Musculoskeletal Hydatid Cysts Resembling Tumors: A Report of Five Cases

Abstract

Although challenges in treatment of musculoskeletal hydatid cysts (HC) lesions have been documented, data regarding the musculoskeletal HC lesions resembling tumor is scarce. This paper presented 5 patients (3 males, 2 females) with a mean age of 41.6 years with tumor-like lesions of HC. Three of them had left ilium and acetabulum involvement, one involved left femur, and one involved left thigh muscle compartments. Pain was the main symptom and was seen in all patients. Clinical examination, radiologic evaluation, and histologic analysis were performed for diagnosis. Patients were treated through different surgical options, including simple debridement, bone cement filling with or without internal fixation, hip arthrodesis, reconstruction using hemipelvic replantation with femoral prosthesis and distal femur endoprosthetic replacement. After surgery, the operation region was washed by 20% hypertonic saline, and debridement was performed carefully without contamination. All patients received albendazole treatment. Cases were followed up 1 to 9 years for the recurrence. Walking difficulty and pain were the main symptoms during the follow-up. One patient was symptom-free. A reoccurrence in the perioperative soft tissue was detected in only one patient and control visits with antihelmintic treatment were recommended. We would like to emphasize that HC should be kept in mind for the differential diagnosis of the cystic or tumoral lesions of the musculoskeletal system, particularly in the endemic regions. Prompt diagnosis is of paramount importance for preventing destruction and complications.

Keywords: Echinococcosis granulosus; Hydatic cyst; Iliac wing; Muscle hydatidosis.

Figure 1

Illustrative case of a 45‐year‐old woman who presented with left thigh pain for 8 months. (A, B) X‐ray films of the femur showing cortical erosions (arrows). (C) T2‐weighted MRI (coronal view showing multiple contrast‐enhanced (peripheral and septal) intra‐ and extra‐medullary cystic lesions, extending into the vastus intermedius muscle and causing cortical destruction. (D, E) Debridement was performed and (F) a distal femur resection prosthesis inserted.

Figure 2

Illustrative case of a 45‐year‐old man who was admitted with left hip pain. (A) X‐ray film of the pelvis showing radiolucency of the left iliac bone. (B) T2‐weighted axial and(C) coronal MRI showing multiple cystic lesions in the left iliac wing on T2‐weighted axial and coronal views. (D, E) Hemipelvectomy and cyst excision were performed. (F) Postoperative radiograph showing total arthroplasty of the left hip joint.

Figure 3

Illustrative case of a 51‐year‐old man who presented with left thigh and groin pain. Physical examination revealed a 7 cm × 5 cm mass over the anteromedial aspect of the left thigh. (A) Anterior‐posterior pelvic X‐ray film is unremarkable. (B, C) MRI of the left thigh showing multiple cystic lesions (hyperintense) involving the pectineus, iliopsoas, and adductor magnus/brevis muscles on T2 weighted coronal and axial views. There is contrast enhancement in the periphery of the cysts.

Figure 4

Illustrative case of a 22‐year‐old male animal breeder who presented with a mass in the left iliac wing. (A, B) Anterior and lateral plain radiographs showing radiolucency of the left iliac bone (destruction). (C) X‐ray belongs to the postoperative image of the pelvis after performing cystectomy. (D, E) T1‐weighted coronal and T2‐weighted axial MRI showing multiple cystic lesions causing destruction of the left iliac wing. The cysts have extended into the gluteal and iliac muscles and contain some include calcification.