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Saudi Journal of Kidney Diseases and Transplantation
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CASE REPORT Table of Contents   
Year : 2008  |  Volume : 19  |  Issue : 5  |  Page : 799-801
Giant Solitary Echinococcal Cyst of the Seminal Vesicle: An Uncommon Cause of Retention of Urine


Yash Diagnostic Center, Yash Hospital and Research Center, Civil Lines, Kanth Road, Moradabad (UP), India

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   Abstract 

Echinococcal cysts (EC) of the retroperitoneum are a rare occurrence. Such cysts involving the seminal vesicle and attaining massive size are very rare. These cysts may remain asymptomatic for long periods or may produce nonspecific symptoms. We herewith present a rare case of isolated giant EC of the seminal vesicle, which presented as acute retention of urine. To the author's knowledge, such a large EC of the seminal vesicle has not been reported previously in the medical literature.

Keywords: Giant echinococcal cyst, Retrovesical, Seminal vesicle

How to cite this article:
Rastogi R. Giant Solitary Echinococcal Cyst of the Seminal Vesicle: An Uncommon Cause of Retention of Urine. Saudi J Kidney Dis Transpl 2008;19:799-801

How to cite this URL:
Rastogi R. Giant Solitary Echinococcal Cyst of the Seminal Vesicle: An Uncommon Cause of Retention of Urine. Saudi J Kidney Dis Transpl [serial online] 2008 [cited 2019 Oct 17];19:799-801. Available from: http://www.sjkdt.org/text.asp?2008/19/5/799/42464

   Introduction Top


Echinococcal cysts (EC) of the urinary tract are an uncommon manifestation of echinoco­cosis. Primary extra-renal retroperitoneal EC is a rare manifestation of the hydatid disease. Among these, EC of the seminal vesicle is even more unusual. Such cysts may present with nonspecific features such as dysuria, hemospermia or sometimes as urinary obs­truction. Acute retention of urine is an infre­quent manifestation of EC of the seminal vesicle. Accurate diagnosis requires a high index of suspicion in the appropriate settings to pre­vent further complications especially anaphy­laxis or disseminated echinococcosis.


   Case Report Top


A 35–year-old male laborer came to us for computed tomography (CT) examination of the abdomen for evaluation of the cause of acute urinary retention. Clinical history of the patient revealed mild dysuria for 4–6 weeks prior to the day of acute retention of urine. There was no significant history of any fever or trauma. Clinical examination of the patient revealed fullness in the hypogastrium. Labora­tory examination was unremarkable except for occasional pus cells in urine. Ultrasonography of the abdomen done at the periphery sugges­ted pelvic collection or mass.

Contrast enhanced CT of the abdomen was performed from the domes of the diaphragm to the pubic symphysis. It revealed a large, cys­tic, retrovesical mass occupying almost the entire pelvis. It measured approximately 125 x 90 x 110 mm in maximum dimensions corres­ponding to approximately 600–650 ml in vo­lume. Located in the anterior part of the mass, and attached to the wall, were multiple, small, conglomerate group of cystic masses. The mass was compressing the urinary bladder to a small volume anteriorly with lifting of the bladder base. The left seminal vesicle was identifiable with difficulty but the right seminal vesicle was not visualized [Figure 1] and[Figure 2]. The re­maining part of the abdomen was unremar­kable. Chest radiograph taken after the CT examination was also unremarkable.

Bases on the above imaging findings, a diagnosis of a giant retrovesical cystic mass, possibly an echinococcal cyst, was suggested. Surgical excision of the mass was performed with utmost precaution keeping in view the provisional diagnosis suggested by imaging and positive serological test for echinococcosis performed after the CT examination. Histo­pathological examination of the surgically excised specimen confirmed the diagnosis of echinococcal cyst. The perioperative period as well as follow-up for six months was un­eventful.


   Discussion Top


Echinococcosis is a parasitic disease caused by ingestion of the larval stage of the parasite echinococcus granulosus. Man is an accidental intermediate host while dog is the definitive host of this parasite. This disease is endemic in many parts of the world including the Indian subcontinent.

The disease usually manifests in the form of cystic masses that may involve any organ in the body. Involvement of urinary tract by echi­nococcosis is uncommon constituting only 2­ 4% of all cases of echinococosis. In the geni­tourinary tract, renal echinococcosis predomi­nates and the involvement of other organs is very unusual. [1],[2]

The seminal vesicle is a very rare and un­usual site for involvement by an EC. Isolated or solitary EC of the seminal vesicle unasso­ciated with EC elsewhere in the body is an extremely rare condition. [3] Hematogenous or lymphatic spread of the parasite has been pro­posed in such cases. It may lie undetected for prolonged periods or may present with non­specific symptoms such as dysuria, hemo­spermia or urinary retention, especially when substantially large in size. [4],[5]

In the initial stages, the EC is usually uni­locular. As the cyst matures, it transforms it­self into a larger multivesicular and occasio­nally multilocular cyst containing numerous daughter cysts. The walls of the cyst are usually thin, smooth and well defined with thin fluid within the cyst. [4] The parasite dies once the nourishing fluid inside the cyst is exhaus­ted followed by wall or complete calcification of the cyst. [1]

The most dreaded complication of echino­coccosis is rupture of the cyst with extrusion of the cyst material, which is highly antigenic and hence may provoke an intense allergic re­action in addition to causing the spread of the disease. Sometimes, secondary bacterial infec­tion of the EC may complicate the clinical and imaging picture.

The role of imaging is to detect and diagnose the lesion so that it can be surgically excised in time to prevent further complications or can be followed-up conservatively in some cases (cal­cified cyst). On ultrasound, the cysts are an­echoic with internal debris and daughter cysts (cyst within cyst appearance) with intense pos­terior acoustic enhancement. Sometimes, a multiseptate cystic mass with spoke-wheel arrangement may be seen. Doppler imaging reveals the cyst to be avascular. CT scan reveals a well-defined mass with fluid ate­nuating internal contents with multiple daugh­ter cysts. Calcification may be seen in the wall of the cyst. Sometimes, the calcification may be dense enough to be visualized even on the plain radiograph. MRI reveals a mass lesion that is isointense to fluid on all sequences and will reveal the internal septations and daughter cysts more conspicuously. [7]

When EC occurs in the seminal vesicle, it gets enlarged and deformed. When the cyst grows to enormous proportion, it may occupy the entire pelvis and may exert a mass effect on the urinary bladder, significant enough to cause dysuria in initial stages and retention of urine later, as seen in our case. In such cases, it might be difficult to find the origin of the cys­tic mass and then it is aptly termed as a retro­vesical cyst. Surgical excision of the intact EC along with prophylactic therapy is the treat­ment of choice. [3],[6]

In summary, EC may occur anywhere in the body and the diagnosis at unusual sites re­quires high degree of suspicion in endemic regions. Isolated giant EC of the seminal vesicle is a very rare entity reported in the medical literature, which may present as reten­tion of urine. The role of imaging is to suggest a diagnosis preoperatively so that it can be adequately excised without contamination of the adjacent tissues and to detect the location,number and other possible sites of involve­ment. Imaging is indicative but only histopa­thology after surgical removal is confirmatory.

 
   References Top

1.Dahniya MH, Hanna RM, Ashebu S, et al. The imaging appearances of hydatid disease at some unusual sites Br J Radiol 2001;74:283-9.  Back to cited text no. 1    
2.Atan A, Ba~ar MM, Akalin Z. A case of hydatid disease with unusual localizations. Scand J Urol Nephrol 1998;32(5):362-4.  Back to cited text no. 2    
3.Safioleas M, Stamatakos M, Zervas A, Agapitos E. Hydatid disease of the seminal vesicle: a rare presentation of hydatid cyst. Int Urol Nephrol 2006;38(2):287-9.  Back to cited text no. 3    
4.Passomenos D, Dalamarinis C, Antonopoulos P, Sklavos H. Seminal vesicle hydatid cysts: CT features in two patients. AJR Am J Roentgenol 2004;182(4):1089-90.  Back to cited text no. 4    
5.Papathanasiou A, Voulgaris S, Salpiggidis G, et al. Hydatid cyst of the seminal vesicle. Int J Urol 2006;13(3):308-10.  Back to cited text no. 5    
6.Emir L, Karabulut A, Balci U, Germiyanoglu C, Erol D. An unusual case of urinary reten­tion: a primary retrovesical echinococcal cyst. Urology 2000;56(5):856-8.  Back to cited text no. 6    
7.Saglam M, Tasar M, Bulakbasi N, Tayfun C, Somuncu I. TRUS, CT and MRI findings of hydatid disease of seminal vesicles. Eur Radiol 1998;8(6):933-5.  Back to cited text no. 7    

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Correspondence Address:
Rajul Rastogi
C-002, Upkari Apartments, Plot no 9, Sector 12, Dwarka, Delhi-110078
India
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    Figures

  [Figure 1], [Figure 2]

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