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LETTER TO EDITOR Table of Contents   
Year : 2010  |  Volume : 53  |  Issue : 3  |  Page : 588-589
An unusual case of primary intrapelvic hydatid cyst


Department of Pathology, R.G. Kar Medical College, Kolkata, India

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Date of Web Publication22-Oct-2010
 

How to cite this article:
Roychowdhury A, Bandopadhyay A, Bhattacharya P, Mitra RB. An unusual case of primary intrapelvic hydatid cyst. Indian J Pathol Microbiol 2010;53:588-9

How to cite this URL:
Roychowdhury A, Bandopadhyay A, Bhattacharya P, Mitra RB. An unusual case of primary intrapelvic hydatid cyst. Indian J Pathol Microbiol [serial online] 2010 [cited 2021 Sep 26];53:588-9. Available from: https://www.ijpmonline.org/text.asp?2010/53/3/588/68264


Sir,

We have come across a case of primary hydatid cyst of broad ligament of uterus. Hydatid cyst is a world wide zoonosis and is caused by Echinococcus granulosus. It is transmitted by the ingestion of eggs and commonly involves the liver (80%) and lung (15%). The involvement of female reproductive system is extremely rare. Bickers et al, [1] after reviewing 532 cases of hydatid disease from an endemic area over a 20 year period recorded 12 instances of hydatid cyst in the pelvis; only 2 of these were in the broad ligament, that is, an incidence of 0.37%.

A 45-year-old woman was admitted with history of abdominal swelling and pain for 1 month. During perabdominal examination, a huge mass was palpable in the right lower abdomen, with restricted mobility. Pervaginal examination revealed the mass separated from the uterus. Ultrasonography revealed 1 huge 175 Χ 126-mm multicystic space occupying lesion in the right side of the pelvis and right lumbar region [Figure 1]. Complete blood count showed eosinophilia. No abnormality was detected in the chest radiograph. She underwent exploratory laparotomy. On opening the abdomen, uterus and both the ovaries were healthy. One large cystic mass with smaller cysts inside was found in the upper part of the broad ligament on the right side.

Gross examination of the specimen revealed multiple cysts and daughter cysts lined by pearly white membranous tissue enclosing a granular opalescent fluid [Figure 2].
Figure 1: Ultrasonography revealed 1 huge 175 × 126-mm multicystic space occupying lesion in the right side of the pelvis and right lumbar region

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Figure 2: Gross examinati on of the specimen revealed multiple cysts and daughter cysts

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Microscopic examination showed wall of cysts and daughter cysts lined by an inner nucleated germinative layer, outer nonnucleated hyaline layer composed of delicate laminations, and an outermost fibrocollagenous adventitious layer. Histomorphology was consistent with hydatid cyst of the broad ligament [Figure 3].
Figure 3: Microscopic examination showed the wall of cysts and daughter cysts lined by a nucleated germinative layer and outer nonnucleated hyaline layer composed of delicate laminati ons (H and E, ×400)

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The involvement of female pelvic organs by hydatid disease is extremely rare and usually not thought of until operation. The hydatid cyst in the broad ligament may simulate a pedunculated fibroid or a parovarian cyst. Surgery followed by histomorphology clinches the diagnosis.

Milano et al[2] described a case of disseminated pelvic echinococcosis-simulating ovarian carcinomatosis. Of the 51 cases of hydatid disease reported in Kuwait, only 1 was located in the pelvis. [3]

Primary pelvic hydatid disease originates in the connective tissue immediately beneath the peritoneum of the pouch of Douglas. It spreads to the uterus, ovaries,  Fallopian tube More Detailss, bladder, and rectum after contact. Nearly all the cases described as developing from the ovary and fallopian tubes are really invasions from the broad ligament. [4]

It is of utmost importance that a correct preoperative diagnosis is made because all precautions must be taken to prevent dissemination and seeding of the surgical field. In the past, fine-needle aspiration cytology of hydatid cyst was thought to cause severe anaphylactic reaction. But in the study of von Sinner et al, [5] the incidence of anaphylactic reactions reported was very low. We conclude that an isolated retroperitoneal or pelvic cyst can be the unique manifestation of hydatid disease, and suspicion of this disease should be justified in patients presenting with a cystic mass in endemic areas.


   Acknowledgment Top


The authors thank Prof. Aparna Bhattachraya, Head of the Department, Department of Pathology, R.G. Kar Medical College, Kolkata.

 
   References Top

1.Bickers WM. Hydatid disease of the female pelvis. Am J Obstet Gynecol 1970;107:477-83.  Back to cited text no. 1  [PUBMED]    
2.Milano CT, Deppe G, Moshirpur JA. Disseminated pelvic echinococcosis simulating ovarian carcinomatosis: Case report and review of pelvic hydatid disease. Obstet Gynecol Surv 1981;36:535-0.  Back to cited text no. 2  [PUBMED]    
3.El Gazzar A, McCreadie DWA. Hydatid disease in Kuwait. Br Med J 1962;2:232-4.  Back to cited text no. 3      
4.Emamy H, Asadian A. Unusual presentation of hydatid disease. Am J Surg 1976;132:403-5.  Back to cited text no. 4  [PUBMED]  [FULLTEXT]  
5.von Sinner WN, Nyman R, Linjawi T, Ali AM. Fine needle aspiration biopsy of hydatid cysts. Acta Radiol 1995;36:168-72.  Back to cited text no. 5  [PUBMED]    

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Correspondence Address:
Anadi Roychowdhury
Department of Pathology, R.G. Kar Medical College, Kolkata - 700 004
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0377-4929.68264

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    Figures

  [Figure 1], [Figure 2], [Figure 3]

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