Human cystic echinococcosis detected in mesentery: A case report

Abstract

Cystic echinococcosis, although rare in Europe, presents a diagnostic challenge when encountered, especially in atypical locations such as the mesentery. This case report is significant because it highlights the unique presentation of mesenteric hydatid cysts, emphasizing the importance of considering uncommon etiologies in differential diagnosis, particularly in immigrant populations. The novelty of this case lies in its rarity and the diagnostic dilemma it posed, ultimately leading to successful management through prompt recognition and accurate diagnosis. A 33-year-old pregnant female from East Africa presented with intermittent abdominal pain during pregnancy. Imaging revealed a cystic mass adjacent to the mesentery, initially misdiagnosed as an ovarian cyst. Postpartum, she developed acute abdominal symptoms, leading to a revised diagnosis of a ruptured hydatid cyst. Antiparasitic treatment and surgical intervention were initiated, resulting in successful management. This case underscores the necessity of prompt recognition and accurate diagnosis of rare conditions such as mesenteric hydatid cysts, particularly in immigrant populations. A multidisciplinary approach is crucial for optimal patient care in such cases.

Keywords: Human cystic echinococcosis; hydatid disease; mesenteric cyst.

Figure 1.

(a) CT scan showing the transverse section (left) and frontal view (right) of the abdomen. The cyst, with a caudal protrusion and focal wall thickening, was present on the right side of the abdomen (blue arrows). (b) MRI scan with transverse section (above) and frontal view (below) of the abdomen showing the cyst with a smooth wall and caudal protrusion with focal wall thickening (green arrows). The cyst contents were mostly homogenous with high T2 and low T1 signal intensities and were diagnosed as a benign cyst, possibly lymphangioma. (c) CT scan of the abdomen showing air content in the cyst (orange arrow on left image) and area of rupture and reactive inflammation (yellow arrow on right image).

Figure 2.

(a) Necrotic protoscoleces. LBC. PAP stain ×40. (b) Degenerated protoscoleces and free hooklets. LBC. PAP stain ×40. (c) and (d) Degenerated protoscoleces and preserved hooklets. LBC. PAP stain ×40. (e) Degenerated protoscoleces with eggs in immature proglottids with calcareous corpuscles (*). LBC. PAP stain ×40. (f) Free hooklets. LBC. PAP stain ×40. LBC: liquid-based cytology; PAP: Papanicolaou.

Figure 3.

(a) Ample background debris with bacteria, necrotic protoscoleces, and degenerated protoscoleces with preserved hooklets (†). Cell block. HPS stain ×40. (b) Ample background debris with bacteria and free hooklets, necrotic and degenerated protoscoleces, immature proglottids with calcareous corpuscles ( _* ) with eggs and laminated membranes (#). Cell block. HPS stain ×40. (c) Ample background debris with bacteria and free hooklets (§), necrotic and degenerated protoscoleces. Cell block. HPS stain ×40. (d) Ample background debris with bacteria, free hooklets, degenerated protoscoleces, and plant remnants (≠) were consistent with feces. Cell block. HPS stain ×40.(e) Overview of large-laminated membranes. Cell block. PAS stain ×20. (f) At the periphery and edge of a laminated membrane is seen. The background bacteria and remnant plant material were consistent with feces. Cell block. PAS stain ×20. (g) Multiple parts of the protoscoleces with hooklets and disrupted immature proglottids with calcareous corpuscles (*) with eggs. Cell block. PAS stain ×20. (h) Part of protoscoleces and laminated membrane material. In the background debris containing bacteria. PAS stain ×20. HPS: hematoxylin-phloxine-saffron; PAP: Papanicolaou.