Unusual Presentation of Echinococcosis Causing Diagnostic Dilemma by Mimicking Neoplasm Clinically: A Case Series

Abstract

Echinococcosis (hydatid disease) is caused by the cestode parasite belonging to genus Echinococcus (tapeworm). It is found frequently in rural areas where domestic livestock-raising is common. Globally, it is endemic in Middle East, Africa, South America, New Zealand, Australia, Turkey and Southern Europe including India. Even though echinococcosis can occur in any organ, it is very rare to see the disease at the sites reported in this article. Even at common sites, the way of presentation might be unusual causing diagnostic dilemma. Hence, current study was undertaken to evaluate the different unusual presentations of echinococcosis and to emphasise that it should be suspected in cystic lesions, especially in endemic areas. A series of six cases of echinococcosis over the period of three years (January 2017-December 2019) has been reported here. The correlation of clinical features, radiological with intraoperative findings (frozen section) wherever available and confirmatory diagnosis given on histopathology was attempted. All six cases which were suspected as neoplasm based on clinical and radiological findings turned out to be echinococcosis on cytopathology and histopathology. The sites involved were breast, brain, ovary, lung single case each followed by two cases in liver. Multisystem involvement was seen in only one case. Thus, the study conclude that echinococcosis can mimic cystic neoplasm clinico-radiologically and hence, should be considered as a differential diagnosis of cystic lesions irrespective of its endemicity, site and clinical presentation.