Radiological, Laparoscopic, Cytology-Histology Correlation of Hepatic and Pelvic Hydatid Cyst

Abstract

•Hydatid cyst results when humans get infected by ingesting the eggs of Echinococcus Granuloses. The oncospheres penetrate the intestinal wall and migrate to various organs. They develop into hydatid cyst and gradually is filled with daughter cysts.•We present a 69-year-old female, a native of Uzbekistan, who presented with vague right upper quadrant pain. Radiologically 20 cm liver cyst and multiple pelvic cysts with a stage of CE2 (Fig. A). Serology for Echinococcal antibody was positive.•After 2 months of Albendazole, she underwent Laparoscopic puncture aspiration and injection with 20% saline (PAIR) and peri-cystectomy of the pelvic cysts. After uneventful recovery and further Albendazole, she underwent a Robotic-assisted PAIR and partial peri-cystectomy of the liver cyst with the repair of the duct to cyst communication. (Fig. F, G, H, I). She did need a post-operative ERCP with Sphincterotomy and then was asymptomatic 2 weeks after. Her Serology tuned intermediate 2 months later.•Pathology:1.Cytology: Aspirate: Scattered scolices, inflammatory cells, and abundant amorphous debris consistent with hydatid cyst (Fig. B)2.Gross: Bilateral 5-cm pelvic cysts with pale yellow, soft to firm walled, multiple cavities (Fig. C)3.Microscopy - Fibrofatty outermost layer and a two-layered cyst wall including a thin germinal epithelium covered by a thick acellular outer membrane (Fig. D), Multiple parasites, some eosinophilic (Fig. E)4.Liver cyst - daughter cysts of Echinococcus and brood capsule with protoscolices (Fig. H)•Our case highlights the role of correlating various modalities in the diagnosis of hydatid disease.