Recurrent pelvic hydatid cyst obstructing labor, with a concomitant hepatic primary. A case report

BACKGROUND: Hydatid disease in pregnancy is a rare condition, with an incidence of 1/20,000 pregnancies. Although the female reproductive system is a rare site for hydatid disease, various obstetric and gynecologic presentations have been reported. CASE: A 31-year-old multipara was evaluated due to obstructed labor. Sonographic evaluation revealed an 18-cm hepatic and 15-cm pelvic hydatid cyst at 38 weeks of gestation. A healthy, 3,200-g infant was delivered by cesarean section. The cyst, originating in the right ovary and occupying the pouch of Douglas, was removed surgically. The hepatic cyst was decompressed via the percutaneous approach. The follow-up was uneventful. CONCLUSION: Hydatid disease should be considered in the differential diagnosis of adnexal masses in pregnancy. The percutaneous technique is a promising treatment option for hepatic cysts. Not only the diagnosis but also the treatment of hydatid disease is facilitated with currently available magnetic resonance imaging, computed tomography and ultrasonography.     

Hydatid of morgagni with torsion diagnosed during cesarean delivery. A case report

BACKGROUND: Hydatids of Morgagni are benign, pedunculated, cystic structures arising from müllerian vestiges below the fallopian tube near the fimbria. They usually are of no clinical significance unless the pedicle becomes twisted and infarction occurs. CASE: A 39-year-old primigravida at 41 weeks and 5 days' gestation underwent primary cesarean delivery for macrosomia and failure to descend during labor. A 4 x 3-cm hydatid of Morgagni with torsion of the pedicle was found on the left fallopian tube. Ligation of the pedicle and excision of the infarcted cyst were performed. Histology of the specimen demonstrated cuboidal epithelium with extensive hemorrhage and necrosis, consistent with an infarcted hydatid of Morgagni. All pain and symptoms experienced by the patient during the previous day were associated with the onset of labor. No specific left lower quadrant pain was reported. CONCLUSION: Hydatids of Morgagni are common findings at pelvic surgery and usually of no clinical significance. Torsion of a hydatid of Morgagni is rarely reported and most likely is a rare occurrence. In this patient, torsion of the hydatid of Morgagni was possibly pregnancy related, and symptoms associated with torsion were probably masked by labor pain.     

Coexistence of borderline ovarian epithelial tumor, primary pelvic hydatid cyst, and lymphoepithelioma-like gastric carcinoma

ObjectivesBorderline ovarian tumors (BOTs) represent a heterogeneous group of ovarian epithelial neoplasms. Despite a favorable prognosis, 10–20% of BOTs exhibit progressively worsening clinic. Primary involvement of pelvic organs with echinococcus is very rare. Lymphoepithelioma-like gastric carcinoma is a rare neoplasm of the stomach.Case ReportA 58-year-old woman referred with abdominal swelling and gastric complaints. Imaging studies revealed a huge cystic mass with multiple septations and solid component, another cystic mass with an appearance of cyst hydatid in the pelvis, and thickening of the small curvature of stomach. Gastroscopy revealed an ulcer with a suspicious malignant appearance, and histology of the endoscopic specimen showed severe chronic inflammation and lymphocytic infiltration. No other involvement of hydatid cyst was detected. In the exploration, there was a 25 cm cystic lesion with solid components arising from right ovary, another 6 cm cyst over the former, 7 cm cystic lesion arising from left ovary, and 10 cm mass near the small curvature of the stomach. Excision of the masses; total gastrectomy with esophagojejunal anastomosis; total abdominal hysterectomy; bilateral salpingo-oophorectomy; omentectomy; appendectomy; splenectomy; and pelvic, paraaortic, and coeliac lympadenectomy were performed. Final pathology revealed lymphoepithelioma-like gastric carcinoma, bilateral serous BOT, and hydatid cyst.DiscussionHydatid cyst should always be considered in the differential diagnosis of abdominopelvic masses in endemic regions of the world. Preoperative diagnosis of primary pelvic hydatid disease is difficult and awareness of its possibility is very important especially in patients residing in or coming from endemic areas.     

Percutaneous treatment of hepatic hydatid cyst in pregnancy: long-term results

Purpose To present the long-term results of percutaneous treatment of hepatic hydatid cyst in pregnancy. Material and methods Six pregnant patients (age range 19–28 years; mean age 23 years) with six hepatic hydatid cysts underwent percutaneous treatment without albendazole prophylaxis. Puncture, aspiration, injection and reaspiration (PAIR technique) were used to treat the cysts. Hypertonic saline solution was used as cytotoxic agent. Follow-up was mainly by sonography every 2 weeks during pregnancy, every third month post-partum for the first year, every 6 months for the second year, and once a year thereafter. The mean follow-up time was 57.5 months. Results Before the treatment, average hydatid cyst volume was 2,145 ml that was reduced to 145 ml post-treatment at the time of delivery. The first five cases of the study had solid appearance of the cyst remnant (indicating complete cure) in 22 months. Cystobiliary fistula was suspected in the sixth case three months after delivery. After confirmation of the cystobiliary fistula with cystography, a percutaneous catheter was placed into the postresidual cavity and a nasobiliary catheter was placed into the common bile duct after syphincterotomy. The fistula was closed in 2 weeks. This patient has a follow-up time of 1 year so far without any problem. No mortality, morbidity, fetal loss, abdominal dissemination, or tract seeding was observed among our cases. Conclusion Percutanous treatment of hydatid cysts in pregnancy is an efficient and safe procedure in cases where percutaneous treatment is indicated.     

Ruptured primary uterine serosal hydatid cyst: a rare case report

A 17-year-old girl presented in the surgical emergency department with clinical features of acute peritonitis. At operation, it was found that she had ruptured a multi-cystic mass arising from the anterior serosal surface of the uterus. The cyst contained multiple daughter cysts and laminated membrane. Hydatid cystic disease was confirmed on histological examination. Pelvic hydatid cystic disease should always be considered in differential diagnosis of pelvic cystic masses in endemic areas and ruled out by appropriate investigations in order to prevent morbidity from the disease, as recurrence is common if precautionary measures are not taken.     

Conservative management of decidualized ovarian endometriotic cyst during pregnancy mimicking malignancy: case report and a review of the literature

We report here the case of a 30-year-old woman with a decidualized ovarian endometriotic cyst (DOEC) during pregnancy mimicking malignancy occurring after fertility-preserving surgery for ovarian carcinoma arising from an endometriotic cyst. Intracystic excrescences appeared in the left ovarian endometriotic cyst at five weeks and three days of gestation. The serum CA-125 level rose to 676.7 U/ml (normal, 0-35). Based on these findings, ovarian carcinoma arising from the left ovarian cyst was strongly suspected. Frequent sonographic examinations revealed that the sizes and quality of the intracystic excrescences remained essentially unchanged. The cyst was evaluated for DOEC during pregnancy. The patient eventually delivered a male infant by normal vaginal delivery. After the delivery, the intracystic excrescences in the left ovarian endometriotic cyst disappeared. Close observation may be a reasonable alternative to antepartum surgery in patients with a DOEC during pregnancy.     

Pelvic hydatid yst: apropos of 8 cases]

The hydatidosis fisues in the endemic state in Morocco, its pelvigenital localization is rare and doubtful. The objective of this study is to examine the epidemio-clinic appearance, the diagnosis means and the therapeutic flow of the pelvigenital hydatid cyst in Morocco. This retrospective study is about eight patients hospitalized and cured for pelvigenital hydatid cyst in lalla Meryem maternity of Casablanca during a period of six years (1992-1997). The hydatid cyst diagnosis was confirmed by anatomopathology. This affection represented 0.80% of the pelvic mass operated during the same periode. The majority of our patients was from rural origin, their age varies between 22 and 70 years old. The discovery circumstances were dominated by abdomino-pelvic mass. The diagnosis was nearly certain prior to the surgery for half of the cases. The genital organs were the most reached by the pelvic hydatidosis (75%). The treatment was purely surgical, adapted to each case in according to the localization, the volume and the contribution of the cyst. The medical treatment has been prescribed in one case in post surgery. The evolution was good in all the cases. The hydatidos cyst must always be present in mind when dealing with cyst pelvic formation in an endemic country like Morocco. The prophylaxia preserves its important value and must constitute a hinder against this disease in endemic countries.     

Quiste hidatídico uterino de localización intramural

We report the case of a woman with a history of hepatic hydatid disease and ultrasonographic diagnosis of a paraovarian cystic mass. Laparotomy revealed normal ovaries, while the uterus showed a node compatible with a cyst-degenerated myoma. Histological examination revealed a hydatid cyst inside the myometrium. The interest of this case lies in the rare location of the cyst. We also present a brief review of the literature.     

Management of hydatid disease (echinococcosis) in pregnancy

Hydatid disease, manifesting as single or multiple hydatid cysts and caused by Echinococcus granulosus, is common in many parts of the world, especially the tropical countries. Although rare, this disease can also present during pregnancy, especially in endemic areas. Although much has been written about hepatic hydatidosis, there are only a few articles (mainly case reports) on hydatid disease in association with pregnancy. A literature search was done through Medline/PubMed and Medscape independently by the authors from 1950 to 2007 for key words "echinococcosis" and "pregnancy" and "management." All retrieved articles were reviewed. Manual cross-referencing was also done with inclusion of all relevant articles. In this review, we have attempted to summarize the presentation and available management approaches to hydatid disease, and have suggested evidence-based guidelines for its management during pregnancy.     

Adenocarcinoma arising in a vaginal müllerian cyst: a case report

BACKGROUND: We report a case of adenocarcinoma arising in a vaginal müllerian cyst. Although the most common pathological type of vaginal cysts is müllerian cyst, malignant change of a müllerian cyst has not been reported before. CASE: A 48-year-old woman presented with a 3 cm-sized ruptured vaginal cyst. The cyst had been asymptomatic for 20 years, but ruptured 2 months before her visit. After the diagnosis of atypical glands was made on punch biopsy of cyst wall, she underwent an operative excision and the final histopathologic examination revealed an adenocarcinoma arising in the müllerian cyst. After the surgery, she received a course of external radiation therapy followed by brachytherapy. At 6 months following treatment, the patient remained without evidence of disease. CONCLUSION: To our knowledge, this is the first case report of an adenocarcinoma arising from a müllerian cyst. The possibility of malignant transformation should be considered and careful follow-up is warranted even in cases of asymptomatic vaginal cysts.     

Prenatal diagnosis of pyriform sinus fistula using ultrasonography by detecting the communication to the pharynx

ObjectivePyriform sinus fistula (PSF) is a congenital anomaly which originates from the pharyngeal pouch. PSF is initially recognized as a cyst around the fetal neck, but accurate prenatal diagnosis of the disease is challenging. We aimed to report the key findings and tips in accurately distinguishing PSF from other differential diagnosis by which enables detection of the communication of the nuchal cyst and the pharynx.Case reportWe report a case in which we were able to diagnose PSF as early as 18 weeks of gestation with ultrasonography. We used epiglottis as a landmark, and detected an unilobular cyst arising from the pharynx.ConclusionUltrasonography is a powerful tool in prenatal diagnosis of PSF especially at early stage of pregnancy. By detecting the epiglottis, it can locate the communication of the nuchal cyst and the pharynx, and thereby enables an accurate diagnosis of PSF.     

Infected tuboovarian hydatid cyst: a rare cause of tuboovarian abcess

Pelvic hydatid cysts, although rare, must be considered when evaluating a pelvic mass in women living in an endemic area. The pelvis may become secondarily involved as a result of a rupture of the cyst in another location or be the only localization of the disease. If the cyst becomes secondarily infected, it may mimic a tuboovarian abscess. A 49-year-old multipara was admitted to the emergency department with the complaint of fever, generalized abdominal pain and distension. Abdominal ultrasound revealed a 4 cm cystic structure in the liver and the gynecological examination was normal. The patient's abdominal pain receded spontaneously, so she was prescribed albendazole and discharged from the hospital. Ten days later, she complained of pelvic pain, pressure and vaginal discharge. The uterus and adnexa were tender on pelvic examination. Ultrasound revealed an 8 cm uniloculated cyst with free floating internal echogenities located between the bladder and the uterus. At surgery a 10 cm right-sided tuboovarian mass was present. A germinative membrane was present inside the abscess and pericystectomy with unilateral salphingo-oophorectomy was performed.     

Borderline endometrioid tumor arising in a paratubal cyst: a case report

BACKGROUND: Paratubal cysts, generally known as hydatid cysts of Morgagni, are small round cysts attached by a pedicle to the fimbriated end of the tube. The following represents the first reported case of an endometrioid tumor of low malignant potential arising in a paratubal cyst. CASE REPORT: A 45-year-old nulliparous female was referred with a complex right adnexal mass on pelvic sonogram. She underwent laparoscopic bilateral ovarian cystectomy and partial right salpingectomy (for a 3-cm torsed paratubal cyst). All frozen-section diagnoses were benign; however, final pathology revealed a borderline tumor of low malignant potential of endometrioid type in the right paratubal cyst. The patient underwent extensive counseling regarding management options and decided to have a laparoscopic right salpingo-oophorectomy. Final pathologic analysis revealed no evidence of persistent borderline tumor. CONCLUSION: Paratubal cysts are very difficult to diagnose with sonography; therefore, their management should be approached as any other adnexal mass. Laparoscopic surgery is an option in the management of adnexal masses; however, rupture or puncture of masses should be avoided when possible to prevent potential tumor dissemination in the event of a malignancy.     

Hydatid cyst of the uterus

BACKGROUND: Hydatidosis is a common zoonosis that affects a large number of humans and animals, especially in poorly developed countries. The infesting parasite has four forms named Echinococcus granulosis, E. multilocularis, E. vogeli and E. oligarthrus (very rare in humans). The most frequently involved organs are liver followed by the lung. The involvement of the genital tract is rare and the occurrence in the uterus is an extreme rarity. We report a case of hydatid cyst in the uterus. CASE: A 70-year-old female with a history of hydatid cysts of the liver, was admitted to hospital after complaining of low abdominal pains. On physical and gynecological examinations, no pathological finding was detected. However, the uterus was significantly large for a postmenopausal patient. Transvaginal sonography (TS) revealed a cystic mass in the uterus with a size of 7 x 6 cm. After further examinations a subtotal hysterectomy was performed. Microscopic examination showed scolices of Echinococcus granulosis. CONCLUSION: Hydatid cysts in the genital tract are rare and the occurrence in the uterus is an extreme rarity. Differentiation between hydatid cyst and malignant disease of the related organ is difficult. To avoid misdiagnosis, a careful examination of pelvic masses should be carried out in endemic areas for detection of hydatid cysts.     

Ovarian hydatid disease

Hydatid disease, also known as Echinococcosis is a zoonosis caused by the larval stage of Echinococcus. The human cystic variant primarily affects liver and lungs. The pelvic location of the disease is a rare finding usually secondary to a ruptured liver cyst, although it may also appear as a primary lesion affecting the genital organs. Despite its rarity, in endemic areas, pelvic hydatid disease should be considered in the differential diagnosis of complex adnexal cystic mass, to make an appropriate treatment strategy. The suspected diagnosis is based on imaging studies and serodiagnostic techniques, in which a new field of research attempts to find a standardized test with sufficient sensitivity and specificity. We report a case of primary pelvic hydatid disease in postmenopausal women operated for suspected ovarian cancer.     

Clear cell ovarian carcinoma in a pregnant woman with a history of infertility, endometriosis and unsuccessful IVF treatment

Ovarian cancer in pregnancy is a very rare event. We present here the case of a 37-year-old woman in whom a clear cell ovarian carcinoma was diagnosed in the first trimester of pregnancy. This patient had a history of infertility, endometriosis and two previous unsuccessful attempts of in vitro fertilization. Transvaginal sonography at six gestational weeks revealed a 6 x 4 cm ovarian cyst with an internal papillary excrescence. The cyst persisted throughout the first trimester, whereas the initial CA 125 value of 226 U/ml dropped to 61 U/ml at 12 gestational weeks. Exploratory laparotomy and cystectomy was performed at 14 weeks and the disease was classified as Stage Ic, arising in endometriosis. The couple decided to continue with pregnancy and the woman was followed by serial sonographic, MRI and CA 125 examinations. A cesarean section, hysterectomy, bilateral salpingo-oophorectomy and omentectomy was performed at 34 weeks. Histology and cytology were negative for recurrence. Four months later the woman and baby are doing well. We review cases of ovarian clear cell carcinoma diagnosed during pregnancy and discuss the association of endometriosis, infertility, infertility drugs and ovarian cancer.     

Mucoepidermoid variant of adenosquamous carcinoma arising in ovarian dermoid cyst: a case report and review of the literature

Abstract.   Karateke A, Gurbuz A, Kir G, Haliloglu B, Kabaca C, Devranoglu B, Yakut Y. Mucoepidermoid variant of adenosquamous carcinoma arising in ovarian dermoid cyst: a case report and review of the literature. Int J Gynecol Cancer 2006; 16(Suppl. 1): 379–384.
A 40-year-old woman with mucoepidermoid variant of adenosquamous carcinoma arising in dermoid cyst in left ovary is presented. The patient was staged as IC. Total abdominal hysterectomy, bilateral salpingo-oophorectomy, omentectomy, and pelvic and para-aortic lymph node sampling were carried out. The disease recurred in postoperative 12th month. To our best knowledge, this is 12th case of adenosquamous carcinoma in dermoid cyst and third case of mucoepidermoid variant of adenosquamous carcinoma in the literature.     

Sedation for percutaneous treatment of hepatic hydatid cyst in a pregnant patient

Background: A 15 cm hepatic hydatid cyst was diagnosed in a multigravida in 16 weeks of pregnancy and was managed percutaneously under sedation. Results: No complication occurred and she gave birth to a healthy male baby after 37 weeks gestation.     

足月妊娠伴自发性卵巢过度刺激综合征1例

目的:报道1例自然妊娠合并自发性卵巢过度刺激综合征(sOHSS)病例。方法:回顾性分析我院1例自然妊娠合并sOHSS患者的临床资料,并复习相关文献。结果:该患者于孕39周行子宫下段剖宫产术,同时行双侧卵巢楔形切除术+双侧卵巢打孔术。术中快速病理检查及术后常规病理检查结果示双侧卵巢黄素化囊肿。术后患者双侧卵巢迅速恢复正常。最终诊断为妊娠合并sOHSS。结论:妇产科医生需对sOHSS有充分的认识,需与卵巢肿瘤性疾病进行鉴别,以免因误诊而采取不适当的治疗。     

Hydatid cyst of the ovary

We report a case of hydatid cyst of the ovary in a woman previously operated for hydatid cyst of the liver. Received: March 1997 / Accepted: 14 July 1997