Giant primary muscular hydatid cyst with a secondary bone localization

Primary Hydatid Cysts in the Extremities: A Systematic Review of the Literature

Primary hydatid cysts (PHCs) in the extremities are uncommon, presenting in the majority of cases with atypical clinical features. Radical surgical excision remains the mainstay of treatment. The aim of our study was to accumulate the already published data on PHCs in the extremities in terms of demographic, diagnostic, and therapeutic aspects. Three electronic databases were meticulously searched for articles published until 2024. A total of 85 studies comprising 118 patients were finally included in our review. Sixteen patients (13.5%) were diagnosed with a hydatid cyst in their upper extremity, 94 (79.7%) with a PHC in the lower extremity, and eight (6.8%) with an echinococcal cyst in the axilla. Pain and swelling were the most frequent symptoms, whereas only two patients were completely asymptomatic. The mean lesion size was 11.6 ± 7.1 cm. Preoperative serology investigation was reported in 82 out of 118 (69.5%) patients; among them, 33 (44.6%) cases had a positive preoperative serology test. The vast majority of patients (96.6%) were treated with an interventional procedure either surgical or radiological, and only seven experienced postoperative complications. No anaphylactic reaction was described perioperatively. Although preoperative diagnosis of PHCs is challenging, they should be considered in the differential diagnosis of soft tissue lesions. Treatment strategies should be individualized on a patient basis, while radical surgical excision remains the gold standard treatment.

Muscle hydatid diseases: percutaneous treatment with Örmeci technique

Aim: To present results of percutaneous treatment with Örmeci technique for muscle hydatid diseases. Material and Method: Twelve patients (9 male, 3 female) with 16 hydatid cysts (10 CE Type 1, 6 CE Type3B) were treated by percutaneous treatment with Örmeci technique. The percutaneous puncture was performed under sonographic guidance using a 22-gauge Chiba needle as a one-step procedure in CE type 1 and 3A. However, two to six Chiba needles according to size of the cysts were used in different locations at the same time in the cyst of CE type 2, and 3B). For every 1 cm of the long diameter of the cyst lesion, 3cc of fluid from the cysts was aspirated, which was almost the same amount of cc in volume for the CE type 1 and CE type 3A hydatid cysts. A 2cc of pure alcohol (96 %) and 1cc of polidocanol 1% (ethoxysclerol 1%, Kreussler Pharma, Wiesbaden, Germany) were injected into the cysts right after the aspiration of CE type 1 and type 3A, without the aspiration of CE type 2 and 3B, for each centimeter of the long diameter of the cysts. The total amount of pure alcohol and polidocanol were injected equally among the CE type 2 and type 3B cyst’s needles. It was waited for five minutes for all scolexes to be killed and the needle/or needles were taken back. The patients with hydatid disease were followed up mean 34.75 ±14.39 (maximum 65-minimum 15) months. Findings: Fifteen out of 16 hydatid cysts (93.75%) cured. We had two complications of treatment. One patient had an abscess in the cyst after the percutaneous treatment. After the percutaneous drainage, patient was cured well, and he had no symptoms during the follow up. Another patient had torpidity in his leg after the treatment. After three months, he had no symptoms. In Conclusion, Percutaneous treatment with Örmeci technique is outpatient based, successful, safe, repeatable, cheap and It can be used as an alternative treatment in selected patients.

Molecular genotyping of Echinococcus granulosus using formalin-fixed paraffin-embedded preparations from human isolates in unusual tissue sites

Cystic echinococcosis (CE) caused by Echinococcus granulosus remains a serious problem worldwide for issues relating to public health and the economy. The most predominantly affected sites are the liver and the lungs, but other organs such as the heart, the spleen and the peritoneum can also be infected. Access to cysts from uncommon sites has limited genomic and molecular investigations. In the present study, genotypes of E. granulosus sensu lato were identified from formalin-fixed paraffin-embedded tissues (FF-PETs) implicated in human CE. Tissue samples were obtained from 57 patients with histologically confirmed CE. DNA samples were analysed using Egss 1 polymerase chain reaction (PCR) specific to the mitochondrial 12S rRNA gene of E. granulosus sensu stricto. All cysts were typed as E. granulosus sensu stricto with up to 35% of the liver and 16.6% of lungs being the most frequently infected, and up to 48.4% of samples being from rare sites. No correlation was found between cyst site and either the gender or the age of patients. This study demonstrates the possibility of exploiting atypical cysts using FF-PET samples and highlights the predominance of E. granulosus sensu stricto species in the Tunisian population, even in unusual infection sites.

Pathological femoral neck fracture caused by an echinococcus cyst of the vastus lateralis--case report

BACKGROUND

Musculoskeletal hydatid cysts are rare, but being locally invasive, can potentially cause significant deformity or pathological fracture.

CASE PRESENTATION

A 39 y.o. male presented to our orthopaedic outpatient clinic complaining of severe right hip pain, and inability to ambulate. Symptoms were not preceded by trauma. Subsequent imaging confirmed a large, 17 × 3 × 5 cm echinococcus cyst in the vastus lateralis, causing erosion of the proximal metaphysis of the femur. As a consequence the patient suffered a non-traumatic pathological intertrochanteric femur fracture. The patient was treated with an en-bloc excision of the lesion - the affected soft tissue envelope containing the large cyst - and as a second surgical step a cemented total hip replacement (THR) was implanted under the same anaesthetic. The manuscript reviews the literature regarding musculoskeletal hydatid disease.