ATYPICALLY LOCATED HYDATID CYST CASES: 4 UNUSUAL CASE REPORTS

Abstract

Objective: Hydatid cyst is endemic in South America, the Middle and Far East and around the Mediterranean. The disease is frequently located in liver (65-70%) and lungs (25%). Hydatid disease is usually asymptomatic when located in the extrahepatic regions. Sometimes, diagnosis can be established in the patients, who were taken to operation with non-specific findings, by observing germinative membrane, rockwater, or daughter vesicles during the operation. The aim of the present study is to present the hydatid cyst cases detected in the anterior of the left abdominal acetabulum, head of the pancreas, in the perianal region, and on the right adrenal gland. Case 1: A 41-year-old female patient applied to our clinic with the complaint of intermittent left inguinal pain. echinococcus Indirect Hemagglutination (IHA) test was positive. In the ultrasonographic examination, a hypoechoic area was observed in the posteromedial of the left femoral head. Cystic lesion was observed in computed tomography (CT) and magnetic resonance imaging (MRI). Pathology result of the patient was assessed as “compatible with hydatid cyst”. Case 2: A 56-year-old female patient, applied with the complaints of intermittent nausea, vomiting, and epigastric pain. She had a history of surgery for liver hydatid cyst 15 years ago and for lung hydatid cyst 10 years ago. IHA test of the patient was positive. The lesion involving septation and accompanied by calcifications around the cyst was reported as a hydatid cyst at dynamic CT for pancreas and upper abdominal MRI. Case3: A 22-year-old female patient applied with perianal pain complaint. Drainage was planned for the patient who had a pre-diagnosis of perianal abscess. Tissues similar to the hydatid cyst membrane were excised together with purulent fluid. The patient was diagnosed with hydatid cyst after the pathology result was reported “as compatible with hydatid cyst”. Case4: A 32-year-old female patient had a non-metabolic adrenal subcapsular cyst (hydatid cyst?) in the right adrenal gland on ultrasonography performed for abdominal pain. In abdominal tomography, a “cystic mass compatible with hydatid cyst located in the adrenal gland in the upper pole of the right kidney” was reported. IHA test of the patient was negative. Surgical intervention was not considered for the patient, who was thought to be diagnosed with adrenal hydatid cyst with a calcified membrane, and follow-up decision was taken. DISCUSSION AND CONCLUSION Echinococcus eggs infect people with direct contact with water, food, and dogs. Echinococcus eggs infect people with direct contact with water, food, and dogs. From the intestines, the larvae reach the liver through the veins. Sometimes they cause the disease by passing through the liver or reaching the lungs via lymphatics. Then, they can reach other places in the body, less frequently through the blood. It is known that Turkey is in an endemic region in terms of hydatid cyst. Hydatid cysts located in the perianal region and muscles have been reported as atypical localizations in the literature, and some of them were diagnosed as a result of preoperative clinical evaluation and radiological imaging. Some were diagnosed as a result of pathological examination after the operation. Surgical treatment is an option in suitable cases, and the definitive diagnosis can be established by pathology. Consequently, it should be considered that cystic lesions detected in the patients living in endemic regions can be extrahepatic hydatid cyst that is localized in different anatomical regions.