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CASE REPORT |
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Year : 2016 | Volume
: 9
| Issue : 5 | Page : 661-662 |
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Primary ovarian hydatid cyst
Sachin A Badge1, Maikal A Kujur1, Avinash T Meshram1, Anjalee G Ovhal2
1 Department of Pathology, Late Shree Baliram Kashyap Memorial Government Medical College, Jagdalpur, Chhattisgarh, India 2 Department of Anatomy, Late Shree Baliram Kashyap Memorial Government Medical College, Jagdalpur, Chhattisgarh, India
Date of Web Publication | 13-Oct-2016 |
Correspondence Address: Sachin A Badge Department of Pathology, Late Shree Baliram Kashyap Memorial Government Medical College, Jagdalpur, Chhattisgarh India
Source of Support: None, Conflict of Interest: None | Check |
DOI: 10.4103/0975-2870.192158
In humans, hydatid cyst is caused by Echinococcus granulosus. E. granulosus mainly affects the liver and lungs. It is very rare to get a primary ovarian hydatid cyst. Hence, we are reporting a very rare case of primary ovarian hydatid cyst.
Keywords: Cyst, hydatid, ovary
How to cite this article: Badge SA, Kujur MA, Meshram AT, Ovhal AG. Primary ovarian hydatid cyst. Med J DY Patil Univ 2016;9:661-2 |
Introduction | | |
The major cause of human hydatid cysts is Echinococcus granulosus. This infection is more common in countries where people keep cattle, sheep, and dogs near their living places.[1] These countries belong to the Mediterranean region, Middle Europe, South America, Middle East, East Africa, and Australia.[1] Humans play the role of accidental intermediate hosts. Usually, the duration of cyst formation from the ingestion of the eggs by a host up to the symptomatic stage of the disease is 10-20 years.[1] The route that larvae choose to spread is through penetration of the intestinal wall, and most of them enter the portal vein to reach the liver. Seventy percent of these larvae are captured by the liver while the remaining 30% escape the hepatic filter. E. granulosus mainly affects the liver (63%), lungs (25%), muscles (5%), bones (3%), kidneys (2%), brain (1%), and spleen (1%).[1] It is rare to diagnose a hydatid cyst in the pelvis, especially as a primary localization.[2] The incidence being given as 0.2-2.25%. In 80% of cases reported with a cyst in this location, the ovary is the most commonly affected organ followed by the uterus.[3] Cases of primary ovarian hydatid cysts are reported, but more commonly, ovarian involvement is secondary to a cyst's dissemination from another site.[4]
Case Report | | |
A 55-year-old female patient presented with the compliant of abdominal pain for 2 months. Ultrasonography of abdomen and pelvis showed a cystic lesion in the left ovary. Rest of the abdominal and pelvic organs were normal. Left oophorectomy was done, and the specimen was sent for histopathological examination. On gross examination, there was an ovary with a pearly white cyst measuring 4 cm in diameter. On cutting, there was serous fluid and no daughter cysts inside. On microscopy, there was a cyst wall having laminar membrane [Figure 1]. As liver and other organs did not have cysts on sonography and there was also no history of hepatic hydatid cyst, this case was labeled as primary ovarian hydatid cyst.
Discussion | | |
Ovarian hydatid cyst is a very rare finding. Patients with hydatid cyst of the ovary have been reported from Saudi Arabia, Ethiopia, India, and other regions.[5],[6],[7],[8] All these reports revealed the low incidence of primary involvement of the ovary as a site of hydatid cyst formation. Pelvic echinococcosis symptomatology is nonspecific and can include abdominal tumefactions, abdominal pain, menstruation irregularities, infertility, and urinary disturbances.[9] Ovarian echinococcosis can simulate either polycystic disease or malignancy. The difficulties that occur in making a correct diagnosis are due to the nonspecific clinical symptoms, associated with atypical ultrasonographic and radiological images which merely show a solid ovarian mass.[10] A high grade of suspicion or a preoperative diagnosis of Echinococcus cyst makes it possible to avoid an intraoperative iatrogenic rupture, and when available, to administer previously an albendazole-based therapy to reduce the risk of dissemination that can lead to recurrences. The ultrasound scan, especially if performed transvaginally, is an important imaging tool to recognize the cystic aspect of the lesion, showing the characteristic fluctuating membranes of the multilocular cyst. Computed tomography (CT) scan confirms the diagnosis revealing daughter cysts and contingent calcifications of the cyst's wall. The treatment of choice in ovarian hydatid cysts is surgery which could be either radical or conservative. Care must be taken to reduce the risk of possible cyst's rupture. Ovarian cystectomy, when possible, represents the gold standard treatment. In some cases, this approach is not possible in the need to preserve surrounding structures. In these circumstances, a partial cystectomy or marsupialization taking all the necessary precautions not to spill daughter cysts together with anti-helminthic therapy to reduce the chance of recurrence are alternative acceptable approaches. Cases of hydatid cysts aspirated using saline agents are reported.
Conclusions | | |
An ovarian hydatid cyst is a rare finding. To diagnose this pathology, one must have a high grade of suspicion. Transvaginal ultrasonography and abdominal CT are the best methods of imaging available to avoid an intraoperative break. When possible, the optimal treatment is radical laparotomic cystectomy.
Financial support and sponsorship
Nil.
Conflicts of interest
There are no conflicts of interest.
References | | |
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[Figure 1]
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