CASE REPORT

A RARE CASE OF HYDATID CYST IN THE THIGH

Abstract – We report a rare case of hydatid cyst in thigh in a 35 years old

male patient who presented with swelling of size 8x9cm in right upper thigh since

12 years and pain in swelling since 1 months. Based on clinical features

provisional diagnosis of Rhabomyosacroma/lipoma thigh/Neurofibroma were

made – results of fine needle aspiration cytology are inconclusive. USG of lump

showed a intramuscular well defined and fusiform lesion (10x5x6.3cm) seen in

postero-medial aspect of right thigh showing multiple, variable sized cysts.

Excision of lump done, well encapsulated, intramuscular soft and cystic swelling.

On cut section, multiple typical shiny daughter cysts are revealed. On

histopathological examination showed the hydatid cyst of thigh.

Key word – Hydatid cyst thigh, extrahepatic hydatid cyst. E. granulosus

Introduction

The occurrence of the hydatid cysts in the thigh is almost rare, most of the

hydatid cysts reported in the liver and lungs. It can also affect fallopian tube,

uterus, mesentery, pancreas and diaphragm. We report this uncommon and rare

case in a middle aged patient.

Surgical resection was done with an excellent prognosis. The purpose of

this case report to draw attention towards the extrahepatic and extra- abdominal

manifestations of E. grannulosus addition in to its rarity.

Case report

A 35 years old male patient was admitted because of palpable mass in

right upper thigh in posteromedical aspect since 12 yers and pain in the swelling

since 1 month. Pain was vague dull acting in nature, low to medium in intensity

and only localized to swelling, non radiating in nature, aggravates on movement

of lower limb, relieved on taking rest.

On examination, he was average built male, afebrile, no any

lymphadenopathy, no any abdominal symptoms. On local examination revealed

non tender, solitary swelling soft to firm to consistency measuring of about 8x9

cm ovoid in shape and smooth surface, present over posteromedial aspect of

right upper thigh, colour of skin over swelling was normal well defined margin, no

impulse on coughing and no pulsation. Mobility of swelling feely mobile in relaxed

position and restricted while muscle of medical compartment of thigh was

contracted. Fluctuation, transmillumination negative. On percussion,dull.

Fluctuation, transillumination negative, on ascultation, no thrill no bruit heard.

Routine lab investigation are in normal limits esoinophil count with in normal limit

fine needle aspiration cytology reports inconclusive, USG lumpright thigh was

performed which is suggested of a fusiform lesion situated in posterior medial

aspect of right high showing multiple variable sized cysts with in it. Lesion was

well defined capsulated and intramuscular.

Features suggestive of hydatid cyst right thigh the surgery was planned

and complete excision of well encapsulated intramuscular cystic lump done with

preservation of all important vessel, nerves and muscles.

On gross examination, there were multiple daughter cysts were present

with in the mother cysts, hydatid fluid and sand were present.

Microscopic finding with photo.

Post operative period was uneventful and patient was discharge after removal of

all stitches wound was healthy and was discharge on Mebendazole and advise

the patient for regular followup after confirm the histopathological report.

Discussion

More than 90% of hydatid cysts occur in the liver, lungs, or both. Peripheral

organ hydatidosis is much less common, as few embryos can escape the

capillary filtering systems of the liver and lung.

Primary hydatid disease of the skeletal muscle is rare and present in 3% of

patients. Theoretically the muscle in hospitable for echinococcal interactions

because of its contractility and high level of lactic acid.

Most of the previous reports of primary muscular hydatidosis have been isolated

intramuscular localizations

Bayram and siricki reported the 1st intermuscular hydatid cysts in forearm region

of 18 year old man

Preoperative diagnosis and evidence of diagnostic biopsy or aspiration is crucial

in preventing local recurrence, cystic infection, and anaphylactic shock.

Rim and multicystic appearance are typical features of hydatid cysts. However,

various pattern such as unilocular cysts, multilocular lesion and atypical complex

or solid lesion may be observed.

Detection of circulating antibodies against several antigens, the brain of

immunodiagnosis of cystic echinococcus has been used in both primary

diagnosis and patients follow up after treatment. ELISA, indirect

immunothorescence antibody test, immunoelectrophoresis and immunoblast

tests.

Compared to imaging method, serological assay are less expensive and easier

to perform. Serology has high semitinvity for liver 80-100% and a lesser

sensitivity of lung cyst infection 55%. 25-56% sensitive in other organ

involvement.

In our case, no preoperative diagnosis made appropriately but the USG leads to

a preopresumtpive diagnosis of hydatid cyst in our patients.

Hydatid cyst should be considered in the differential diagnosis of soft tissue

swelling, especially in endemic areas.