Article by

G. V. Quadros
P. Saldanha

Abstract

We encountered three cases of Hydatid disease with varying presentations and in unusual sites which are being reported in this article.

Introduction:
Hydatid disease is a zoonotic disease caused by Echinococcus granulosus. Humans are accidental intermediate hosts and are infected by ingestion of food contaminated by the ova of Echinococci which then form hydatid cysts. We are describing three cases of hydatid disease with varying presentations and in unusual sites.

Case Reports:
Case 1:
A 50-year-old female presented with abdominal pain and swelling of one month duration. Computed tomography (CT) of the abdomen showed multiple cystic lesions in the liver, ovary and peritoneal cavity. Hysterectomy with bilateral salpingo-oophorectomy and peritoneal cyst wall excision was done (Figure 1).

TC-July2017-001- Speciment of Uterus with bilateral adnexae

Figure 1. Specimen of uterus with bilateral adnexae and separately sent fibrofatty tissue with multiple cysts.

Case 2:
A 13-year-old boy presented with abdominal pain and fever of twenty days duration. CT of the abdomen showed a large cystic lesion arising from the body and the tail of the pancreas. Biopsy was done.

Case 3:
A 76-year-old male presented with abdominal pain of ten days duration. Ultrasonography of the abdomen showed a cystic mass in the liver. A malignant tumour was suspected. Biopsy was done.

HISTOPATHOLOGICAL EXAMINATION
In all the three cases portions of the cyst wall composed of the characteristic three layers: an innermost germinal layer with nuclei, the laminated membrane (Figure 2), an avascular refractile layer and an outer adventitial layer consisting of dense fibrovascular tissue with a varying amount of chronic inflammatory infiltrate. The cyst wall was surrounded by granulation tissue with a fibrous capsule. The cyst was filled with colourless fluid which contained daughter cysts and brood capsules with scolices.

TC-July2017-002- Portions of a laminated membrane

Figure 2. Portions of a laminated membrane as seen with Hematoxylin Eosin stain (H&E, x 10 magnification)

Discussion:
Hydatid disease is endemic in the Middle East, South America, India, northern China, and other sheep-raising areas. In India, it is common in Andhra Pradesh and Tamil Nadu[1]. Hydatid cysts are most commonly found in the liver (55-70%)[2-4], in the lung (18-35%)[4] and rarely in other organs like ovary[5] and pancreas[6]. Among the cases that we encountered, one case was Hydatid disease of the ovary with multiple disseminated cysts in the liver and peritoneal cavity. Intra peritoneal hydatid cysts usually develop secondary to spontaneous, traumatic or iatrogenic rupture of hepatic, splenic or mesenteric cysts. Hydatid cyst in the pelvic region, especially as primary disease is a rare event. According to the literature, the incidence is between 0.2 and  2.25%[2,4]. The ovarian involvement is often secondary to a cysts’ dissemination localized in a different site[5]. The pancreas is an organ rarely infected by hydatid cysts, and the literature gives an incidence ranging between 0.19 and 2%[6]. Hydatid disease of the liver may be asymptomatic for many years. Its presence may become evident when hepatomegaly is found or a cystic lesion is noted when the liver is imaged for other reasons[2-4]. This case of hepatic hydatid cyst was clinically suspected to be malignant but histopathology revealed hydatid disease.

Conclusion:
Hydatid disease although rare should be kept in mind while investigating intra-abdominal cystic lesions.

Gloria Venissa Quadros, MBBS,

Resident

Prema Saldanha, MD, DNBE,

Professor, Department of Pathology,

Yenepoya Medical College,

Mangalore-575018, Karnataka, India

Email: premasaldanha@yahoo.co.in

 

References:
1. Kayal A, Hussain A. A Comprehensive Prospective Clinical Study of Hydatid Disease. Gastroenterology. 2014. https://www.hindawi.com/journals/isrn/2014/514757/

2. Young TH, Hsieh TY, Liu YC, et al. Hydatid cysts in the liver. J Formos Med Assoc. 1996; 95: 176-9.

3. Mahadevia PS, Tanaka K, Fineberg S. In: Rosai J. Rosai and Ackerman’s Surgical Pathology, 10th edition. Mosby, Edinburgh, 2004; p969.

4. Sachar S, Goyal S, Goyal S, Sangwan S. Uncommon Locations and Presentations of Hydatid Cyst. Annals of Medical and Health Sciences Research 2014; 4: 447-52.

5. Cattorini L, Trastulli S, Milani D, et al. Ovarian hydatid cyst : A case report. International Journal of Surgery Case Reports 2011; 2: 100-2.

6. Khiari A, Mzali R, Ouali M, Kharrat M, Kechaou MS, Beyrouti MI.Hydatid cyst of the pancreas. Apropos of 7 cases. Ann Gastroenterol Hepatol (Paris) 1994; 30:87- 91.