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Saudi Journal of Kidney Diseases and Transplantation
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CASE REPORT  
Year : 2021  |  Volume : 32  |  Issue : 5  |  Page : 1482-1484
Primary retroperitoneal hydatid cyst masquerading as malignancy


Department of Nephrology, New Jersey Kidney Care and Christ Hospital, NJ, USA

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Date of Web Publication4-May-2022
 

   Abstract 


Hydatid cysts, usually found in liver and lungs, are rare to be primarily located in the retroperitoneal region. It may mimic malignant mass and differentiation may be difficult. Surgical exploration in undiagnosed cases may lead to adverse complications. High index of suspicion is crucial, especially in patients from endemic region. Diagnosis can be aided by imaging and serologic testing for Echinococcus IgG. We present a 61-year-old Tibetan female visiting to North America and found to have a complex cystic and solid capsulated right retroperitoneal mass. Echinococcus IgG western blot assay was positive, and the patient was diagnosed to have primary retroperitoneal hydatid cyst.

How to cite this article:
Goel N. Primary retroperitoneal hydatid cyst masquerading as malignancy. Saudi J Kidney Dis Transpl 2021;32:1482-4

How to cite this URL:
Goel N. Primary retroperitoneal hydatid cyst masquerading as malignancy. Saudi J Kidney Dis Transpl [serial online] 2021 [cited 2022 May 25];32:1482-4. Available from: https://www.sjkdt.org/text.asp?2021/32/5/1482/344773



   Introduction Top


Hydatid cyst is a parasitic zoonotic infection caused by tapeworm larva and usually found in liver and lungs. However, it is rare for it to be in primarily in the retroperitoneal region and described primarily in case reports.[1] These cysts may mimic malignant mass, especially if found in unexpected area, and differentiation may be difficult. Clinicians need to have high index of suspicion to consider it in the differential diagnosis.


   Case Report Top


A 61-year-old Tibetan female visiting to the United States of America presented with right flank pain for the past two months. She did not have any significant medical or surgical history. Her physical examination was unremarkable, except mild fullness noted on the right flank. Imaging showed a 15 cm × 12 cm complex cystic and solid capsulated right retroperitoneal mass with multiple internal cystic structures with calcifications [Figure 1]a and [Figure 1]b. It was unclear whether the mass was arising from the right kidney, or the adrenal gland and it was concerning for a malignant lesion. However, due to her endemic residence and possibility of daughter cysts in the mass, surgical exploration was deferred. She was discharged home with albendazole 400 mg twice a day empirically for four weeks with outpatient surgical follow-up. Echinococcus IgG western blot assay was also sent and later came back positive. She was diagnosed to have primary retroperitoneal hydatid cyst but lost to follow-up.
Figure 1: (a) Axial MRI abdomen and (b) coronal MRI abdomen section showing the presence of large right retroperitoneal mass with multiple internal cystic structures.
MRI: Magnetic resonance imaging.


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The authors obtained all appropriate consent forms from the patient for the publication of this case report.


   Discussion Top


Cystic echinococcosis or hydatid cyst is a parasitic infection caused by the tapeworm (Echinococcus granulosus) larva, which may occur by the ingestion of contaminated soil, water, or food. Dogs are the definite host for tapeworm, while sheep, cattle, goats, and pigs are known to be the intermediate host for it.[1] Humans are the accidental intermediate host for it. Once embryonated eggs are ingested by humans, oncospheres are released in the intestines and cysts develop in the liver. Thereafter, dissemination to other organs such as lung, brain, heart, and bone may also occur.[1] However, liver and lung hydatid cysts account for 90% of cases of Echinococcus. Retroperitoneal involvement is usually due to rupture or spillage of hepatic hydatid cysts during surgical intervention.[2] However, it is very rare for hydatid cyst to be located primarily in the retroperitoneal region.[3],[4] Lymphatic spread and venovenous shunts within the liver and space of Retzius are the proposed mechanisms, leading to cysts’ retroperitoneal site as primary.[2] Often, patients are asymptomatic as it takes years for hydatid cyst to grow in to size enough to cause symptoms. Due to their frequency of location, hepatic and pulmonary signs and symptoms are most common among those who are symptomatic. In addition, hydatid cysts may be incidentally discovered during imaging done for other indications. At times, cysts may mimic malignant mass and differentiation may be difficult.[5] Diagnosis can be aided by imaging such as ultrasonography, computed tomography, or magnetic resonance imaging and serologic testing for Echinococcus IgG. Treatment with antihelminthic medication as albendazole is preferred in asymptomatic patients and those with small cysts <4 cm. Treatment with albendazole can help prevent recurrence as well. In addition, it can also lead to size reduction and deaths of hydatid cysts.[6] Surgical resection is the treatment of choice in symptomatic patients and especially those with large hydatid cysts. Chemotherapy, cyst puncture and percutaneous aspiration, injection of chemicals, and respiration may be an alternative option to surgical resection.[1] Surgical exploration in undiagnosed cases may lead to adverse complications such as death due to anaphylactic reaction from cyst content spillage into the abdominal cavity. Hence, consideration of hydatid cyst in the differential is crucial, especially in patients from endemic region.


   Disclosure Top


The author has served on nephrology advisory board meeting for Horizon Therapeutics.



 
   References Top

1.
Center for Disease Control and Prevention. Global Health, Division of Parasitic Disease. December 12, 2012. Available from: https:// www.cdc.gov/parasites/echinococcosis/. [Last accessed on 2020 June 27].  Back to cited text no. 1
    
2.
Yusuf Sherwani A, Sarmast A, Malik A, et al. Primary retroperitoneal hydatid cyst: A rare case report. Acta Med Iran 2015;53:448-51.  Back to cited text no. 2
    
3.
Pratap V, Ayyar P, Prabhakar S. Primary retroperitoneal hydatid cyst: A rare case with atypical presentation. Int Surg J 2018;5:1959-61.  Back to cited text no. 3
    
4.
Akbulut S, Senol A, Ekin A, Bakir S, Bayan K, Dursun M. Primary retroperitoneal hydatid cyst: Report of 2 cases and review of 41 published cases. Int Surg 2010;95:189-96.  Back to cited text no. 4
    
5.
Gavriilidis P, Ananiadis A, Theodoulidis V, Barbanis S. Primary retroperitoneal echinococcal cyst. BMJ Case Rep 2012;2012:bcr2012006465.  Back to cited text no. 5
    
6.
Dehkordi AB, Sanei B, Yousefi M, et al. Albendazole and treatment of hydatid cyst: Review of the literature. Infect Disord Drug Targets 2019;19:101-4.  Back to cited text no. 6
    

Top
Correspondence Address:
Narender Goel
Department of Nephrology, New Jersey Kidney Care and Christ Hospital, NJ
USA
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/1319-2442.344773

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    Abstract
   Introduction
   Case Report
   Discussion
   Disclosure
    References
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