Letters to the Editor
Primary hydatid cyst of frontotemporo-zygomatic region: A rare presentation Sir, Primary hydatid cyst of head and neck region is a rare presentation even in the geographical areas known to be endemic for echinococcosis.[1] Only a few cases of primary hydatid cyst located in head and neck region have been reported. Therefore, in this case, we wish to draw attention to possibility of the hydatid disease in the specific region. An 8-year-old male came to pediatric surgery department of our institution with 3-year history of a slowly growing fronto-temporal mass that was painless and without fever [Figure 1]. Clinical examination revealed 8 × 6 × 4 cm round swelling to be cystic and fluctuant with no local inflammatory response. Physical and neurological examinations revealed no abnormalities. Computed tomography (CT) scan showed a cyst in the left temporal region, measuring 6.1 × 7 × 3.9 cm in size. The cystic lesion was round and well-delineated by a thin wall. As the past history was unremarkable and findings were suggestive of cystic lesion, it was thought to be a benign cyst. Possibility of cystic hygroma was ruled out as the lesion appeared at the age of 8 year and was absent at the time of birth. The cyst was removed surgically intact through a lateral approach. In histopathology, there was a single globular cyst measuring 6 × 5.5 × 4 cm in diameter. On sectioning, the cyst was unilocular, filled with white gelatinous membrane. Wall thickness was 0.2 cm microscopic examination demonstrated a unicellular hyalinized lamellated layer of ectocyst with fibrous outer layer. Marked foreign body type giant cell reaction was also seen confirming hydatid cyst. Ultrasonography of the abdomen was done to know status of other visceral organs but it did not reveal any other organ involvement
by the disease process. Patient was given medical treatment with albendazole (200 mg/d) for 6 weeks. The outcome was good, and patient remained asymptomatic for the follow-up period of 2 month. Soft tissue hydatid disease represents less than 3% of all hydatid disease.[2] Hydatid disease in extracranial region is rare, with only a few cases reported in the literature. Hydatid cysts are usually not considered in the differential diagnosis of head and neck cystic swellings, especially in non-endemic areas in the absence of hydatid disease elsewhere in the body.[3] The rarity of the disease in this anatomical location presents a diagnostic difficulty for the physician if he or she is not familiar with the disease. Our patient did not have any evidence of hydatid disease elsewhere in the body, neither at the time of presentation nor on post-operative diagnostic imaging. These symptoms are characteristic of any slow-growing benign tumor in the body. The case is a reminder that although rare in head and neck, clinicians has to bear in mind hydatid cyst in the differential diagnosis of extracranial swellings especially in countries where echinococcus infestation is endemic.
Lukesh A. Patil, Ashok K. Laddha, Shashi S. Sharma, Brajesh K. Lahoti Department of Surgery, Devision of Pediatric Surgery, Mahatma Gandhi Memorial Medical College and Maharaja Yeshwantrao Hospital, Indore, Madhya Pradesh, India Address for correspondence: Dr. Lukesh Patil, Room No. 31, P G Block, Mahatma Gandhi Memorial Medical College Boys Hostel, White Church Colony, Indore - 452 001, Madhya Pradesh, India. E-mail: [email protected]
REFERENCES 1. Geramidazadeh B. Unusual locations of the hydatid cyst: A review from Iran. Iran J Med Sci 2013;38:2-14. 2. Mushtaque M, Mir MF, Malik AA, Arif SH, Khanday SA, Dar RA. Atypical localizations of hydatid disease: Experience from a single institute. Niger J Surg 2012;18:2-7. 3. Zulfikaroglu B, Koc M, Ozalp N, Ozmen MM. A rare primary location of echinococcal disease: Report of a case. Ups J Med Sci 2005;110:167-71. Access this article online Website: www.jiaps.com
Quick Response Code:
DOI: 10.4103/0971-9261.151562
Figure 1: Picture of the patient with visible swelling on left temporal region with streching of the lateral canthus of left eye Journal of Indian Association of Pediatric Surgeons / Apr-Jun 2015 / Vol 20 / Issue 2
99
Copyright of Journal of Indian Association of Pediatric Surgeons is the property of Medknow Publications & Media Pvt. Ltd. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use.
Primary hydatid cyst of frontotemporo-zygomatic region: A rare presentation Sir, Primary hydatid cyst of head and neck region is a rare presentation even in the geographical areas known to be endemic for echinococcosis.[1] Only a few cases of primary hydatid cyst located in head and neck region have been reported. Therefore, in this case, we wish to draw attention to possibility of the hydatid disease in the specific region. An 8-year-old male came to pediatric surgery department of our institution with 3-year history of a slowly growing fronto-temporal mass that was painless and without fever [Figure 1]. Clinical examination revealed 8 × 6 × 4 cm round swelling to be cystic and fluctuant with no local inflammatory response. Physical and neurological examinations revealed no abnormalities. Computed tomography (CT) scan showed a cyst in the left temporal region, measuring 6.1 × 7 × 3.9 cm in size. The cystic lesion was round and well-delineated by a thin wall. As the past history was unremarkable and findings were suggestive of cystic lesion, it was thought to be a benign cyst. Possibility of cystic hygroma was ruled out as the lesion appeared at the age of 8 year and was absent at the time of birth. The cyst was removed surgically intact through a lateral approach. In histopathology, there was a single globular cyst measuring 6 × 5.5 × 4 cm in diameter. On sectioning, the cyst was unilocular, filled with white gelatinous membrane. Wall thickness was 0.2 cm microscopic examination demonstrated a unicellular hyalinized lamellated layer of ectocyst with fibrous outer layer. Marked foreign body type giant cell reaction was also seen confirming hydatid cyst. Ultrasonography of the abdomen was done to know status of other visceral organs but it did not reveal any other organ involvement
by the disease process. Patient was given medical treatment with albendazole (200 mg/d) for 6 weeks. The outcome was good, and patient remained asymptomatic for the follow-up period of 2 month. Soft tissue hydatid disease represents less than 3% of all hydatid disease.[2] Hydatid disease in extracranial region is rare, with only a few cases reported in the literature. Hydatid cysts are usually not considered in the differential diagnosis of head and neck cystic swellings, especially in non-endemic areas in the absence of hydatid disease elsewhere in the body.[3] The rarity of the disease in this anatomical location presents a diagnostic difficulty for the physician if he or she is not familiar with the disease. Our patient did not have any evidence of hydatid disease elsewhere in the body, neither at the time of presentation nor on post-operative diagnostic imaging. These symptoms are characteristic of any slow-growing benign tumor in the body. The case is a reminder that although rare in head and neck, clinicians has to bear in mind hydatid cyst in the differential diagnosis of extracranial swellings especially in countries where echinococcus infestation is endemic.
Lukesh A. Patil, Ashok K. Laddha, Shashi S. Sharma, Brajesh K. Lahoti Department of Surgery, Devision of Pediatric Surgery, Mahatma Gandhi Memorial Medical College and Maharaja Yeshwantrao Hospital, Indore, Madhya Pradesh, India Address for correspondence: Dr. Lukesh Patil, Room No. 31, P G Block, Mahatma Gandhi Memorial Medical College Boys Hostel, White Church Colony, Indore - 452 001, Madhya Pradesh, India. E-mail: [email protected]
REFERENCES 1. Geramidazadeh B. Unusual locations of the hydatid cyst: A review from Iran. Iran J Med Sci 2013;38:2-14. 2. Mushtaque M, Mir MF, Malik AA, Arif SH, Khanday SA, Dar RA. Atypical localizations of hydatid disease: Experience from a single institute. Niger J Surg 2012;18:2-7. 3. Zulfikaroglu B, Koc M, Ozalp N, Ozmen MM. A rare primary location of echinococcal disease: Report of a case. Ups J Med Sci 2005;110:167-71. Access this article online Website: www.jiaps.com
Quick Response Code:
DOI: 10.4103/0971-9261.151562
Figure 1: Picture of the patient with visible swelling on left temporal region with streching of the lateral canthus of left eye Journal of Indian Association of Pediatric Surgeons / Apr-Jun 2015 / Vol 20 / Issue 2
99
Copyright of Journal of Indian Association of Pediatric Surgeons is the property of Medknow Publications & Media Pvt. Ltd. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use.
