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Year : 2011  |  Volume : 54  |  Issue : 2  |  Page : 411-413
Isolated hydatid cyst in the submandibular salivary gland: A rare primary presentation (Diagnosis by fine needle aspiration cytology)


Department of Pathology, NKP Salve Institute of Medical Sciences and Research Centre, Digdoh Hills, Hingna, Nagpur, Maharashtra, India

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Date of Web Publication27-May-2011
 

How to cite this article:
Karmarkar PJ, Mahore SD, Wilkinson AR, Joshi AM. Isolated hydatid cyst in the submandibular salivary gland: A rare primary presentation (Diagnosis by fine needle aspiration cytology). Indian J Pathol Microbiol 2011;54:411-3

How to cite this URL:
Karmarkar PJ, Mahore SD, Wilkinson AR, Joshi AM. Isolated hydatid cyst in the submandibular salivary gland: A rare primary presentation (Diagnosis by fine needle aspiration cytology). Indian J Pathol Microbiol [serial online] 2011 [cited 2014 Apr 24];54:411-3. Available from: http://www.ijpmonline.org/text.asp?2011/54/2/411/81597


Sir,

A 30 years old female field laborer with a history of contact with dogs presented with left submandibular swelling of size 3 cm x 2 cm since 6 months. On examination, it was non-tender, diffuse and soft to firm in consistency. Clinical diagnosis was cervical lymphadenopathy. Hematological investigations were within normal limits. Fine needle aspiration cytology (FNAC) of the mass was requested.

Fine needle aspiration (FNA) of the left submandibular swelling was performed, which yielded blood-mixed scanty fluid. Smears were stained with hematoxylin and eosin and Papanicolaou stains. The smears revealed many scolices with hooklets [Figure 1], scolices with rostellum, multiple detached hooklets and protoscolices with calcareous corpuscles [Figure 2]. Laminated membranes were not found. Cytological features suggested the diagnosis of hydatid cyst. There were no post-procedure complications like urticaria or hypersensitivity reactions.
Figure 1: Photomicrograph of submandibular aspirate smear showing scolex with hooklets (Papanicolaou stain, ×400)

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Figure 2: Photomicrograph of submandibular aspirate showing protoscolex with calcareous spherules (H and E stain, ×400)

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To locate the exact site of the lesion, first computed tomography (CT) scan and then sialography were performed, which confirmed the left submandibular salivary gland to be the primary site. Chest radiograph and ultrasound of the abdomen were performed to rule out pulmonary, hepatic or other common sites of involvement.

The patient was operated and the left submandibular gland was excised and sent for histopathology. On gross examination, the salivary gland measured 4 cm x 2.5 cm x 1 cm and contained a lamellated white cyst measuring 3 cm x 2 cm. Histopathology confirmed our cytological diagnosis of hydatid cyst in the submandibular gland.

Although hydatosis is known since the days of Hippocrates, Thomas, in the year 1954, worked out the life cycle consisting of three developmental stages: (a) adult worm in the definitive host, (b) eggs in the environment and (c) metacestodes in the intermediate host (humans). [1]

Humans are infected through direct contact with eggs. The liver is the most frequently affected organ (75%), followed by lungs (15%) and other parts of the body such as bone, brain and kidneys (0.27%). [2],[3]

Hydatid cyst of the submandibular salivary gland, especially if primary, is very rare and unusual. It presents with a submandibular swelling with clinical diagnosis as cervical lymphadenopathy. It is a slowly growing, soft to firm painless mass. Routine investigations like X-ray, ultrasonography and CT scan are helpful for clinical diagnosis but fine needle aspiration cytology is a simple and effective means to reach the working diagnosis without clinical suspicion. [4] Hydatid cyst is classically confirmed by direct demonstration of parasitic elements such as hooklets, scolices, scolices with rostellum and calcified corpuscles in the stained aspirated smear. [2],[5]

FNA is conventionally contraindicated in suspected cases of hydatid cyst because of the risk of anaphylaxis and dissemination. However, this risk has been overemphasized in the past as there are many reports on the cytological diagnosis of hydatid disease without complications. No urticarial or anaphylactic reactions have been occurred in our case and minimal complications can be managed by appropriate antianaphylactics. [4],[5]

In our case, chest radiograph and ultrasound abdomen were performed to rule out the involvement of other common sites such as liver, lungs and other organs. CT scan and sialography were performed to locate the exact site of the lesion.

The treatment of hydatid cyst is principally surgical with pre-operative medical treatment. Histopathology confirms the diagnosis of submandibular salivary gland hydatid cyst. [5],[6]

In conclusion, despite its rarity, occurrence of isolated hydatid cyst in the submandibular salivary gland as a primary location is a definite possibility and, hence, should always be considered while aspirating. The presence of distinctive cytomorphological features can be confidently diagnosed on cytology. As the post-procedure period was uneventful in the literature reviewed by us, aspiration cytology can be considered as a safe, simple and effective modality for the primary diagnosis of hydatid cyst. Hydatid cyst in the submandibular salivary gland is an important differential diagnosis of cervical swellings.

 
   References Top

1.Das S, Kalyani R, Kumar U, Kumar HM. A varied presentation of hydatid cyst: A report of four cases with review of literature. Indian J Pathol Microbiol 2007;50:550-2.  Back to cited text no. 1
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2.Gutierrez Y. Diagnostic pathology of parasitic infections with clinical correlations. Philadelphia, London: Lea and Febiger; 1990. p. 460-80.  Back to cited text no. 2
    
3.Marwah S, Subramaniam P, Marwah N, Rattan KN, Karwasra RK. Infected primary intramuscular echinococcosis of thigh. Indian J Pediatr 2005;72:799-800.   Back to cited text no. 3
    
4.Saha A, Paul UK, Kumar K. Diagnosis of primary hydatid cyst in thyroid by fine needle aspiration cytology. J Cytol 2007;24:137-9.  Back to cited text no. 4
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5.Handa U, Bal A, Mohan H. Cytomorphology of hydatid cyst. Internet J Trop Med 2005;2:6. Available from: http://www.ispub.com. [Last accessed on 2010 Jan 14].  Back to cited text no. 5
    
6.Kacheriwala SM, Mehta KD, Pillai B, Jain Y. A rare presentation of primary hydatid cyst. Indian J Surg 2004;66:47-9.  Back to cited text no. 6
    

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Correspondence Address:
Anne R Wilkinson
37 Chitnavis Layout, Byramji Town, Nagpur - 440 013, Maharashtra
India
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DOI: 10.4103/0377-4929.81597

PMID: 21623112

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