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• W2004552768 abstract "Hydatid disease, caused by the larval form of Echinococcus granulosus, is endemic in cattle- and sheep-raising regions, such as Central Europe, the Mediterranean, the Middle East, South America, Australia, New Zealand, and South Africa (1Abu-Eshy S.A. Some rare presentations of hydatid cyst (Echinococcosis granulosus).JR Coll Surg Edinb. 1998; 43: 347-352PubMed Google Scholar). Dogs are the principal host and sheep are the common intermediate host. Humans are infected through the oral-fecal route by ingestion of food or milk contaminated by dog feces that contain ova of the parasite or by direct contact with dogs. When ingested, the eggs lose their enveloping layer in the stomach and release the embryos. The embryos pass through the intestinal mucosa and reach the liver via the portal vein, where most larvae become trapped and encysted. Some may reach the lungs and, occasionally, some may pass through the capillary filter of the liver and lungs and enter the circulation (2McManus D.P. Zhang W. Li J. Bartley P.B. Echinococcosis.Lancet. 2003; 362: 1295-1304Abstract Full Text Full Text PDF PubMed Scopus (813) Google Scholar).Recent case studies on the subcutaneous presentation of hydatid disease suggest that echinoccocosis should be considered in the differential diagnosis of any cystic mass in any anatomical location, with or without visceral involvement, particularly in endemic areas (3Guiral J. Rodrigo A. Tello E. Subcutaneous echinococcosis of the knee.Lancet. 2004; 363: 38Abstract Full Text Full Text PDF PubMed Scopus (11) Google Scholar, 4Dilege S. Aksoy M. Okan I. Toker A. Kalaycı G. Demiryont M. Hydatid cystic disease of the soft tissues with pulmonary and hepatic involvement: report of a case.Surg Today. 2003; 33: 69-71Crossref PubMed Scopus (9) Google Scholar).In October 2003, a 58-year-old woman was referred to our department for a slowly growing painless mass of 1-year duration in the right axilla. Fine needle aspiration 5 months previously had been nondiagnostic. The patient reported residence in a suburban region and no exposure to farming or pets. On physical examination, she was afebrile and had a painless, smooth-surfaced, mobile mass 4 cm in diameter in the right axilla. There were no local signs of infection. Breast and systemic examination were unremarkable. Routine blood chemistry was normal except for mild elevation of liver enzymes. Despite normal white blood cell count, marked eosinophilia (6%) was detected in a peripheral blood smear. Computed tomographic (CT) scan of the thorax showed a multiseptated cystic mass 4 cm in diameter at the inferior part of the right axilla (Figure). Immunoglobulin G enzyme-linked immunosorbent assay for echinococcosis was negative. Abdominal CT scan disclosed two cystic masses 59 × 52 mm and 77 × 44 mm in diameter, suggestive of a Gharbi type III hydatid cyst in the left lobe of the liver (5Gharbi H.A. Hassine W. Brauner M. Dupuch K. Ultrasound examination of the hydatic liver.Radiology. 1981; 139: 459-463PubMed Google Scholar). The patient underwent partial cystectomy with omentoplasty and the axillary mass was excised. She was treated with albendazole 1 week before surgery and 8 weeks afterwards. Recovery was uneventful and the patient was discharged on the sixth day. Pathologic examination of both liver and axillary masses revealed hydatid cysts.Echinococcosis is a public health problem of global concern (2McManus D.P. Zhang W. Li J. Bartley P.B. Echinococcosis.Lancet. 2003; 362: 1295-1304Abstract Full Text Full Text PDF PubMed Scopus (813) Google Scholar). It is a prognostically favorable and operable lesion. Percutaneous aspiration and treatment could be a possible alternative to surgery in selected cases (6Akhan O. Ozmen M.N. Percutaneous treatment of liver hydatid cysts.Eur J Radiol. 1999; 32: 76-85Abstract Full Text Full Text PDF PubMed Scopus (119) Google Scholar). Mismanagement, such as diagnostic puncture of the lesions, should be avoided. Inadvertent rupture of cysts releases viable scolices, which may enter the circulation, disseminate to distant organs, and reproduce asexually to form additional cysts. Leakage of cyst contents may even cause anaphylactic shock.The incidence of unusual presentations of hydatid cysts is not known, but local case reports have been increasing. Clinicians, in endemic regions in particular, should be aware of the possibility of hydatid cysts in patients presenting with soft-tissue masses anywhere in the body and that other sites of involvement must be carefully explored. Hydatid disease, caused by the larval form of Echinococcus granulosus, is endemic in cattle- and sheep-raising regions, such as Central Europe, the Mediterranean, the Middle East, South America, Australia, New Zealand, and South Africa (1Abu-Eshy S.A. Some rare presentations of hydatid cyst (Echinococcosis granulosus).JR Coll Surg Edinb. 1998; 43: 347-352PubMed Google Scholar). Dogs are the principal host and sheep are the common intermediate host. Humans are infected through the oral-fecal route by ingestion of food or milk contaminated by dog feces that contain ova of the parasite or by direct contact with dogs. When ingested, the eggs lose their enveloping layer in the stomach and release the embryos. The embryos pass through the intestinal mucosa and reach the liver via the portal vein, where most larvae become trapped and encysted. Some may reach the lungs and, occasionally, some may pass through the capillary filter of the liver and lungs and enter the circulation (2McManus D.P. Zhang W. Li J. Bartley P.B. Echinococcosis.Lancet. 2003; 362: 1295-1304Abstract Full Text Full Text PDF PubMed Scopus (813) Google Scholar). Recent case studies on the subcutaneous presentation of hydatid disease suggest that echinoccocosis should be considered in the differential diagnosis of any cystic mass in any anatomical location, with or without visceral involvement, particularly in endemic areas (3Guiral J. Rodrigo A. Tello E. Subcutaneous echinococcosis of the knee.Lancet. 2004; 363: 38Abstract Full Text Full Text PDF PubMed Scopus (11) Google Scholar, 4Dilege S. Aksoy M. Okan I. Toker A. Kalaycı G. Demiryont M. Hydatid cystic disease of the soft tissues with pulmonary and hepatic involvement: report of a case.Surg Today. 2003; 33: 69-71Crossref PubMed Scopus (9) Google Scholar). In October 2003, a 58-year-old woman was referred to our department for a slowly growing painless mass of 1-year duration in the right axilla. Fine needle aspiration 5 months previously had been nondiagnostic. The patient reported residence in a suburban region and no exposure to farming or pets. On physical examination, she was afebrile and had a painless, smooth-surfaced, mobile mass 4 cm in diameter in the right axilla. There were no local signs of infection. Breast and systemic examination were unremarkable. Routine blood chemistry was normal except for mild elevation of liver enzymes. Despite normal white blood cell count, marked eosinophilia (6%) was detected in a peripheral blood smear. Computed tomographic (CT) scan of the thorax showed a multiseptated cystic mass 4 cm in diameter at the inferior part of the right axilla (Figure). Immunoglobulin G enzyme-linked immunosorbent assay for echinococcosis was negative. Abdominal CT scan disclosed two cystic masses 59 × 52 mm and 77 × 44 mm in diameter, suggestive of a Gharbi type III hydatid cyst in the left lobe of the liver (5Gharbi H.A. Hassine W. Brauner M. Dupuch K. Ultrasound examination of the hydatic liver.Radiology. 1981; 139: 459-463PubMed Google Scholar). The patient underwent partial cystectomy with omentoplasty and the axillary mass was excised. She was treated with albendazole 1 week before surgery and 8 weeks afterwards. Recovery was uneventful and the patient was discharged on the sixth day. Pathologic examination of both liver and axillary masses revealed hydatid cysts. Echinococcosis is a public health problem of global concern (2McManus D.P. Zhang W. Li J. Bartley P.B. Echinococcosis.Lancet. 2003; 362: 1295-1304Abstract Full Text Full Text PDF PubMed Scopus (813) Google Scholar). It is a prognostically favorable and operable lesion. Percutaneous aspiration and treatment could be a possible alternative to surgery in selected cases (6Akhan O. Ozmen M.N. Percutaneous treatment of liver hydatid cysts.Eur J Radiol. 1999; 32: 76-85Abstract Full Text Full Text PDF PubMed Scopus (119) Google Scholar). Mismanagement, such as diagnostic puncture of the lesions, should be avoided. Inadvertent rupture of cysts releases viable scolices, which may enter the circulation, disseminate to distant organs, and reproduce asexually to form additional cysts. Leakage of cyst contents may even cause anaphylactic shock. The incidence of unusual presentations of hydatid cysts is not known, but local case reports have been increasing. Clinicians, in endemic regions in particular, should be aware of the possibility of hydatid cysts in patients presenting with soft-tissue masses anywhere in the body and that other sites of involvement must be carefully explored." @default.
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• W2004552768 title "A hydatid cyst presenting as an axillary mass" @default.
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