A case report of primary isolated extrahepatic hydatid cyst of the soft tissues of the breast and thigh

Pathological Fracture of the Tibia Due to Lytic Bone Lesion Caused by Hydatidosis with Absence of Systemic Involvement: A Case Report and Review of Literature

BACKGROUND

This report raises attention to hydatidosis in bone as a neglected lytic osseous disease.

CASE PRESENTATION

The authors reported a case of a 49-year-old female who presented with pain and swelling in the right upper leg. X-ray suggested a lytic lesion in the right proximal tibia. Adenocarcinoma metastasis was suspected, yet, the investigations revealed negative Positron emission tomography (PET) scan metastatic work-up and negative alpha-fetoprotein, Cancer Antigen (CA) 15.3, CA 19.9, CA125, and Carcinoembryonic antigen (CEA). The histopathological evaluation of the extracted core biopsy showed a granulomatous reaction with reactive fibrosis. Immune reactive CD68 cells were recorded in the epithelioid macrophages and foreign body giant cells. Four months later, the patient was presented with a pathological fracture in the upper right leg. Surprisingly, the histopathological evaluation of the Hematoxylin and Eosin sections and the cytological assessment reported pathognomonic structures for hydatid in the form of foreign body giant cells engulfing laminated hyaline eosinophilic material and a scarce number of hooks. The absence of cellular atypia excluded malignancy. Periodic acid schiff highlighted the pathognomonic laminated fragments and granulation tissue. Masson trichrome staining emphasized collagen deposition.

CONCLUSION

Osseous hydatidosis is a neglected disease that may mimic lytic bone tumors. Vague radiological features and scarce parasite-derived structure in histopathology may misinterpret the disease. Raising attention to bone hydatidosis among clinicians is recommended.

Double Trouble on the Lower Leg-Unique Human Coinfection with Echinococcus granulosus and Echinococcus multilocularis Without Liver Involvement

The tapeworms Echinococcus granulosus and Echinococcus multilocularis cause two different clinical manifestations in humans: cystic echinococcosis (CE) and alveolar echinococcosis (AE), respectively. Both forms of echinococcosis manifest primarily in the liver, while other organs or tissues are less frequently affected. Simultaneous occurrence of CE and AE is extremely rare, and all previously reported patients exhibited affected livers, while simultaneous infection without liver involvement has not yet been described. Herein, we present an exclusively extrahepatic E. granulosus and E. multilocularis coinfection localized between the calf muscles of a patient. Due to progressive painful local swelling, an abscess was suspected, but there was no improvement after the administration of multiple courses of antibiotics. When imaging diagnostics suggested a parasitic origin of the two identified cystic lesions, positive serology for both species indicated a dual infection. Albendazole therapy was started, and extensive surgical excision was performed. Both species were confirmed using PCR and sequencing from intraoperative samples. The current case shows that coinfection without liver involvement can occur, even in patients from low-incidence regions, which should be considered in the differential diagnosis of patients with unusual clinical presentation.

Giant Hydatid Cyst Originating From Psoas Muscle Extending to the Iliac Bone: A Case Report

Hydatid cysts, caused by the Echinococcus granulosus parasite, predominantly affect the liver and lungs, but can also impact other organs such as the kidneys, brain, and muscles. Infection occurs when individuals ingest eggs from contaminated food or water, leading to cyst formation primarily in the liver. While hydatid cysts are commonly found in various endemic regions, muscular involvement is rare, particularly in the psoas muscle. This report presents a case of a muscular hydatid cyst, describes its management, and emphasizes the need for awareness and prompt intervention. A 50-year-old man presented with abdominal and left lower limb pain, along with weakness over several days. He was febrile, and a physical examination revealed pain during leg movement. Routine laboratory tests were normal. Ultrasound and computed tomography scans identified a solid cystic mass in the left lower quadrant, extending to the left lumbar muscle. After 28 days of preoperative albendazole therapy, the patient underwent surgery through a Rocky Davis incision, where a large hydatid cyst containing daughter cysts in the psoas muscle was discovered. The cyst was unroofed, and its contents were evacuated, followed by irrigation with hypertonic saline. Postoperative recovery was uneventful. He also received standard medication therapy with albendazole, and during monthly visits, no complications were observed during the one-year follow-up. This case contributes to the limited literature on muscular hydatid disease and highlights the importance of awareness among healthcare providers to ensure timely diagnosis and management.

Isolated breast hydatid cyst: A case report

A hydatid cyst is a parasitic infestation most frequently caused by the larval tapeworm known as Echinococcus granulosus. Breast hydatidosis is a very uncommon condition that may be the main site or one of its components in cases of extensive hydatidosis. We discussed a 28-year-old female patient who had been experiencing left breast pain for a year prior to her presentation.

Muscular hydatid cyst in Iran: A case report

INTRODUCTION AND IMPORTANCE

Hydatid disease, caused by the larval stage of Echinococcus granulosus, is a common parasitic infection of humans and herbivores. Although livers and lungs are the most commonly affected organ, hydatid cysts may develop in any body part. Primary muscular hydatid cyst is extremely rare.

CASE PRESENTATION

We reported the case of a 40-year-old-woman with the presentation of a soft, mobile, and non-tender lump in the dorsal part of her left upper arm (triceps brachii), which emerged one year ago. Her past medical history was unremarkable. The arm sonography revealed a single uniloculated cystic mass (6.5 cm × 5.5 cm) with a thick wall containing cystic lesions. It suggested the diagnosis of echinococcosis. The patient underwent surgery, and the hydatid cyst was excised. Histopathological examination confirmed hydatidosis.

CLINICAL DISCUSSION

Hydatid cysts occur rarely (about 4 %) in muscles even in endemic regions. The study is the first case of hydatidosis found in triceps brachii in Fars province, Iran. In endemic regions, considering the hydatid cyst possibility is very important because it presents with many diversities. As it clinically presents a painless slow-growing mass, may be misdiagnosed with benign soft tissue tumors.

CONCLUSION

Although muscular hydatidosis is extremely rare, it should be considered a differential diagnosis of any growing subcutaneous or muscular masses or tumors. Imaging modalities and blood tests are highly relevant for diagnosis. Surgical excision, a choice of treatment, should be done with cautions and is combined with anthelmintic therapy to reduce the risk of recurrence.

Isolated breast hydatid cyst: Imaging features

Hydatid cyst (HC) of the breast is a rare entity, even in endemic areas. We report the radiologic features of an isolated breast HC in a 50-year-old woman. Imaging findings may mimic other common breast lesions, but specific imaging features help establish an accurate diagnosis to adapt therapeutic management.

A rare phenotype of breast hydatid cyst causing misdiagnosis and unnecessary intervention: a case report

Hydatid cyst (cystic echinococcosis) is a chronic parasitic infection by the larval stage of the cestode that is called Echinococcus granulosus (E. granulosus) resulting in the development of cystic lesions in animals and humans. In this report, we describe a rare phenotype of hydatid cyst in the breast of a 23-year-old female presented with breast mass in the left upper outer quadrant for 3 months with palpable left axillary lymph nodes. Both US and mammography provided a picture of complex suspicious cystosolid lesion with amorphous micro-calcification (BIRAD-4A). Surgical consultation was performed and Tru-Cut biopsy was recommended. Histopathology results revealed multiple viable protoscolices of E. granulosus and suggested the final diagnosis of breast hydatid cyst. The patient returned with ruptured and infected hydatid cyst of the breast and started treatment with Albendazole 400 mg twice daily in addition to antibiotics. Following-up after two months of Albendazole treatment showed a dramatic shrinkage in the size of the cystic lesion. In conclusion, hydatid cyst should be considered as a differential diagnosis of any cystic or cystosolid lesion in the breast and any organ in the body from head to toe apart from the hair and nails. Radiologists should be aware to the benign lesions that may mimic breast cancer to avoid misdiagnosis and unnecessary invasive procedures and consequent complications.