Table of Contents  
CASE REPORT
Year : 2015  |  Volume : 8  |  Issue : 2  |  Page : 214-216  

Primary cerebral hydatid cyst in a child


Department of Pathology, Prathima Institute of Medical Sciences, Karimnagar, Andhra Pradesh, India

Date of Web Publication13-Mar-2015

Correspondence Address:
Srikanth Shastry
Department of Pathology, Prathima Institute of Medical Sciences, Karimnagar, Andhra Pradesh
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0975-2870.153168

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  Abstract 

Cerebral hydatid disease is very rare, representing only 2% of all cerebral space occupying lesions even in the countries where the disease is endemic. Echinococcal cysts are usually found in the liver and lungs, but can affect any part of the body. Differential diagnosis of hydatid disease should be considered for every cystic mass in any anatomical location, especially in areas where the disease is endemic. Hydatid disease has a worldwide distribution and causes health problems in endemic countries. Here, we are presenting a case of cerebral hydatid cyst in a 7-year-old female child. The main aim of this case is to highlight the rarity of this location and that hydatid cysts must be considered as differential diagnosis in patients with cystic lesions of brain, especially in endemic areas.

Keywords: Cerebral, hydatid cyst, parieto-temporal region


How to cite this article:
Shastry S, Anandam G, Kumari B S, Sreelatha K. Primary cerebral hydatid cyst in a child. Med J DY Patil Univ 2015;8:214-6

How to cite this URL:
Shastry S, Anandam G, Kumari B S, Sreelatha K. Primary cerebral hydatid cyst in a child. Med J DY Patil Univ [serial online] 2015 [cited 2020 Oct 24];8:214-6. Available from: https://www.mjdrdypu.org/text.asp?2015/8/2/214/153168


  Introduction Top


Hydatid disease, which is a zoonotic infection caused by larval forms (metacestodes) of tapeworms of the genus Echinococcus found in the small intestine of carnivores, still remains an important health problem in endemic regions. [1],[2]

In humans, the two main types of Hydatid disease are caused by Echinococcus granulosus and Echinococcus multilocularis. The liver is the most common organ involved (77%) followed by lungs (43%).

Hydatid cysts have been reported in the brain (2%), heart (2%), kidneys (2%), spinal cord (1%) spleen, spermatic cord, soft tissue. [3]


  Case Report Top


The case we present here is about a 7-year-old female child who was presented with the complaints of swelling in left parieto-temporal region since 1½ year, headache since 1-year, blurring of vision since 1 month and vomiting since 1-week. The swelling was of size 5 cm × 3 cm, firm to cystic, nontender and no local rise of temperature. There is no history of trauma. Initially, it was diagnosed as lipoma or sebaceous cyst. Complete blood picture, erythrocyte sedimentation rate and other routine investigations were within the normal limits. There is no rise in eosinophil count. On radiological imaging computed tomography scan brain showed a large well-defined hypodense lesion in left parieto-temporal region with evidence of internal septa with a provisional diagnosis of cerebral hydatid cyst [Figure 1]. Patient was given albendazole preoperatively. Left temporoparietal craniotomy with excision of cyst in toto was done (Dowling's technique). Grossly, we received pearly white cystic mass of size 8 cm × 4 cm with multiple daughter cysts [Figure 2] and [Figure 3]. Histopathologically, it was confirmed the diagnosis of hydatid cyst [Figure 4] and [Figure 5].
Figure 1: Computed tomography brain showing a well defined hypodense lesion in left parieto-temporal region

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Figure 2: Gross picture of cyst

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Figure 3: Gross picture showing daughter cysts

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Figure 4: Section showing cyst wall comprising outer chitinous and inner germinal layer with scolices and hooks. Adjacent to this cellular eosinophilic laminated membranous structure seen (H and E, ×10)

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Figure 5: Section showing scolices and hooks of varying sizes (H and E, ×40)

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  Discussion Top


Hydatid disease is caused by ingestion of eggs of a cestode parasite, E. granulosus. The definitive hosts are dogs and sheep and humans are the intermediate host. Humans get infected by ingestion of food contaminated with eggs shed by dogs and sheep. Eggs hatch in the duodenum and invade the liver, lungs, or bones.

Two of the four recognized species of Echinococcus: E. granulosus and E. multilocularis, cause cystic echinococcosis and alveolar echinococcosis in humans, respectively. The eggs of these tapeworms excreted by carnivores may infect humans as natural intermediate host. [2]

Cerebral hydatid disease is a rare space occupying lesion and more common in the pediatric population. [4],[5] The incidence is around 5%. The parietal lobe is the most frequently involved region. [6] In India, it is more commonly seen in Kurnool district of Andhra Pradesh, Madurai district of Tamil Nadu and in Punjab. [5]

Cerebral hydatid disease may either be secondary or primary. In secondary disease, there is a primary location of hydatid cyst in liver, lung, or spleen that has been operated or not operated. Patients with cerebral hydatid cysts complain of head ache, blurring of vision, and vomiting.

The primary cysts are formed as a result of direct infestation of larvae in the brain without demonstrable involvement of other organs. Primary hydatid disease of the brain is very rare, as the parasite has to cross pulmonary and hepatic barriers to reach the nervous system.

The primary cysts are fertile as they contain scolices and brood capsules, hence rupture of primary cyst can result in recurrence. The secondary multiple cysts result from spontaneous, traumatic or surgical rupture of primary intracranial Hydatid cyst and lack brood capsules and scolices. [5],[6]

This patient had not been operated for hydatid disease previously, and investigations did not revealed any hydatid cyst in liver, lung, or spleen. Hence, this patient was diagnosed, having primary hydatid disease of cerebral region.

The treatment of hydatid cyst is surgical and the aim of surgery is to excise cyst in toto without rupture to prevent recurrence or anaphylactic reaction. [6]

In many cases adjunctive chemotherapy was given to eliminate any possible larvae dissemination and to take care of possible hydatid disease at other sites.

We present this case of cerebral Hydatid disease due to its rare occurrence in pediatric population, which should be considered as differential diagnosis in cystic lesions of brain, especially in endemic population.

 
  References Top

1.
Guidelines for treatment of cystic and alveolar echinococcosis in humans. WHO Informal Working Group on echinococcosis. Bull World Health Organ 1996;74:231-42.  Back to cited text no. 1
    
2.
Eckert J, Deplazes P. Biological, epidemiological, and clinical aspects of echinococcosis, a zoonosis of increasing concern. Clin Microbiol Rev 2004;17:107-35.  Back to cited text no. 2
    
3.
Gana R, Skhissi M, Maaqili R, Bellakhdar F. Multiple infected cerebral hydatid cysts. J Clin Neurosci 2008;15:591-3.  Back to cited text no. 3
    
4.
Andronikou S, Welman CJ, Kader E. Classic and unusual appearances of hydatid disease in children. Pediatr Radiol 2002;32:817-28.  Back to cited text no. 4
    
5.
Dharker SR. Hydatid disease. In: Ramamurthi B, Tandon PN, editors. Text Book of Neurosurgery. 2 nd ed. New Delhi: Churchill Livingstone; 1996. p. 535-44.  Back to cited text no. 5
    
6.
Gupta S, Desai K, Goel A. Intracranial hydatid cyst: A report of five cases and review of literature. Neurol India 1999;47:214-7.  Back to cited text no. 6
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  [Figure 1], [Figure 2], [Figure 3], [Figure 4], [Figure 5]



 

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