An extremely large primary omental hydatid cyst: report of a rare case

Hydatid disease is a parasitic infection caused by Echinococcus granulosus (larval form) in humans with lesionsmost frequently encountered in the liver and lungs. It can rarely involve extra-hepatic organs. It is endemicin some regions of Iran. The omental hydatid cyst is a very rare manifestation of the disease. This report presentsthe interesting case of a very large omental hydatid cyst.     

Echinococcosis (Hydatid Disease): Review and Report of a Case of Secondary Echinococcosis

Echinococcosis is a disease caused by the larval form of Echinococcus granulosus. The adult worm lives parasitically in the intestine of the definitive host, the dog, wolf and other wild carnivores. The ova, which are passed in the feces, are ingested by grazing animals. The intestinal juices free the ovum from its cuticle and, having entered a capillary, it is carried by the blood stream to the liver or lung, where it develops into a hydatid cyst. Man becomes infected by ingesting contaminated vegetables or drinking contaminated water.

In a mature hydatid cyst there may be thousands of scolices and each one of these, if released from the hydatid cyst, may form a new cyst if it is planted in a suitable environment. Hydatid cysts are most commonly found in the liver and the lung, but may occur in other organs.

A hepatic cyst may rupture into the peritoneal cavity and produce a hydatidoperitoneum. A pulmonary cyst frequently ruptures into a bronchus and is thus evacuated.

The disease is of world-wide distribution. In Canada most of the cases of this disease have occurred among Indians and Eskimos. It is now known that a sylvatic cycle has been established in North America and that it serves as a source of infection of the dog and man.

The patient reported herein had spontaneous rupture of a hepatic hydatid cyst, with subsequent development of secondary peritoneal echinococcosis. Repeated laparotomies had to be performed to relieve pressure on or obstruction of various organs. The patient made an uneventful recovery and is again usefully employed. No effective medical treatment for this disease is available.

     

Disappearance of recurrent intra-abdominal extrahepatic hydatid cyst following oral albendazole administration

A 44-year old male patient with a past medical history of a complete surgical excision of pelvic hydatid cyst two years previously presented with constant pelvic floor pain and plasma IgG anti-echinococcal antibody titres of 14.27 U/mL. Based on that and the imaging findings of abdominal ultrasound (US), Computed Tomography (CT) and Magnetic Resonance (MR) the diagnosis of a recurrent retrorectal pelvic hydatid cyst was made. Three courses of oral albendazole treatment were administered and sixteen weeks later, the patient was admitted for a planned elective operation. At that time, a new CT scan revealed disappearance of the cyst, while the serological tests showed a decrease in the IgG anti-echinococcal antibody titres to 0. 71 U/mL. Four different species of the Echinococcus tapeworm can produce infection in humans. E granulosus and E multilocularis are the most common, causing cystic and alveolar echinococcosis respectively, while E vogeli and E oligarthrus, have only rarely been associated with human infection. Although surgical resection remains the treatment of choice for hydatid disease, the present case could suggest that especially in cases of recurrent intraabdominal extrahepatic hydatid cyst, treatment with albendazole may lead to disappearance of the recurrent cyst therefore, should constitute a first line therapeutic option prior to any planned reoperation.     

Cardiac echinococcosis: echocardiographic diagnosis with a fatal clinical outcome

Hydatid disease HD is an endemic disease found in various regions of the world. The organs mostly affected are the liver and lung. Cardiac involvement in HD is rare. The symptoms are mainly due to the mass effect of the calcific hydatid cyst obstructing the blood or the lymphatic vessels. Other manifestations are secondary infection or cyst rupture in the involved organ. Here, we report a middle aged female patient with no history of medical illness who presented to the emergency room with an unrecordable blood pressure. Echocardiogram showed multiple calcific cysts of echinococcosis granulosa in the left ventricle cavity. In the clinical setting, where there is detection of HD elsewhere in the body, an echocardiogram is mandatory as cardiac involvement is serious and may be fatal.     

Splenic recurrence of liver hydatid cyst and spleen preserving therapy

Hydatid cyst disease remains a considerable public health problem, especially in pastoral and farming regions. Although the spleen is the third most commonly affected organ after the liver and lungs, splenic hydatid cyst is an uncommon entity even in areas that are endemic for echinococcosis. The recurrence rate after surgical therapy of the liver hydatid cyst is reported as 6.8-22.3 percent. Recurrences most frequently occur in the liver. Extrahepatic recurrences occur in the lung or peritoneum and the serosa of the abdominal organs. Splenic recurrence of liver hydatid cyst has not previously been reported. The most common surgical therapy is splenectomy, and the other option is spleen preserving surgery. We report the first case of recurrent splenic hydatid cyst in the spleen and liver synchronously after surgical therapy for liver hydatid disease. The patient was treated with liver resection and spleen preserving surgery.     

Splenic hydatid cyst perforating into the colon manifesting as acute massive lower gastrointestinal bleeding: an unusual presentation of disseminated abdominal echinococcosis

Hydatid disease can occur in all viscera and soft tissues, although the liver and the lungs are the organs most commonly involved. Isolated splenic involvement with the disease is extremely rare. Splenic hydatid cysts may suppurate, fistulise to adjacent organs, or rupture into the peritonaeal cavity. However, acute, massive lower gastrointestinal bleeding due to splenocolic communication resulting from splenic echinococcal cyst has not been previously reported. We present a 77-year-old woman with disseminated abdominal echinococcosis, and active lower gastrointestinal bleeding due to splenocolic fistula resulting from splenic hydatid cyst. She was treated successfully with en-bloc excision of the spleen and splenic flexure of the colon.     

Giant abdominal hydatid cyst masquerading as ovarian malignancy

Hydatid disease, caused by Echinococcus granulosus, is a common parasitic infection of the liver. Disseminated intra-abdominal hydatid disease may occur with the rupture of the hydatid cyst into the peritoneal cavity, producing secondary echinococcosis. Occasionally, the cyst may not rupture, and instead, enlarge, thus mimicking gross ascites or huge ovarian tumours. We present a 30-year-old woman with a giant intra-abdominal hydatid cyst communicating with the liver, and discuss the management of her case.     

Primary pelvic hydatid cyst presenting with obstructive uropathy and renal failure.

Primary pelvic hydatid cyst is a rare entity. Pelvic hydatid cysts usually present with pressure symptoms involving adjacent organs (bladder and rectum usually). A case of primary pelvic hydatid cyst presenting with obstructive uropathy leading to chronic renal failure is presented. A combination of preoperative albendazole therapy of 1.2 g/day for 8-12 weeks and surgical excision were effective in alleviating the symptoms and improving the renal function.     

Hydatid cyst/cystic echinococcosis: anatomical and surgical nomenclature and method to quantify the cyst content solidification

The terminology related to the hydatid cyst is sometimes inappropriate and wrong designations are used, based on incorrect concepts. “Hydatid cyst” is the larval form of the tapeworms of the genus Echinococcus granulosus, a parasite found in the small intestine of carnivores. The disease, called cystic echinococcosis, is among the most neglected parasitic diseases despite the development of new drugs and other treatment modalities. Although all of us know the vital cycle of the parasite and the different aspects of the disease, the designations around the parasite, its evolution and some therapeutic procedures are not uniform. It would be useful, for all of us, to use the same nomenclature and it is absolutely necessary that the nomenclature is correct and universally accepted. In this paper I remember the correct terms related to all aspects of the hydatid cyst’s nomenclature, including especially the anatomical and surgical terminology, as well as the criteria to define the cyst inactivity and the way to know when the cyst range the inactive stage after therapy.

     

Surgical management of primary retroperitoneal hydatid cyst

Hydatid disease is caused by the cystic stage of infestation by Echinococcus granulosus. Most hydatid cysts occur in the liver followed in frequency by the lung but no site is immune. Hydatid disease of the retroperitoneum is a rare condition. A case study is described here of a 30-year-old female with diagnosis of hydatid cyst of retroperitoneum which was treated surgically.     

Hydatid disease: the threat within Papua New Guinea

Hydatid disease is a problem in those countries where man, grazing animals and dogs live in close association. The adult tapeworm of Echinococcus granulosus causes few, if any, symptoms in the dog and so its presence may be unsuspected. Transmission to man is by ingestion of eggs, which resist desiccation and may be viable for up to one year. Food or water may be directly contaminated or infection acquired by close contact with dogs carrying eggs in their saliva or hair. Though quarantine regulations exist, the introduction of the disease as the tapeworm in dogs or as the hydatid cyst in imported sheep from New Zealand has occurred and its spread is a possibility. The life cycle, clinical manifestations and significance if introduced to rural communities are discussed.     

细粒棘球绦虫(中国大陆株)诊断抗原P-29重组蛋白的免疫保护性研究

目的:探讨细粒棘球蚴(Eg)诊断抗原P-29重组蛋白的免疫保护性及其作为候选疫苗的潜在价值.方法:ICR小鼠随机分为蛋白免疫组和佐剂对照组,每隔2wk皮下免疫1次,在第3次免疫后2wk,用Eg原头蚴进行攻击感染,感染后20wk剖杀小鼠,检获棘球蚴包囊,计算免疫保护力,并用ELISA法测定血清中IgG及其亚型和IgE水平.结果:与佐剂对照组比较,蛋白免疫组小鼠的免疫保护力为96.6%;与免疫前比较,免疫后和攻击感染后蛋白免疫组小鼠血清IgG,IgG1,IgG2a和IgE水平均明显升高(P<0.05),IgG2b降低(P<0.05).结论:细粒棘球绦虫诊断抗原P-29重组蛋白能诱导小鼠产生一定的保护性免疫,是潜在的疫苗候选抗原分子.     

Spontaneous intraperitoneal expulsion of an unruptured hydatid cyst

We report a 43-year-old man with a 20 x 20 cm hydatid cyst, spontaneously extruded out from the left lobe of the liver. This complication of hydatid cyst has not been recorded earlier, and makes the case unique in itself and worth reporting. The patient presented with a rare complication of biliary peritonitis of hydatid disease.     

新疆不同宿主来源细粒棘球蚴囊液可溶性蛋白质组分抗原性分析

应用免疫印渍法对新疆羊、人、牛、骆驼源细粒橡球蚴囊液可溶性蛋白质组分的抗原性进行比较分析。十二烷基硫酸钠—聚丙烯酰胺凝胶电泳(SDS—PAGE)显示羊、人、牛、骆驼源细粒棘球蚴囊液各含有多个蛋白质组分,免疫印渍法显示包虫病人血清主要识别囊液中65、56、38、35、30、25、23、16、12和10KD蛋白质抗原成分,以38KD蛋白质抗原组分反应性最强。泡球蚴病人、绦虫病人和一些非寄生虫病患者血清可广泛地与38KD组分发生交叉反应。16、12和10KD蛋白质抗原组分敏感性较弱但特异性较强,仅与泡球蝴病人血清发生交叉反应,是棘球属特异的。     

Clinical Experience in Treating Intracranial Hydatid Cysts: Report of 97 Cases

Background: Echinococcosis is still endemic in many countries, including China, especially in its north-west part, but the world literature which describes the Chinese experience in treating the cerebral hydatid cyst is still lacking. In this report, clinical manifestations, radiological features and surgical outcomes of 97 patients with intracranial hydatid cysts were analyzed and the transmission pattern, preoperative diagnosis, treatment methods and long-term outcome were discussed. Methods: We retrospectively reviewed the clinical features ( neurological symptoms and signs), radiological manifestations( X-ray, CT, MRI) and surgical outcome of 97 patients with intracranial hydatid cysts whom received surgical treatment at the neurosurgical department of Xinjiang Medical University between the year 1985 to 2010.We have followed up the patients via sending questionnaire or telephone contact. Clinical outcome was evaluated by using Karnofsky Performance Scale Index (KPSI). Results: Headache and vomiting were the most common initial symptoms in our patients. Neurological deficits caused by the mass effect of the cysts were seen in 82 cases, which include hemiparesis, visual deficit, diplopia and aphasia. Epilepsy was occurred in five patients with hemispheric hydatid cysts. On X-Ray, significant bone erosion was seen in only two cases with epidural hydatid cysts. Round shaped and thin walled homogeneous low-density cystic lesion without surrounding edema and enhancement were the main findings on CT in 95 patients with intraparenchymal hydatid cysts, while two cases with epidural hydatid cysts were manifested as a heterodensity lesions. On MRI, Hydatid cyst was manifested as a round low signal lesion in T1-Weighted images and high signal lesion in T2-weighted images, without enhancement after contrast media injection, while the two cases with epidural cysts were manifested as mixed signal masses. Surgical removal of cyst was performed in all cases. Total removal was achieved in 93 cases without rupturing the cyst wall. Only two cysts ruptured during the dissection, resulted in two surgery related mortality. There was no other additional neurological deficit caused directly by surgery. Patient outcome was 97.2% with Karnofsky Performance Scale score 80 to 90. Conclusion: Intracranial hydatid cyst is still a main cause of increased intracranial pressure among the patients in endemic areas. CT and MRI have been proven to be the best diagnostic modality for diagnosing intracranial hydatid cyst. Surgery is the treatment of choice for intracranial hydatid cyst whenever possible.     

Uncommon locations of hydatid cysts

Human echinococcosis remains a complex problem that may affect several organs, and requires mostly surgical management. We present two cases with uncommon locations of hydatid cysts that were successfully managed in our hospital during the last two years. The first case was a 62-year-old woman with a multicystic lesion in her right thigh that was radically excised, and histology confirmed the diagnosis of echinococcosis. The second case was a 78-year-old man with multiple large intraabdominal hydatid cysts that required a complex operation, including splenectomy, partial removal of the liver cyst wall and evacuation of the content, and excision of pelvic, mesenteric cysts, and suprahepatic cysts. Both cases have not shown any sign of recurrence to date. Since the disease is still endemic in certain parts of the world and pharmaceutical agents are not radical, specific surgical procedures remain the treatment of choice with good results and acceptable morbidity, mortality and recurrence rates.     

Hydatid disease: an unusual breast lump

Hydatid disease of the breast is rare, but it should be included under differential diagnosis of a breast lump especially in endemic areas of this disease. Fine needle aspiration cytology can provide a safe pre-operative diagnosis, although mammogram, ultrasonography of breast, magnetic resonance imaging and serological tests like Casoni's test can also be done. Complete excision of the cyst without spillage can be a curative procedure for primary hydatid cyst of the breast. It is important to explore other common sites like liver and lung by means of ultrasonography and chest x-ray and treat accordingly. Here in this report, a lady of 27 years old presented with a painless lump of the left breast. Fine needle aspiration cytology was inconclusive. Lumpectomy was done. Histopathological examination confirmed it to be a case of hydatid disease involving the left breast.     

Primary hydatidosis of the gluteus muscles: report of three cases

Background  Hydatid disease caused by the tapeworm Echinococcus granulosus is a worldwide problem especially in sheep and cattle raising countries. Aims  Muscle involvement is most commonly encountered as recurrence of previously treated disease or concurrently with primary lesions of the liver or lung. Furthermore, the rarity of muscle hydatidosis has unique implications in diagnosis and management. Methods  We report on three cases of primary echinococcus of the gluteus muscles presented in our clinic during a 10-year period. Results  We have administered albendazole for one cycle of 28 days in two of our patients based on the size and appearance of the cyst. All patients underwent total pericystectomy without cyst rupture. We have not found any recurrences after minimum follow up of 12 months. Conclusions  Muscle echinococciasis respond well to surgical intervention. Complete and intact removal of the cyst in primary muscular hydatidosis should be considered curative.     

A rare presentation of hydatid cyst

Hydatid disease, although known to occur in most body areas, is extremely rare in the female reproductive system. There are different modes of presentation for the disease; however, we report and discuss a case presented with cystic vesicles passing through the vagina, which is considered as a rare presentation for secondary involvement of the uterus and both ovaries. We confirmed diagnosis with radiological examinations and serological tests. We operated on the patient, and studied the excised cysts microscopically. The gynecologist should be aware of hydatid cyst when vaginally passing a grape like vesicle is presented by the patient.