of mesenteric cystic lymphangioma. Mesenteric lymphangiomas are rare in adults and present with vague, nonspecific abdominal symptoms. Imaging studies play an essential role in diagnosis, although definitive confirmation requires histopathological evaluation of the tissue. Complete surgical resection remains the treatment of choice and is critical for preventing recurrence and potential complications, such as infection, rupture, or intestinal obstruction. Given the rarity and diagnostic challenges of mesenteric cystic lymphangioma in adults, clinicians should maintain a high index of suspicion when evaluating abdominal cystic lesions in adults. Early surgical intervention is fundamental for achieving optimal outcomes and preventing future complications.