Laparoscopic management of a hydatid cyst of the adrenal gland

Primary Renal Hydatid in Children

Isolated renal hydatid disease, caused by the larvae of the parasitic tapeworm Echinococcus granulosus is a rare phenomenon and accounts for only 2% of all reported cases. The authors report a case of a 12-year-old female who presented with right flank pain. Initial abdominal ultrasound revealed a complex cystic mass in the upper pole of the right kidney. A contrasted CT scan better defined it as a well-circumscribed cyst with multiple thin septations. Laboratory investigations showed eosinophilia and a positive IgG Echinococcus serology. Considering these radiological and laboratory findings, a tentative diagnosis of primary renal hydatid was made. With perioperative antihelmintic therapy, the authors used a combination of an open puncture-aspiration-injection-reaspiration technique pericystectomy to manage the isolated renal hydatid. Renal hydatid can easily be misinterpreted pre-operatively for more sinister renal cystic pathology, including cystic renal cell carcinoma. An accurate pre-operative diagnosis requires a high index of suspicion, especially in endemic regions. Surgical therapy, with perioperative antihelmintic therapy, offers the best chance of cure.

Primary Hydatid Cyst of the adrenal gland: A case report and a review of the literature

INTRODUCTION

In North Africa which is an endemic region for Hydatid Cyst, Tunisia is considered as an endemic country. The liver and lungs are common locations for Hydatid Cysts, whereas the Adrenal Glands are unusual and rare locations.

PRESENTATION OF CASE

Here is a report of primary Hydatid Cyst in a 55-year old patient, with left hypochondrium pain as chief complain. No remarkable findings were revealed by physical examination and blood analysis showed normal range. Hydatid serology was negative. The diagnosis of Hydatid Cyst was suspected based on CT Scan results which showed a well-circumscribed, non-enhanced, multi-cystic, 12 cm mass with scattered calcifications located in the left adrenal gland. Therefore, the patient underwent an open surgery with resection of the protruding dome of the cyst as it was attached to the renal pedicle, the pancreatic tail, the spleen and the jejunum. The final pathological examination of the specimen led to a Hydatid Cyst.

DISCUSSION

Throughout an extensive literature review that we have made, we have analyzed 54 reported cases, with their clinical presentations, biological exams, radiological features and surgical managements. The treatment should be surgical and has to be as conservative as possible. The prevention of the parasite transmission has to be the cornerstone of the disease management.

CONCLUSION

The hydatid cyst of the adrenal gland remains a rare diagnosis that has to be evoked in case of an adrenal gland cyst, especially in an endemic country.

Hydatid Cyst of the Adrenal Gland: Is Radical Surgery Necessary for Recurrent Hydatid Disease?

Hydatid cyst disease caused by E. granulosus is a zoonotic disease that may involve many body tissues and organs, mainly liver. Adrenal glands are rarely involved even in regions where hydatid cyst disease is endemic. A limited number of studies have been reported on adrenal gland involvement by hydatid cyst disease. Herein, we aimed to report a recurrent case of adrenal hydatid cyst that was misdiagnosed as a hepatic hydatid cyst. A 16-year-old boy with a history of partial cyst excision and evacuation for perforated adrenal hydatid cyst disease three years ago presented to our outpatient clinic with nonspecific abdominal pain. Ultrasonography and computed tomography showed a lesion with an approximate size of 70 × 70 mm compatible with a hydatid cyst, which originated from the segment 5-6 of the liver and extended to the posterior-inferior direction. A surgical intervention was scheduled after a 2-week prophylactic albendazole treatment. During laparotomy using the old incision, it was noted that the cystic lesion that reportedly located in liver was actually a recurrent right adrenal cyst. As dense adhesions existed, the cystic lesion was excised en bloc with the right adrenal gland. As the lesion was totally removed without getting ruptured, albendazole was not administered at the postoperative period. No recurrence was observed at one-year follow-up.

Primary retroperitoneal mucinous cystadenoma

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PRMCs are very rare and they share macroscopical and histological similarity to ovarian cystadenomas.

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It is important to rule out Echinococcosis specially in endemic regions such as South America.

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Complete surgical excision of the PRMCs is recommended to eliminate the risk of infection, recurrence and malignant degeneration.

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It is important to remember that cystic fluid spillage has to be prevented due to the uncertain pathology of the tumor in most of the cases.

Mucinous cystadenomas and carcinomas of the ovary are well-established and common tumors. However, Primary retroperitoneal mucinous cystadenomas (PRMCs) are very rare. We present a 50-year-old woman referred to our institution with history of intermittent abdominal pain and palpable mass in her left flank. On CT-scan an unilocular cystic mass with thin wall measuring 171 × 155 × 108 mm in the retroperitoneum was shown. Patient underwent surgical excision of the tumor. The histopathology examination showed a cystic mass with a fibrous wall and an epithelium composed of a single layer of columnar cells with mucin vacuoles compatible with PRMC.

A Large Isolated Hydatid Cyst of the Adrenal Gland: A Case Report and Review of the Literature

A 44-year-old patient presented with two-year history of (R) lumbar pain. There was a strong history of childhood animals' contact, including dogs. A brother had multiple hydatid cysts requiring surgery. Initial ultrasound showed a large (R) adrenal mass measuring 10 × 9 × 8 cm. Subsequent CT scan confirmed a heavily calcified cyst in the (R) adrenal gland. Hormonal studies were normal. He had an uneventful course following a total adrenalectomy. Isolated adrenal hydatid is extremely rare with an incidence of less than 0.5%; however, the diagnosis should always be suspected in all patients from an endemic area presenting with an adrenal cystic mass.

Incidentally detected hydatid cyst of the adrenal gland: A case report

Hydatid cysts are a zoonotic disease that can involve many organs and tissues in the human body but primarily involve the liver and lungs. Of the main organs, adrenal glands are those seldom affected by hydatid cysts. The purpose of this study was to present a case with an incidentally detected hydatid cyst of the right adrenal gland on computed tomography, and a positive echincoccus IgG enzyme-linked immunosorbent assay test on top of a toxic multinodular thyroid goiter for which thyroidectomy was indicated.

Laparoscopic resection of a bulky primary adrenal hydatid cyst

A 55-year-old man with no medical history of relevance was referred to our department for chronic back pain. Plain radiographs of the abdomen showed a round calcified image with liquid level inside in the upper-left quadrant. On computed tomography (CT) a bulky solid-cystic mass with calcified wall of 65 × 34 mm was shown in the left adrenal gland with no-contrast enhancement. The patient underwent a laparoscopic approach. Intraoperatively there was a large hard stony mass depending on the left adrenal gland, which was entirely supplanted by the tumor. Complete excision was done. The patient underwent uneventful recovery. Histopathology examination showed a solid-cystic mass with a thick fibrous wall and calcified areas compatible with hydatid cyst. To date there have been published few cases of adrenal hydatid cyst. To our awareness it is the fourth case issued in all literature resected by the laparoscopic approach.

[Hydatid cyst of the adrenal: about a case]

Le kyste hydatique de la surrénale reste une affection exceptionnelle et une localisation inhabituelle du kyste hydatique, même dans les pays où l'hydatidose sévit à l’état endémique. Nous rapportons un cas de kyste hydatique surrénalien révélé par des douleurs de l'hypochondre droit. Le diagnostic a été évoqué en préopératoire sur les données de la tomodensitométrie abdominale qui avait objectivé une masse kystique surrénalienne droite. La sérologie hydatique était positive. Le traitement chirurgical avait consisté en une résection du dôme saillant et avait permis de conserver la glande. Le kyste était univésiculaire contenant un liquide eau de roche avec une membrane proligère. Les suites opératoires étaient simples. La surveillance à distance, échographique et immunologique, n'avait pas décelé de récidive avec un recul de deux ans