Cytologic diagnosis of complicated pulmonary unilocular cystic hydatidosis. A study of 131 cases

The clinical and cytomorphological spectrum of hydatid disease

INTRODUCTION

Hydatid disease (HD) is caused by the tapeworm of the genus Echinococcus. Fine-needle aspiration cytology (FNAC) is an expedient diagnostic technique that may be used for its rapid diagnosis.

AIM

To study the clinical and cytomorphological spectrum of HD diagnosed by cytology.

MATERIAL AND METHODS

A total of 24 patients diagnosed with HD on FNAC and fluid were studied over a period of 5.5 years. May Grunwald Giemsa, Periodic acid Schiff, and Haematoxylin and Eosin stained smears were studied and analysed for the cytomorphological spectrum of HD.

RESULTS

Amongst the 24 patients studied, the mean age was 29.8 years (range 6-64 years). There was equal sex preponderance with 12 males and 12 females. The most common organ involved was lung (54.1% of cases) followed by liver (25% of cases). Presence of laminated membranes (n-20, 83.3%) followed by presence of hooklets (n-13, 54.1%) were the common cytological features. Scolices and protoscolices representing endocyst were seen in 37.5% of cases (n-9).

CONCLUSION

Clinicians and pathologists should be aware of the clinical and morphological spectrum of HD respectively for immediate diagnosis followed by prompt management.

Abdominal wall hydatid cyst: case report and review of literature

A 60-year-old woman presented with a swelling in right paraumbilical region of one-year duration. Examination revealed a painless cystic swelling 15 × 10 cm with cough impulse. Ultrasound and CECT abdomen showed a subcutaneous cystic swelling with intramuscular extension. No other intraabdominal cystic lesions were found. Surgical exploration showed a cystic lesion adherent to peritoneum without any intraperitoneal extension. Cyst was carefully excised without any spillage. Gross specimen on opening showed multiple daughter cysts consistent with hydatid cyst, confirming the diagnosis of solitary abdominal wall hydatid cyst.

Respiratory Tract and Mediastinum

Normal cytology, abnormal and atypical cells, non-cellular components, and infectious cell changes are largely described together with benign, malignant, and neuroendocrine lesions regarding exfoliative and aspiration cytology of the lung. A separate section broadly addresses diagnostic findings and differential diagnoses in bronchoalveolar washings.

The section ‘Fine needle aspiration biopsy of mediastinal disorders’ covers in particular biopsy techniques, accuracy of liquid-based cytology, and the complex lesions of the thymus gland. Cytodiagnostic algorithms of the major benign and malignant pulmonary and mediastinal lesions and their respective differential diagnoses are additionally presented in synoptic setups.

Worm-like artifacts in exfoliative cytology

The presence of worms in cytological smears is occasionally reported, although various other structures exist that may be confused with such parasites. We present eight worm-like artifacts observed in routine Papanicolaou smears. Recognition of these structures is important to avoid overvaluation or confusion with true worms.

Pulmonary complications of cystic echinococcosis in children in Uruguay

Cystic echinococcal lesions surgically removed from 99 patients aged 1-15 years in Uruguay were histopathologically studied. The lesions were collected from the lungs, liver, peritoneum, omentum, pleura, ovary, appendix and perinephrium. All intact cysts were well-developed and unilocular. Pulmonary and hepatic fertile cysts in which protoscoleces were produced were in 75% and 47%, respectively, of all patients. Fertile cysts having many protoscoleces were in the lungs of a 1-year-old infant. Sixteen ruptured pulmonary cysts were found in the lungs of 13 patients and four ruptured hepatic cysts were found in the liver of three patients. Pulmonary complications were seen in patients having pulmonary echinococcal cysts. In lung tissue surrounding echinococcal cysts, pulmonary complications included chronic congestion, hemorrhage, bronchopneumonia, as well as interstitial pneumonia that included histological changes caused by bronchiolitis, organizing pneumonia and obstructive pneumonia. Liver tissue adjacent to echinococcal cysts showed atrophy of hepatic cells, proliferation of interstices, small focal hemorrhages, and infiltration of mononuclear cells. The present study shows that a close relationship exists between pulmonary echinococcosis and pneumonia. The term 'echinococcal pneumonia' is proposed for pneumonia accompanying pulmonary echinococcosis.