Pancreatic Hydatid Cyst Misdiagnosed as Mucinous Cystadenoma: CT and MRI Findings

Presentation and management of pancreatic hydatid cyst: A comprehensive systematic review of the literature with meta-data

INTRODUCTION

Hydatid cysts are among many cysts that can develop in the pancreas. Both the size and location of these cysts significantly influence clinical presentation and surgical approach required for management. This study aims to review the literature concerning pancreatic hydatic cysts, their presentations, and management strategies.

METHODS

A comprehensive search was conducted across CINAHL, Pubmed/Medline, Cochrane Library, Web of Science, and EMBASE Databases to identify English-language studies published up to January 2nd, 2024.

RESULTS

The mean age of the patients was 35.4 ± 17.4years, with females comprising 92 (59.0 %) of the cohort. Abdominal pain was the most common complaint, reported by 92 (59.0 %) patients. Serological testing for the echinococcal antigen demonstrated highest sensitivity at 67.0 %, whereas computed tomography exhibited a sensitivity of 34.1 %, and ultrasonography showed a sensitivity of 27.7 %. Among surgical interventions, laparotomy was the most frequently performed approach, utilized in 42(26.9 %) of the cases.

CONCLUSION

Although pancreatic hydatid cysts are rare and can be challenging to diagnose, their prognosis is generally favorable when appropriate therapeutic measures are employed. Surgical intervention, often combined with Albendazole, remains the mainstay of treatment.

The unusual location of primary hydatid cyst: A case series study

Background

Cystic echinococcosis mainly affects the liver and lungs, in which the larvae from the microvascular wall in the liver pass to the lungs and then to the blood circulation and settle in any tissue or organ.

Objectives

The objective of this study was to report the unusual location of hydatid cysts in infected patients in Sulaimaniyah City, Iraq.

Patients and methods

This retrospective case series study enrolled 13 patients. They underwent a surgical operation to excise their cyst after confirmed diagnosis with blood investigations, electrocardiogram, chest X-ray, computed tomography scan, and magnetic resonance imaging (when needed). After the operation, the cyst was confirmed with histopathological examination, and patients were advised to take an Albendazole tablet.

Results

Most patients were females from rural areas, with a mean age of 38.93 ± 14.4 years. Patients presented with cysts on the skin of the anterior abdominal wall, gluteal region, mesenteric area, pericardium, tibia bone meta diaphysis, right inguinal region, right thigh, skin of the anterior neck, spleen, left suprarenal gland, right breast, and the iliopsoas muscle.

Conclusions

The hydatid cyst can affect any body part with no site immune and often produces nonspecific symptoms.

Primary pancreatic hydatid cyst: A rare case report and diagnostic challenges

Key Clinical Message

In cystic lesions of the pancreas, hydatid cyst should be considered in the differential diagnoses and its presence should be ruled out before any invasive interventions. Serological tests along with imaging studies related to hydatid cyst diagnostic indicators should be performed in people who live in Echinococcus granulosus endemic areas and suffer from cystic lesions of the gastrointestinal tract.

Abstract

Primary pancreatic hydatid cysts, caused by the tapeworm Echinococcus granulosus, represent a rare occurrence often challenging to diagnose due to their similarity to other pancreatic conditions. This case report outlines a 67-year-old male presenting with jaundice and cholestasis but lacking typical symptoms associated with pancreatic hydatid cysts. Laboratory findings revealed elevated bilirubin levels, liver enzyme abnormalities, and tumor markers, prompting imaging studies that indicated a cystic mass near the pancreatic head. Misdiagnosed initially as a mucinous cystic neoplasm, the patient underwent Whipple surgery, unveiling a large cystic lesion upon examination.

Primary Hydatid Cyst of the Pancreas: A Literature Review on a Rare and Challenging Occurrence of Echinococcosis

Hydatid disease is caused by the Echinococcus tapeworm and is a zoonosis that endemically affects certain geographic areas with a high prevalence in animal husbandry. Due to globalization, the pathology can also be encountered beyond these preferred geographic areas. It predominantly affects the liver and lungs, with pancreatic localizations of hydatid cysts being rare and posing a challenge for differential diagnosis and surgical tactics. The present study aimed to provide a recent scoping of the literature on this type of localization, analyzing demographic data, therapeutic management, and postoperative outcomes. It was observed that females are more frequently affected in pancreatic hydatid localizations (p < 0.001), with the most common symptomatology represented by abdominal pain. The preferred localization was at the level of the pancreatic tail (32.5%), followed by cephalic localizations (25%). The preferred surgical approach was open surgery, with an observed preference for open surgery in specific localizations, such as the head, isthmus, and body of the pancreas (p < 0.001). Radical procedures are more commonly used than conservative ones (52.5% vs. 47.5%), and paradoxically, although less invasive, procedures such as inactivation and drainage are associated with more frequent complications (p = 0.03). This type of localization, due to the elements of local anatomical topography, requires adequate preparation in biliopancreatic surgery, considering that sometimes preoperative diagnosis is not oriented, and intraoperative records may require extensive interventions. Our research encompassed a thorough review of literature spanning the last decade using PubMed and Google Scholar databases, focusing specifically on cases involving primary hydatid cysts found within the pancreas. Thirty-three relevant articles were published between 2014 and 2024. In addition, we presented a unique case study that illustrates this uncommon occurrence.

Hydatid Cyst of the Pancreas: An Unusual Cause of Abdominal Pain

Pancreas is an uncommon site of hydatid cysts (HCs) even in endemic countries. Primary pancreatic hydatid cysts (PHCs) mainly occur through hematogenous dissemination. Their rarity and the absence of clinical manifestations in most cases explain their challenging preoperative diagnosis. In symptomatic cases, clinical findings may be similar to those of other diseases. We report a case of a 54-year-old female presented with a six-month history of abdominal pain, although her abdominal examination was normal. Radiological imaging revealed a serous cyst in the body and tail of the pancreas. Biliopancreatic endoscopic ultrasound (EUS) suggested a peritoneal hydatid cyst. Intraoperatively, it was diagnosed as a PHC. The patient underwent resection of the PHC and was then placed on albendazole. She did not have any symptoms for the last seven months. Through this case report, we can conclude that peritoneal hydatid cyst of the pancreas should be considered in the differential diagnosis of the cystic lesions of the pancreas. Moreover, surgery achieves a definitive treatment of the disease.