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Year : 2018  |  Volume : 61  |  Issue : 3  |  Page : 454-455
An unusual presentation of hydatid cyst in the neck: A cytological diagnosis


Department of Pathology, Karnataka Institute of Medical Sciences, Hubli, Karnataka, India

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Date of Web Publication13-Jul-2018
 

How to cite this article:
Giriyan SS, Navyashree N. An unusual presentation of hydatid cyst in the neck: A cytological diagnosis. Indian J Pathol Microbiol 2018;61:454-5

How to cite this URL:
Giriyan SS, Navyashree N. An unusual presentation of hydatid cyst in the neck: A cytological diagnosis. Indian J Pathol Microbiol [serial online] 2018 [cited 2019 Dec 9];61:454-5. Available from: http://www.ijpmonline.org/text.asp?2018/61/3/454/236633





   Case Report Top


A 22-year-old female presented with slowly growing painless swelling in the left side of the neck for 3 years. Local examination revealed a swelling over the left posterior triangle of the neck measuring 4 cm × 3 cm in the subcutaneous plane and was soft-cystic, mobile, and nontender. The overlying skin showed no signs of inflammation. Fine-needle aspiration cytology (FNAC) yielded 9 ml of clear fluid aspirate with white granularity and the swelling reduced in size.

Microscopic_smears studied from wet mount and centrifuged preparation of cyst fluid stained with hematoxylin and eosin (H and E) and Wright's stain showed scolices and hooklets of Echinococcus granulosus suggestive of hydatid cyst [Figure 1].
Figure 1: (a) Fine-needle aspiration smear showing scolex and hooklets (Wright's, ×100). (b and c) FNA smear showing scolex and hooklets (H and E, ×100). (d) Wet mount smear (×40). (e) Ultrasonography neck showing a well-defined cystic lesion

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Ultrasonography_ (USG) neck was done later and revealed a well-defined cystic lesion of size 3.9 cm * 3.2 cm in the upper one-third of the posterior triangle of the left side of the neck in the subcutaneous plane. It showed linear echogenic structure within, suggestive of hydatid cyst. USG abdomen showed normal study without any lesions in the liver, spleen, and other organs. The complete blood counts were unremarkable.


   Differential Diagnosis Top


The following are the differential diagnosis to be kept in mind while dealing with swellings in the neck region.

  • Benign swellings: Branchial cyst (congenital), sebaceous cyst (congenital), plunging ranula, dominant nodule of multinodular goiter, laryngocele, lipoma, hemangioma, pseudoaneurysm, arteriovenous fistula, neurofibromas or extracranial schwannomas with mucinous degeneration, hemorrhage, and necrosis
  • Infectious/inflammatory swellings: Adenitis, especially tubercular lymphadenitis, abscesses, acute suppurative thyroiditis, and cellulitis
  • Malignant swellings: Cystic metastatic nodes from papillary carcinoma of thyroid, necrotic lymph nodes.[1]



   Discussion Top


Hydatid disease is a zoonotic infection caused by dog tapeworm E. granulosus. Humans, who are incidental intermediate hosts, do not play a role in the biological cycle and usually a “dead-end” for parasite.[2] The usual destinations are liver (75%) and lungs (15%) but it also tends to reach different and unusual body sites, where they end up transforming into cysts.[3] It is extremely rare in the head-and-neck region even in endemic areas; only a few cases located in this region have been reported in the literature.[4] This accounts for about 0.5%–4.7%.[5] Goyal et al.,[2] Khalifa et al.,[6] and Ghartimagar et al.[4] have reported hydatid cysts in the neck region adding literature to its unique presentation.

Hydatid disease is mostly asymptomatic as presenting symptoms and signs depend on anatomic location, size, and pressure effects caused by the growing cysts. Moreover, it is not usually considered in the differential diagnosis of head-and-neck cystic swellings due to its rarity.[6]

This kind of unusual presentations, especially around vital structures, should be considered while working out for diagnosis. And also from all the reported cases, we are aware of the fact that head-and neck region is a rare site for this disease and we should be careful while proceeding through the investigations and treatment.

Although FNAC has been discouraged as a diagnostic tool in suspected hydatid cases due to the risk of anaphylaxis, it helped in the diagnosis of the present case as it was not suspected clinically. To conclude, we present this case for its unique presentation and to highlight the fact that hydatid cyst should be considered in the differential diagnosis of cystic lesions in head-and-neck region, particularly in the endemic regions for proper management and also to emphasize the role of FNAC in detection of hydatid cysts.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
   References Top

1.
Mittal MK, Malik A, Sureka B, Thukral BB. Cystic masses of neck: A pictorial review. Indian J Radiol Imaging 2012;22:334-43.  Back to cited text no. 1
[PUBMED]  [Full text]  
2.
Goyal P, Ghosh S, Sehgal S, Panda I, Kumar A, Singh S, et al. Primary multilocular hydatid cyst of neck with unique presentation: A rare case report and literature review. Head Neck Pathol 2014;8:334-8.  Back to cited text no. 2
    
3.
Gossios KJ, Kontoyiannis DS, Dascalogiannaki M, Gourtsoyiannis NC. Uncommon locations of hydatid disease: CT appearances. Eur Radiol 1997;7:1303-8.  Back to cited text no. 3
    
4.
Ghartimagar D, Ghosh A, Shrestha MK, Talwar OP. Supraclavicular hydatid cyst: An unusual cause of neck swelling. Clin Med 2015;1:134-7.  Back to cited text no. 4
    
5.
Keser SH, Selek A, Ece D, Barişik CC, Şensu S, Geçmen GG, et al. Review of hydatid cyst with focus on cases with unusual locations. Turk Patoloji Derg 2017;33:30-6.  Back to cited text no. 5
    
6.
Khalifa R, Nasser F, Elsetouhy A, Farag I. Hydatid cyst of the neck. A case report and literature review. Egypt J Ear Nose Throat Allied Sci 2016;17:103-5.  Back to cited text no. 6
    

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Correspondence Address:
N Navyashree
Department of Pathology, Karnataka Institute of Medical Sciences, PB Road, Vidyanagar, Hubballi - 580 021, Karnataka
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/IJPM.IJPM_9_18

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