echinococcus granulosus

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echinococcus granulosus treatment

 

 

Page 1

The hydatid cyst caused by echinococcus granulosus is

often manifested by a slowly growing cystic mass, most

often involving the liver and the lungs (78%) (1,2).

Echinococcus granulosus can be found on any part of the

body except the hair, teeth and nails (3). We describe a

patient who had an isolated hydatid cyst in subcutaneous

fat.

 

Case Report

A female 42-year–old patient presented to our clinic

with the complaint of a slow-growing, slightly tender

mass of the medial aspect of the right thigh. When she

found this mass four years previously, it was very small.

It had become larger over time. In the patient's history,

there was nothing remarkable except for the dog that she

had at home. On physical examination of the patient, we

found a nontender, semimobile, smooth bordered mass

measuring 5 cm in diameter. The overlying skin was

normal and mobile.

 

Because of our suspicion of a malignancy, a fine

needle aspiration (FNA) biopsy was performed (4,5). Ten

milliliters of clear fluid was taken from the lesion but in

the chemical and pathological analyses nothing was

found. Smears prepared from the sediment were fixed in

95% ethyl alcohol and stained by the Papanicolaou

technique. Microscopic examination of smears showed

some polychromatic spherical and oval structures with

eosinophilic granules which were observed and identified

as scoleces of Echinococcus granulosus. The diagnosis of

a hydatid cyst in the soft tissue was made. In this way we

diagnosed this illness as a hydatid cyst. We determined

the viability with dye-uptake (1% Eosin) and the flame

cell activity of the scoleces that were obtained from the

cyst (6).

 

Because of the FNA biopsy we did not need to use

imaging methods or serologic tests. Due to the fact that

we diagnosed the patient's illness as a hydatid cyst, a CT

scan of the chest and ultrasound examination of the

abdomen were performed. These diagnostic tests showed

no evidence of other organ involvement. Therapy with

albendazole (10 mg/kg/day) was started and the patient

underwent surgery 4 weeks later (7). The mass was

surgically removed (Figure). She made an uneventful

recovery and no recurrence was apparent at follow-up

after 6 months.

 

E. Granulosus infestation is frequently seen in sheep

and cattle raising areas. And the hydatid cyst is endemic

in South America, Australia, most of Africa, and the

Mediterranean countries (8). Soft-tissue hydatid cysts

occur in 2.3% of cases reported from endemic areas;

they are usually associated with the involvement of other

structures. In the medical literature there are few articles

about the isolated subcutaneous hydatid cyst (9,10).

 

In our patient there was an isolated hydatid cyst that

was located on the inner surface of the right thigh. In the

medical literature, it is pointed out that after the

daughter scoleces that were in the hydatid cyst of the

liver leave the cyst and places in the subcutaneous area,

the cyst occurs entirely by being collapsed (11).

Symptoms are caused by pressure of the expanding

cyst (11). Our patient's symptom was a pain that

occurred with the growing of the mass.

 

Serologic tests have a role in the follow-up of patients

after surgery, when any subsequent titer rise is likely to

indicate recurrence (12).

Ultrasonography is considered the diagnostic method

of first choice for the subcutaneous hydatid cyst.

Turk J Med Sci

31 (2001) 575-576

© TÜB‹TAK

575

Department of General Surgery, Emergency

Aid and Traumatology Hospital, Balgat,

Ankara - TURKEY

Tanju ACAR

Ramazan TAÇYILDIZ

Salih TUNCAL

Isolated Hydatic Cyst in the Subcutaneous Tissue

Short Report

Received: April 03, 2001

 

Page 2

Computed tomography and MR imaging must be the

second method (13). Especially for subcutaneous lesions

that may be malignant, FNA biopsy must not be used.

FNA biopsy of the hydatid cyst is not recommended

because of the possibility of introducing protoscoleces

into the needle tract and the risk of anaphylactic reactions

(13). However, percutaneous aspiration of unsuspicious

hydatid cysts, as in our case, has been done without

complications.

 

Many surgeons prefer a course of albendazole before

surgery in an attempt to sterilize the cystic contents.

Percutaneous drainage combined with chemotherapy is a

relatively safe procedure in experienced hands, but

dissemination and anaphylaxis are potential risks (13).

For the subcutaneous hydatid cyst, the treatment

must always be total surgical excision.

 

 

Correspondence author:

Tanju ACAR

Sancak Mahallesi.237. Sokak Ergi Apt. 4/7

Çankaya, Ankara - TURKEY

Isolated Hydatic Cyst in the Subcutaneous Tissue

576

Figure:

Macrospopic view of the hydatid cyst.

1.

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Bakshandeh K. Clinical echinococcosis.

Ann Surg 182: 541-546, 1975.

2.

Emany HDM, Assadian A. Unusual

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Ismail MA, Alda Bagh MA, Aljanabi TA.

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(3): 234-236,2000.

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(8882): 1269-72, 1993.

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Turner JA Cestodea in: Feigin RD,

Cherry JD (eds) Textbook of the

paediatric infectious diseases. Saunders,

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Chevalier X, Rhamouni A, Bretagne S.

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neck mass in a four-year old boy. Ped

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Percutaneous treatment of hydatid cysts

under sonographic guidance. Dig Dis Sci

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13. Morris DL, Richards (eds) (1992)

Hydatid disease: Current medical and

surgical management. Butterworth-

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References