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Ren Q, Dong Y, Huang Y, Xiao J, Ma Y, Liu Y, Sun H, Dai Y, Shi C, Wang S. Nrf2 induces angiogenesis in spinal cystic echinococcosis by activating autophagy via regulating oxidative stress. Biochem Pharmacol 2024; 226:116337. [PMID: 38844265 DOI: 10.1016/j.bcp.2024.116337] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2024] [Revised: 05/31/2024] [Accepted: 06/03/2024] [Indexed: 06/10/2024]
Abstract
Spinal cystic echinococcosis (CE) is a rare but malignant zoonosis that can cause disability or even death in more than half of patients. Due to the complex pathological features, it is not curable by conventional drugs and surgery, so new therapeutic targets urgently need to be discovered. In this study, we clarify the occurrence of the phenomenon of spinal encapsulation angiogenesis and explore its underlying molecular mechanisms. A co-culture system was established by protoscoleces (PSCs) with human umbilical vein endothelial cells (HUVECs) which showed a high expression level of Nrf2. A short hairpin RNA (shRNA) and Sulforaphane (SFN) affecting the expression of Nrf2 were used to treat HUVECs. The results showed that Nrf2 could promote the tube formation of HUVECs. Nrf2 also exerts a protective effect against HUVECs, which is achieved by promoting NQO1 expression to stabilize ROS levels. Furthermore, autophagy activation significantly promotes angiogenesis in the spinal echinococcosis model (SEM) as a result of Nrf2 regulation of oxidative stress. These results suggest that the ROS/Nrf2/autophagy axis can induce angiogenesis and may be a potential target for the treatment of spinal cystic echinococcosis.
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Affiliation(s)
- Qian Ren
- Laboratory for Bone Cystic Echinococcosis Research, Orthopaedic Centre, The First Affiliated Hospital of Shihezi University, Shihezi City Xinjiang Uygur Autonomous Region, 832000, China
| | - Yimin Dong
- Department of Orthopedics, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430101, China
| | - Yiping Huang
- Laboratory for Bone Cystic Echinococcosis Research, Orthopaedic Centre, The First Affiliated Hospital of Shihezi University, Shihezi City Xinjiang Uygur Autonomous Region, 832000, China
| | - Jun Xiao
- Laboratory for Bone Cystic Echinococcosis Research, Orthopaedic Centre, The First Affiliated Hospital of Shihezi University, Shihezi City Xinjiang Uygur Autonomous Region, 832000, China
| | - Yibo Ma
- Laboratory for Bone Cystic Echinococcosis Research, Orthopaedic Centre, The First Affiliated Hospital of Shihezi University, Shihezi City Xinjiang Uygur Autonomous Region, 832000, China
| | - Yaqing Liu
- Laboratory for Bone Cystic Echinococcosis Research, Orthopaedic Centre, The First Affiliated Hospital of Shihezi University, Shihezi City Xinjiang Uygur Autonomous Region, 832000, China
| | - Haohao Sun
- Laboratory for Bone Cystic Echinococcosis Research, Orthopaedic Centre, The First Affiliated Hospital of Shihezi University, Shihezi City Xinjiang Uygur Autonomous Region, 832000, China
| | - Yi Dai
- Laboratory for Bone Cystic Echinococcosis Research, Orthopaedic Centre, The First Affiliated Hospital of Shihezi University, Shihezi City Xinjiang Uygur Autonomous Region, 832000, China
| | - Chenhui Shi
- Laboratory for Bone Cystic Echinococcosis Research, Orthopaedic Centre, The First Affiliated Hospital of Shihezi University, Shihezi City Xinjiang Uygur Autonomous Region, 832000, China.
| | - Sibo Wang
- Department of Spine Surgery, Xi'an Jiao Tong University Affiliated HongHui Hospital, Xi'an 710054, China.
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Paspala A, Mela E, Vailas M, Nastos K, Dellaportas D, Kykalos S, Machairas N, Schizas D. Primary Hydatid Cysts in the Extremities: A Systematic Review of the Literature. Cureus 2024; 16:e63174. [PMID: 39070504 PMCID: PMC11273176 DOI: 10.7759/cureus.63174] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/25/2024] [Indexed: 07/30/2024] Open
Abstract
Primary hydatid cysts (PHCs) in the extremities are uncommon, presenting in the majority of cases with atypical clinical features. Radical surgical excision remains the mainstay of treatment. The aim of our study was to accumulate the already published data on PHCs in the extremities in terms of demographic, diagnostic, and therapeutic aspects. Three electronic databases were meticulously searched for articles published until 2024. A total of 85 studies comprising 118 patients were finally included in our review. Sixteen patients (13.5%) were diagnosed with a hydatid cyst in their upper extremity, 94 (79.7%) with a PHC in the lower extremity, and eight (6.8%) with an echinococcal cyst in the axilla. Pain and swelling were the most frequent symptoms, whereas only two patients were completely asymptomatic. The mean lesion size was 11.6 ± 7.1 cm. Preoperative serology investigation was reported in 82 out of 118 (69.5%) patients; among them, 33 (44.6%) cases had a positive preoperative serology test. The vast majority of patients (96.6%) were treated with an interventional procedure either surgical or radiological, and only seven experienced postoperative complications. No anaphylactic reaction was described perioperatively. Although preoperative diagnosis of PHCs is challenging, they should be considered in the differential diagnosis of soft tissue lesions. Treatment strategies should be individualized on a patient basis, while radical surgical excision remains the gold standard treatment.
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Affiliation(s)
- Anna Paspala
- Department of Surgery, Evgenideio Hospital, Athens, GRC
| | - Evgenia Mela
- First Department of Surgery, Laiko General Hospital, Athens, GRC
| | - Michail Vailas
- First Department of Surgery, Laiko General Hospital, Athens, GRC
| | | | | | - Stylianos Kykalos
- Second Propaedeutic Department of Surgery, Laiko General Hospital, Athens, GRC
| | - Nikolaos Machairas
- Second Propaedeutic Department of Surgery, Laiko General Hospital, Athens, GRC
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Sun H, Wang S, Tan W, Li Y, Ren Q, Liu Y, Huang Y, Shi C, Li J. Echinococcus granulosus promotes bone resorption by increasing osteoclasts differentiation. Acta Trop 2023; 248:107027. [PMID: 37722448 DOI: 10.1016/j.actatropica.2023.107027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2023] [Revised: 09/14/2023] [Accepted: 09/15/2023] [Indexed: 09/20/2023]
Abstract
Osseous cystic echinococcosis (CE) is a rare disease caused by Echinococcus granulosus, which is characterized by high morbidity, disability, and mortality. However, it is severely neglected due to its mainly regional epidemic. The development of osseous CE is usually accompanied by severe bone erosion and destruction at the site of infection; however, there is a gap in research on the mechanism of this phenomenon. The current treatment for this disease is single-sided, ineffective, and has a high rate of disability and recurrence. Our study investigated the mechanism of bone destruction caused by osseous CE and provided a theoretical basis for basic research and innovative ideas for treating clinical disease. A co-culture system of osteoclast progenitor cells and protoscoleces (PSCs) was established to test the effects of PSCs on osteoclast differentiation. We also created two disease models of spinal and femoral CE, with the highest incidence of osseous CE. We verified the effect of E. granulosus on osteoclasts at the infection site in vivo. The stimulatory effect of E. granulosus on osteoclast formation was confirmed by in vivo and in vitro experiments. This study elucidates the elementary mechanism of bone destruction in osseous CE and fills a gap in the field of basic osseous CE research, which is conducive to treating the disease.
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Affiliation(s)
- Haohao Sun
- Medical College of Shihezi University, Shihezi, Xinjiang 832000, China
| | - Sibo Wang
- Xi'an Honghui Hospital, Xi'an, Shanxi 710000, China
| | - Wenbo Tan
- Medical College of Shihezi University, Shihezi, Xinjiang 832000, China
| | - Ye Li
- The Second Xiangya Hospital of Central South University, Changsha, Hunan 410000, China
| | - Qian Ren
- Medical College of Shihezi University, Shihezi, Xinjiang 832000, China
| | - Yaqing Liu
- Medical College of Shihezi University, Shihezi, Xinjiang 832000, China
| | - Yiping Huang
- Medical College of Shihezi University, Shihezi, Xinjiang 832000, China
| | - Chenhui Shi
- Orthopaedic Center of the First Affiliated Hospital of Shihezi University, Shihezi, Xinjiang 832000, China.
| | - Jing Li
- Orthopaedic Center of the First Affiliated Hospital of Shihezi University, Shihezi, Xinjiang 832000, China.
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Meng Y, Ren Q, Xiao J, Sun H, Huang Y, Liu Y, Wang S, Wang S. Progress of research on the diagnosis and treatment of bone cystic echinococcosis. Front Microbiol 2023; 14:1273870. [PMID: 37920269 PMCID: PMC10618348 DOI: 10.3389/fmicb.2023.1273870] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2023] [Accepted: 09/27/2023] [Indexed: 11/04/2023] Open
Abstract
Bone cystic echinococcosis (CE) is one of the most complex and dangerous of all echinococcoses. The lack of typical imaging features and clinical manifestations makes diagnosis and treatment of this disease difficult. X-ray and computed tomography (CT) images of bone CE are similar to those of bone cysts, giant-cell bone tumors, and bone metastases, but magnetic resonance imaging (MRI) shows good diagnostic value due to excellent soft-tissue imaging features. Serological tests cannot be used as a definitive diagnostic method for bone CE due to cross-reactivity, which can lead to false-positive or false-negative results. The development of novel antigens can open new frontiers in the diagnosis of the disease. Currently, views conflict on how to diagnose and treat bone CE. Both surgical and pharmacological treatments can be used, but determining which is appropriate is difficult due to the different sites and clinical manifestations of bone CE. Radical resection is not indicated for large-bone injuries, and Pharmacotherapy becomes important. This article reviews the progress of research into the pathogenesis and clinical manifestations of, and diagnostic strategies and treatment options for, bone CE. We aimed to provide a reference for clinical diagnosis and -treatment options.
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Affiliation(s)
- Yibin Meng
- Department of Spine Surgery, Xi’an Jiaotong University Affiliated HongHui Hospital, Xi’an, China
| | - Qian Ren
- Laboratory of Translational Medicine, School of Medicine, Shihezi University, Shihezi, China
| | - Jun Xiao
- Laboratory of Translational Medicine, School of Medicine, Shihezi University, Shihezi, China
| | - Haohao Sun
- Laboratory of Translational Medicine, School of Medicine, Shihezi University, Shihezi, China
| | - Yiping Huang
- Laboratory of Translational Medicine, School of Medicine, Shihezi University, Shihezi, China
| | - Yaqing Liu
- Laboratory of Translational Medicine, School of Medicine, Shihezi University, Shihezi, China
| | - Shan Wang
- Laboratory of Translational Medicine, School of Medicine, Shihezi University, Shihezi, China
| | - Sibo Wang
- Department of Spine Surgery, Xi’an Jiaotong University Affiliated HongHui Hospital, Xi’an, China
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Orhan Ö, Kaptan AY, Perçin A, Tekpınar İ, Sepetçi Ö, Çetin VB, Altay MA. Don't miss it: Extremity-located cyst hydatid may mimic soft tissue tumors. Jt Dis Relat Surg 2023; 34:687-693. [PMID: 37750274 PMCID: PMC10546836 DOI: 10.52312/jdrs.2023.1371] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2023] [Accepted: 08/24/2023] [Indexed: 09/27/2023] Open
Abstract
OBJECTIVES In this study, we present our experience in patients with hydatid cysts located intramuscularly. PATIENTS AND METHODS Between May 2018 and May 2023, a total of 11 patients (3 males, 8 females; mean age: 29.1±13.6 years; range, 8 to 56 years) with intramuscular hydatid cysts were retrospectively analyzed. Demographic data, laboratory values, serological test results, location and size of the cyst, radiological imaging findings, and complications were recorded. RESULTS The mean follow-up was 44.3±17.3 (range, 5 to 60) months. The mean mass size at the time of admission was 5.4±3.3 (range, 2 to 14) cm. Serologic tests were positive in the majority of cases (72.7%). Eosinophilia was negative in 72.7% patients. The rate of isolated muscle involvement was 81.8%. The rate of lower extremity involvement was 72.7%. The most common involvement was leg (36.4%), thigh (18.2%), and shoulder (18.2%). One patient developed compartment syndrome after cyst rupture during neoadjuvant antihelmintic therapy. There was no recurrence in any of the patients. CONCLUSION Hydatid cysts should be considered in the differential diagnosis of slowly growing, deeply located, painless soft tissue masses, particularly in endemic areas. Although it is a rare complication, compartment syndrome may develop after spontaneous cyst rupture. Neoadjuvant antihelmintic chemotherapy can reduce complications. The combination of total surgical excision and chemotherapy yields successful results in the treatment of hydatid cysts located in the muscle.
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Affiliation(s)
- Özlem Orhan
- Department of Orthopedics and Traumatology, Medicine Faculty of Harran University, 63300 Şanlıurfa, Türkiye.
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Laasri K, Naggar A, Bahlouli N, Chait F, Ahallat I, Boufettal M, Bassir RA, Mekkaoui J, Kharmaz M, Omar lamrani M, Berrada MS, zouaidia F, El aoufir O, Laamrani FZ, Jroundi L. Osseous hydatid disease: A mimic of other skeletal pathologies. Radiol Case Rep 2023; 18:3145-3151. [PMID: 37409101 PMCID: PMC10318460 DOI: 10.1016/j.radcr.2023.06.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2023] [Revised: 06/02/2023] [Accepted: 06/08/2023] [Indexed: 07/07/2023] Open
Abstract
Hydatid disease is still endemic in several regions worldwide including Morocco, and is caused in most cases by the larval form of 2 species of the tapeworm Echinococcus: E. granulosus and E. multilocularis. Primary hydatid disease of the bone without systemic involvement is rare. The disease has a silent clinical evolution until it reaches complicated stages. Complications may include pathological fracture, neural deficit, infection, and fistulization of the abscess. Preoperative diagnosis is based on clinical history, imaging findings, and serological tests, which lack high sensitivity and specificity. Although the interpretation of imaging studies can prove to be very confusing because the bone changes evolve with time, and the nonspecificity of these findings often leads to a mistaken diagnosis. The diagnosis requires a high index of suspicion, especially in patients who reside in or travel to sheep-raising areas where hydatid disease is endemic. A high index of suspicion is necessary for the diagnosis, especially in patients that live in or travel to sheep-raising areas where hydatid disease is endemic. The treatment of choice remains surgical, following the principles of a locally malignant lesion. Chemotherapy (albendazole alone or in combination with praziquantel) is indicated when surgery is not possible or as an adjuvant treatment. The prognosis is often poor. We report the case of a 28-year-old woman with long-standing pain in the left hip joint in which the imaging findings were thought of as being either tuberculous or neoplastic. The result of a CT-guided biopsy concurred with an unexpected diagnosis of a hydatid cyst. This case highlights that in the absence of a high index of suspicion for echinococcal infection, the semblance of imaging findings of hydatid disease in the bone to those of other skeletal pathologies can lead to misinterpretation.
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Affiliation(s)
- Khadija Laasri
- Department of Emergency Radiology, Ibn Sina University Hospital, Mohammed V University, Rabat, Morocco
| | - Amine Naggar
- Department of Emergency Radiology, Ibn Sina University Hospital, Mohammed V University, Rabat, Morocco
| | - Nourrelhouda Bahlouli
- Department of Emergency Radiology, Ibn Sina University Hospital, Mohammed V University, Rabat, Morocco
| | - Fatima Chait
- Department of Emergency Radiology, Ibn Sina University Hospital, Mohammed V University, Rabat, Morocco
| | - Ilyass Ahallat
- Department of Orthopedics and Traumatology, Ibn Sina University Hospital, Mohammed V University, Rabat, Morocco
| | - Moncef Boufettal
- Department of Orthopedics and Traumatology, Ibn Sina University Hospital, Mohammed V University, Rabat, Morocco
| | - Reda Allah Bassir
- Department of Orthopedics and Traumatology, Ibn Sina University Hospital, Mohammed V University, Rabat, Morocco
| | - Jalal Mekkaoui
- Department of Orthopedics and Traumatology, Ibn Sina University Hospital, Mohammed V University, Rabat, Morocco
| | - Mohamed Kharmaz
- Department of Orthopedics and Traumatology, Ibn Sina University Hospital, Mohammed V University, Rabat, Morocco
| | - Moulay Omar lamrani
- Department of Orthopedics and Traumatology, Ibn Sina University Hospital, Mohammed V University, Rabat, Morocco
| | - Mohamed Saleh Berrada
- Department of Orthopedics and Traumatology, Ibn Sina University Hospital, Mohammed V University, Rabat, Morocco
| | - Fouad zouaidia
- Department of Anatomo-Patholgy, Ibn Sina University Hospital, Mohammed V University, Rabat, Morocco
| | - Omar El aoufir
- Department of Emergency Radiology, Ibn Sina University Hospital, Mohammed V University, Rabat, Morocco
| | - Fatima Zahra Laamrani
- Department of Emergency Radiology, Ibn Sina University Hospital, Mohammed V University, Rabat, Morocco
| | - Laila Jroundi
- Department of Emergency Radiology, Ibn Sina University Hospital, Mohammed V University, Rabat, Morocco
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Alshoabi SA, Alkalady AH, Almas KM, Magram AO, Algaberi AK, Alareqi AA, Hamid AM, Alhazmi FH, Qurashi AA, Abdulaal OM, Aloufi KM, Alsharif WM, Alsultan KD, Omer AM, Gareeballah A. The Neoplasms Mimicker: A Pictorial Review of Hydatid Disease. Diagnostics (Basel) 2023; 13:diagnostics13061127. [PMID: 36980435 PMCID: PMC10047450 DOI: 10.3390/diagnostics13061127] [Citation(s) in RCA: 10] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2023] [Revised: 03/09/2023] [Accepted: 03/13/2023] [Indexed: 03/18/2023] Open
Abstract
Hydatid cyst is a common name for the larval stage of a tapeworm species of the genus Echinococcus granulosus, which is transmitted from animals to humans via the fecal–oral route. Hydatid cysts predominantly affect the liver (75%), followed by the lung (15%), and they can affect many organs in the human body. Medical imaging modalities are the keystone for the diagnosis of hydatid cysts with high sensitivity and specificity. Ultrasound imaging with high resolution is the first choice for diagnosis, differential diagnosis, staging, establishing a role in interventional management, and follow-up, and it can differentiate Type I hydatid cysts from simple liver cysts. Unenhanced computed tomography (CT) is indicated where or when an ultrasound is unsatisfactory, such as with chest or brain hydatid cysts, when detecting calcification, and in obese patients. Magnetic resonance imaging (MRI) is superior for demonstrating cyst wall defects, biliary communication, neural involvement, and differentiating hydatid cysts from simple cysts using diffusion-weighted imaging (DWI) sequences. According to the phase of growth, hydatid cysts occur in different sizes and shapes, which may mimic benign or malignant neoplasms and may create diagnostic challenges in some cases. Hydatid cysts can mimic simple cysts, choledochal cysts, Caroli’s disease, or mesenchymal hamartomas of the liver. They can mimic lung cystic lesions, mycetoma, blood clots, Rasmussen aneurysms, and even lung carcinomas. Differential diagnosis can be difficult for arachnoid cysts, porencephalic cysts, pyogenic abscesses, and even cystic tumors of the brain, and can create diagnostic dilemmas in the musculoskeletal system.
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Affiliation(s)
- Sultan Abdulwadoud Alshoabi
- Department of Diagnostic Radiology Technology, College of Applied Medical Sciences, Taibah University, Almadinah Almunawwarah 42353, Saudi Arabia
- Correspondence:
| | | | | | | | | | - Amal A. Alareqi
- Radiology Department, 21 September University of Medical and Applied Science, Sana’a, Yemen
| | | | - Fahad H. Alhazmi
- Department of Diagnostic Radiology Technology, College of Applied Medical Sciences, Taibah University, Almadinah Almunawwarah 42353, Saudi Arabia
| | - Abdulaziz A. Qurashi
- Department of Diagnostic Radiology Technology, College of Applied Medical Sciences, Taibah University, Almadinah Almunawwarah 42353, Saudi Arabia
| | - Osamah M. Abdulaal
- Department of Diagnostic Radiology Technology, College of Applied Medical Sciences, Taibah University, Almadinah Almunawwarah 42353, Saudi Arabia
| | - Khalid M. Aloufi
- Department of Diagnostic Radiology Technology, College of Applied Medical Sciences, Taibah University, Almadinah Almunawwarah 42353, Saudi Arabia
| | - Walaa M. Alsharif
- Department of Diagnostic Radiology Technology, College of Applied Medical Sciences, Taibah University, Almadinah Almunawwarah 42353, Saudi Arabia
| | - Kamal D. Alsultan
- Department of Diagnostic Radiology Technology, College of Applied Medical Sciences, Taibah University, Almadinah Almunawwarah 42353, Saudi Arabia
| | - Awatif M. Omer
- Department of Diagnostic Radiology Technology, College of Applied Medical Sciences, Taibah University, Almadinah Almunawwarah 42353, Saudi Arabia
| | - Awadia Gareeballah
- Department of Diagnostic Radiology Technology, College of Applied Medical Sciences, Taibah University, Almadinah Almunawwarah 42353, Saudi Arabia
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Yang L, Tuxunjiang P, Liu W, Guo H. Vertebral and pelvic echinococcosis in northwestern China. INTERNATIONAL ORTHOPAEDICS 2023; 47:1153-1162. [PMID: 36826481 PMCID: PMC10079730 DOI: 10.1007/s00264-023-05731-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/19/2023] [Accepted: 02/07/2023] [Indexed: 02/25/2023]
Abstract
PURPOSE Echinococcosis remains a major economic and severe public health problem in endemic areas. Bone echinococcosis is rare, and the vertebra and pelvis are the most common sites of echinococcosis involving the skeletal. Because of the clinical severe symptoms and high recurrence rate, it brings excellent trouble to patients. METHODS This study retrospectively analyzed the clinical manifestations, laboratory tests, radiological findings, and treatment of 44 patients with vertebral and pelvic echinococcosis during a period of 16 years (2005-2020). RESULTS The mean age was 43 years (25 males, 19 females; 19-68 years). The most common symptom was pain, followed by numbness, weakness, activity limitation, and progressive paraparesis. Enzyme-linked immunosorbent assay test (ELISA) results were positive in 18 cases (75%). There are 24 cases of hydatid infection of the spine, 14 hydatid infection of the pelvis, and six hydatid infection of both vertebra and pelvis. The site of infection was 13 (29.5%) thoracic, five (11.4%) lumbar, four (9.1%) lumbosacral, seven (15.9%) sacral, 19 (43.2%) ilium, seven (15.9%) hip, six (13.6%) ischium, five (11.4%) pubis, and two (4.5%) femur, respectively. The imaging findings were cystic dilatancy, septal, and irregular bone destruction. MRI has a special value in showing the relationship between the surrounding tissues and organs of cystic bone echinococcosis. All patients were followed up for at least one year. The mean follow-up time was 3.6 years. CONCLUSIONS Even in epidemic areas, the incidence of bone echinococcosis is relatively rare. However, when encountering the vertebral and pelvic destruction, consider bone echinococcosis's possibility, especially for the herdsmen in endemic regions.
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Affiliation(s)
- Laihong Yang
- Medical Imaging Center, Xinjiang Medical University Affiliated First Hospital, Urumqi, 830054, People's Republic of China
| | - Pahati Tuxunjiang
- Medical Imaging Center, Xinjiang Medical University Affiliated First Hospital, Urumqi, 830054, People's Republic of China
| | - Wenya Liu
- Medical Imaging Center, Xinjiang Medical University Affiliated First Hospital, Urumqi, 830054, People's Republic of China
| | - Hui Guo
- Medical Imaging Center, Xinjiang Medical University Affiliated First Hospital, Urumqi, 830054, People's Republic of China. .,State Key Laboratory of Pathogenesis, Prevention and Treatment of High Incidence Diseases in Central Asia, Xinjiang Medical University, Urumqi, People's Republic of China.
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ÖRMECİ N, ASİLLER ÖÖ, YAĞCI C, ÖRMECİ T, ELLİK Z, KALKAN Ç, İLHAN A. Muscle hydatid diseases: percutaneous treatment with Örmeci technique. JOURNAL OF HEALTH SCIENCES AND MEDICINE 2022. [DOI: 10.32322/jhsm.1011096] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Aim: To present results of percutaneous treatment with Örmeci technique for muscle hydatid diseases.
Material and Method: Twelve patients (9 male, 3 female) with 16 hydatid cysts (10 CE Type 1, 6 CE Type3B) were treated by percutaneous treatment with Örmeci technique. The percutaneous puncture was performed under sonographic guidance using a 22-gauge Chiba needle as a one-step procedure in CE type 1 and 3A. However, two to six Chiba needles according to size of the cysts were used in different locations at the same time in the cyst of CE type 2, and 3B). For every 1 cm of the long diameter of the cyst lesion, 3cc of fluid from the cysts was aspirated, which was almost the same amount of cc in volume for the CE type 1 and CE type 3A hydatid cysts. A 2cc of pure alcohol (96 %) and 1cc of polidocanol 1% (ethoxysclerol 1%, Kreussler Pharma, Wiesbaden, Germany) were injected into the cysts right after the aspiration of CE type 1 and type 3A, without the aspiration of CE type 2 and 3B, for each centimeter of the long diameter of the cysts. The total amount of pure alcohol and polidocanol were injected equally among the CE type 2 and type 3B cyst’s needles. It was waited for five minutes for all scolexes to be killed and the needle/or needles were taken back. The patients with hydatid disease were followed up mean 34.75 ±14.39 (maximum 65-minimum 15) months.
Findings: Fifteen out of 16 hydatid cysts (93.75%) cured. We had two complications of treatment. One patient had an abscess in the cyst after the percutaneous treatment. After the percutaneous drainage, patient was cured well, and he had no symptoms during the follow up. Another patient had torpidity in his leg after the treatment. After three months, he had no symptoms.
In Conclusion, Percutaneous treatment with Örmeci technique is outpatient based, successful, safe, repeatable, cheap and It can be used as an alternative treatment in selected patients.
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Affiliation(s)
| | | | - Cemil YAĞCI
- ANKARA UNIVERSITY, ANKARA FACULTY OF MEDICINE
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10
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Mateo L, Roure S, Prior Á, Torres MCS, Subirats JL, Hermoso JAH. Multiple Primary Muscular Hydatidosis in an Immunosuppressed Patient. J Clin Rheumatol 2021; 27:S603-S606. [PMID: 30640809 DOI: 10.1097/rhu.0000000000000954] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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11
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Kaya H, Karahan G, Sabah D. Is Hydatid Cyst with Musculoskeletal Involvement a Problem that Causes Morbidity? Long-Term Follow-Up and Functional Results. Indian J Orthop 2021; 56:680-688. [PMID: 35342525 PMCID: PMC8921364 DOI: 10.1007/s43465-021-00556-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2021] [Accepted: 10/25/2021] [Indexed: 02/04/2023]
Abstract
BACKGROUND The aim of study is to evaluate the involvement characteristics of hydatid cysts, which are rarely involved the musculoskeletal system, and the results of recurrence, morbidity, and functional and mental scoring. METHODS We retrospectively investigated 18 patients with skeletal hydatid disease. Patients were categorized as those with bone or skeletal muscle involvement. Pre- and post-operative physical component scores (PCS) and mental component scores (MCS) on the functional Short Form 12-item Survey were recorded in these patients.We compared the functional scores, number of recurrences, and lesion volumes between patients with hydatid cyst of bone (HCOB) and those with hydatid cyst of soft tissue (HCOST). RESULTS This study included 11 women and 7 men with bone hydatid cysts. Patients' mean age was 38 years (range 22-70 years). Patients were followed up for a mean of 118.16 months (range 49-230 months). The mean lesion volume was 447.39 cm3 (36-1260 cm3). The 12th and 48th month PCS, the PCS was lower in the HCOB group during both periods (p = 0.04 and p = 0.001, respectively). The 48th month MCS was lower in the HCOB group (p = 0.04). Postoperative residual cysts were detected in five patients who underwent surgical treatment for bone c; all residual lesions were located in the pelvis. CONCLUSIONS Bone hydatid cysts are associated with high recurrence rates, and treatment is challenging. In view of the low functional results and high infection and recurrence rates observed in patients over long-term follow-up, particularly in those with pelvic hydatid cysts, we conclude that this disease is associated with significant morbidity.
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Affiliation(s)
- Huseyin Kaya
- grid.8302.90000 0001 1092 2592Orthopedics and Traumatology Tumor Surgery Department, Ege University Faculty of Medicine, Izmir, 35040 Turkey
| | - Gokhan Karahan
- grid.414850.c0000 0004 0642 8921Sports Traumatology, Arthroscopy, Shoulder and Elbow Surgery, Istanbul Basaksehir Pine and Sakura City Training and Research Hospital, Basaksehir Olimpiyat Bulvarı Yolu, 34480 Basaksehir, Istanbul Turkey
| | - Dündar Sabah
- grid.8302.90000 0001 1092 2592Orthopedics and Traumatology Tumor Surgery Department, Ege University Faculty of Medicine, Izmir, 35040 Turkey
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12
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Cystic Echinococcosis of the Ilium Treated with Curettage and Microwave Thermoablation Followed by Bone Cement Installation: A Novel Treatment Technique for a Rare Disease. Case Rep Orthop 2021; 2021:5533183. [PMID: 34258091 PMCID: PMC8249124 DOI: 10.1155/2021/5533183] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2021] [Revised: 06/05/2021] [Accepted: 06/09/2021] [Indexed: 11/17/2022] Open
Abstract
Bone cystic echinococcosis (CE) is a rare condition requiring a high level of suspicion during primary diagnosis. Wide excision of the lesion is the gold standard of treatment, posing however extreme challenges in certain parts of the skeleton, since it may well be accompanied by increased morbidity. We report the case of a 35-year-old Caucasian female with iliac bone CE, referred to our department (a regional referral center for the treatment of patients with musculoskeletal tumors). The patient reported gradually increasing dull pain at the right iliac fossa and antalgic gait, with an onset of approximately 5 years before her referral. Bone CE diagnosis was established based on physical examination, imaging studies, and two subsequent CT-guided core needle biopsies, performed within a period of 3 months, of which the second was diagnostic. Following a musculoskeletal tumor multidisciplinary meeting, it was decided that the optional treatment was the surgical removal of the cyst. Aiming to minimize the morbidity accompanying a wide resection of the lesion, we performed extended curettage of the lesion through a typical iliac spine approach, followed by microwave ablation of the walls of the remaining bone cavity. The remaining iliac defect was treated with the installation of polymethyl methacrylate bone cement. The patient reported immediate remission of symptoms postoperatively and was able to return to everyday activities two weeks postoperatively. She began oral treatment with albendazole on the 7th postoperative day. She remained symptom-free for a period of 25 months, until she developed a seroma at the gluteal area, which was treated with simple drainage. On her latest follow-up six months later, she remained symptom-free and was able to perform all her previous activities. Microwave ablation may serve as a useful adjuvant modality when treating patients with bone CE, in order to prevent relapse of the disease.
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13
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Cattaneo L, Manciulli T, Cretu CM, Giordani MT, Angheben A, Bartoloni A, Zammarchi L, Bartalesi F, Richter J, Chiodini P, Godbole G, Junghanss T, Stojkovic M, Sammarchi L, Dore R, Vercelli A, Benazzo F, Cuzzocrea F, Tamarozzi F, Brunetti E. Cystic Echinococcosis of the Bone: A European Multicenter Study. Am J Trop Med Hyg 2020; 100:617-621. [PMID: 30693857 DOI: 10.4269/ajtmh.18-0758] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023] Open
Abstract
Cystic echinococcosis (CE) is a zoonosis caused by the larval stage of the tapeworm Echinococcus granulosus. In humans, the infection induces the formation of parasitic cysts mostly in the liver and lungs, but virtually any organ can be affected. CE of the bone is one of the rarest forms of the disease, yet it is also extremely debilitating for patients and hard to manage for clinicians. Unlike abdominal CE, there is currently no expert consensus on the management of bone CE. In this study, we conducted a survey of the clinical records of seven European referral centers for the management of patients with CE and retrieved data on the clinical management of 32 patients with a diagnosis of bone CE. Our survey confirmed that the patients endured chronic debilitating disease with a high rate of complications (84%). We also found that diagnostic approaches were highly heterogeneous. Surgery was extensively used to treat these patients, as well as albendazole, occasionally combined with praziquantel or nitaxozanide. Treatment was curative only for two patients, with one requiring amputation of the involved bone. Our survey highlights the need to conduct systematic studies on bone CE, both retrospectively and prospectively.
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Affiliation(s)
- Letizia Cattaneo
- Department of Clinical, Surgical, Diagnostic and Pediatric Science, University of Pavia, Pavia, Italy
| | - Tommaso Manciulli
- PhD School of Experimental Medicine, University of Pavia, Pavia, Italy.,Department of Clinical, Surgical, Diagnostic and Pediatric Science, University of Pavia, Pavia, Italy
| | - Carmen-Michaela Cretu
- Parasitology Department, Colentina Clinical Hospital, Carol Davila University of Medicine and Pharmacy, Bucharest, Romania
| | | | - Andrea Angheben
- Centre for Tropical Diseases, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Sacro Cuore-Don Calabria Hospital, Verona, Italy
| | - Alessandro Bartoloni
- Infectious and Tropical Diseases Unit, Careggi University Hospital, University of Florence, Florence, Italy
| | - Lorenzo Zammarchi
- Infectious and Tropical Diseases Unit, Careggi University Hospital, University of Florence, Florence, Italy
| | - Filippo Bartalesi
- Infectious and Tropical Diseases Unit, Careggi University Hospital, University of Florence, Florence, Italy
| | - Joachim Richter
- Institute of Tropical Medicine and International Health, Charité - Universitätsmedizin, Berlin, Germany
| | - Peter Chiodini
- Department of Clinical Parasitology, Hospital for Tropical Diseases, London, United Kingdom
| | - Gauri Godbole
- Department of Clinical Parasitology, Hospital for Tropical Diseases, London, United Kingdom
| | - Thomas Junghanss
- Section of Clinical Tropical Medicine, University Hospital, Heidelberg, Germany
| | - Marija Stojkovic
- Section of Clinical Tropical Medicine, University Hospital, Heidelberg, Germany
| | - Luigi Sammarchi
- Division of Radiology, IRCCS San Matteo Hospital Foundation, Pavia, Italy
| | - Roberto Dore
- Department of Radiology, Istituti Clinici di Pavia e Vigevano, University Hospital, Pavia, Italy
| | - Alessandro Vercelli
- Department of Radiology, Istituti Clinici di Pavia e Vigevano, University Hospital, Pavia, Italy
| | - Francesco Benazzo
- Division of Orthopedics and Traumatology, IRCCS San Matteo Hospital Foundation, Pavia, Italy.,Department of Clinical, Surgical, Diagnostic and Pediatric Science, University of Pavia, Pavia, Italy
| | - Fabrizio Cuzzocrea
- Division of Orthopedics and Traumatology, IRCCS San Matteo Hospital Foundation, Pavia, Italy
| | - Francesca Tamarozzi
- Centre for Tropical Diseases, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Sacro Cuore-Don Calabria Hospital, Verona, Italy
| | - Enrico Brunetti
- Unit of Infectious and Tropical Diseases, IRCCS San Matteo Hospital Foundation, Pavia, Italy.,Department of Clinical, Surgical, Diagnostic and Pediatric Science, University of Pavia, Pavia, Italy
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14
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Foad AFA, Abdul Satir AA. Skeletal manifestations of hydatid cystic disease in Sudan. J Taibah Univ Med Sci 2018; 13:564-571. [PMID: 31435379 PMCID: PMC6694899 DOI: 10.1016/j.jtumed.2018.10.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2018] [Revised: 10/23/2018] [Accepted: 10/24/2018] [Indexed: 10/27/2022] Open
Abstract
Objectives Hydatid bone disease is a zoonotic disease caused mainly by Echinococcus granulosus. Middle Eastern, African, and Mediterranean populations are endemically affected. Hydatid disease of the bone is a rare clinical condition that affects people with a history of animal contact. This research aims to revisit clinical presentations of hydatid cystic disease in the skeletal system. Methods Data of all clinical cases with hydatid cystic disease of the skeletal system, presenting between 2011 and 2016 were collected. Clinical manifestations and radiographic and histopathological reports were reviewed, and the patients were followed for a period of 12-22 months. Results Two patients had hydatid disease in the spine, one in the pelvis, one in the sternum, and one in the femur. The symptoms were suggestive of pathological fractures and bony deformities. Spinal hydatid disease presented with nerve root compression and paraparesis in one case, and radicular pain in the other case. Sternal involvement of hydatid disease presented with pain and deformity, while femoral involvement presented with deformity and fracture. Surgical resection with a pre- and post-surgical anthelminthic course and application of the puncture, aspiration, injection, and aspiration (PAIR) technique were completed in four cases. One case showed residual disease during follow-up visits. Conclusions Hydatid cystic disease of the skeletal system is a rare presentation of a common disease. A multidisciplinary approach is optimal for the management of these cases. Long-term follow-up is mandatory to prevent complications and recurrence, and to monitor residual disabilities.
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Affiliation(s)
- Ayman F A Foad
- Department of Pathology, Faculty of Medicine, University of Tabuk, Tabuk, KSA
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15
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Cystic Echinococcosis of the Bone in Kazakhstan. Case Rep Infect Dis 2018; 2018:9682508. [PMID: 30319824 PMCID: PMC6167588 DOI: 10.1155/2018/9682508] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2018] [Accepted: 07/05/2018] [Indexed: 12/30/2022] Open
Abstract
Cystic echinococcosis (CE) is a parasitic zoonosis caused by E. granulosus primarily affecting the liver and lungs. CE of the bone is by far the most debilitating form of the disease and is very difficult to manage as it mimics malignant tumors. We reviewed bone CE cases admitted to a reference oncological hospital in Kazakhstan from January 2010 to February 2017. Among eight patients, the mean age was 33.5 years, and the male/female ratio was 1 : 3. Patients were examined by X-ray (8/8), CT (7/8), and MRI (3/8). CE was in the spine (2 cases), pelvis (3 cases), and long bones (humerus, tibia, and femur; one case for each). All patients were treated surgically. No perioperative albendazole was administered. No patient received albendazole afterwards. The mean hospital stay was 25 days. Interventions are urgently needed to assess the burden of CE in Kazakhstan and to inform clinicians of the existence of the disease.
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16
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Nascimento G, Silva C, Marques R, Silva C, Oliveira JF, Santos J, Leiria J. Periprosthetic pathologic fracture following tibial Echinoccocosis: A case report. Int J Surg Case Rep 2018; 51:231-236. [PMID: 30216900 PMCID: PMC6139003 DOI: 10.1016/j.ijscr.2018.08.045] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2017] [Revised: 08/22/2018] [Accepted: 08/23/2018] [Indexed: 01/25/2023] Open
Abstract
Cystic Echinococcus in the bone is rare, comprising 0.5%–2.5% of all human hydatidosis. Association of Hydatid disease to pathologic fractures envolving knee prosthesis have not yet been described. A combined surgical and medical approach is of paramount importance to avoid recurrence. Resulting osseus defects is challenging and require specific prosthesis when treating this entity.
Introduction Hydatid disease in humans caused by the parasitic tapeworm Echinococcus granulosus has an osseous involvement of about 0.5%–2.5% of all cases in humans. The location of hydatid cysts in the tibia is seldom described in the medical literature, and its diagnosis and treatment is challenging. Case report This paper presents a patient, with a long term, well tolerated, bilateral total knee arthroplasty (TKA), treated at our clinic, with a recent history of pain and oedema in her left upper leg. After achieving a, radiologically and histhopathologically, well documented, diagnosis of Echinoccocosis lesion in her left proximal tibia, a surgical intervention was planed, a wide resection of the cyst performed, and a specific anti-helmintic therapy was instituted. Four years later, she returns to our observation complaining of pain and unable to bear weight on her left knee, from which a pathologic fracture, adjacent to the tibial component, was diagnosed. After surgical debridement of the newly advanced hydatid cyst growth, the TKA was revised, and due to the tibial component failure and the femoral implant loosening, a semi-constrained total knee revision arthroplasty was executed. Functional outcome was excellent. Conclusion Although challenges in treatment of musculoskeletal hydatid cysts (HC) lesions have been documented, data regarding the musculoskeletal HC lesions resembling tumor is scarce, and those resulting in a prosthetic failure have not been published. The authors intend to add data concerning the therapeutic approach to this entity.
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Affiliation(s)
- Germano Nascimento
- Hospital Dr. Manoel Constâncio, Lg. Eng. Bioucas, 2200-200, Abrantes, Portugal.
| | - Carmen Silva
- Hospital Dr. Manoel Constâncio, Lg. Eng. Bioucas, 2200-200, Abrantes, Portugal.
| | - Raquel Marques
- Hospital Dr. Manoel Constâncio, Lg. Eng. Bioucas, 2200-200, Abrantes, Portugal.
| | - Carlos Silva
- Hospital Dr. Manoel Constâncio, Lg. Eng. Bioucas, 2200-200, Abrantes, Portugal.
| | | | - Jorge Santos
- Hospital Dr. Manoel Constâncio, Lg. Eng. Bioucas, 2200-200, Abrantes, Portugal.
| | - João Leiria
- Hospital Dr. Manoel Constâncio, Lg. Eng. Bioucas, 2200-200, Abrantes, Portugal.
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A recurrent hydatid cyst of the thigh diagnosed 13 years after initial presentation. IDCases 2017; 11:12-15. [PMID: 29255673 PMCID: PMC5725221 DOI: 10.1016/j.idcr.2017.11.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2017] [Revised: 11/21/2017] [Accepted: 11/21/2017] [Indexed: 12/13/2022] Open
Abstract
This case presents a hydatid cyst of the thigh in a 57-year-old patient born and raised in rural Montenegro. He presented with a painful erythematous mass on the lateral aspect of the right thigh at the site of a previous cystic mass resection 13 years earlier. Complete surgical resection was conducted, histopathology revealed laminated membranes and polymerase chain reaction was positive for Echinococcus granulosus. Primary musculoskeletal hydatidosis is a rare entity and diagnosis is challenging. Any cystic lesion in a patient from an endemic area should raise the possibility of echinococcosis, regardless of anatomic location. The key aspects of diagnosis, albendazole treatment and surgical management are discussed.
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