Differential Diagnosis and Management of a Recurrent Hepatic Cyst: A Case Report and Review of Literature

Abstract

Echinococcus granulosus, which causes cystic echinococcosis, is an uncommon condition in the United States. We report a case of a 78-year-old Caucasian female who presented to her primary care physician in 1999 with right upper quadrant pain. She had a history of frequent foreign travel. Abdominal imaging demonstrated a 12.5-cm hepatic cyst. The cyst was drained and the pathology report on the fluid indicated no bacterial, parasitic, or malignant etiology. Serology tests for Entamoeba and Echinococcus antibodies were negative. The patient underwent multiple hepatic cyst aspirations until 2008 for recurring symptoms. In 2008, abdominal imaging demonstrated solid internal components within the cyst. Repeat Echinococcus antibodies ordered were abnormally elevated. Cyst aspiration demonstrated Echinococcus protoscolex. We report this case to discuss the diagnosis and management of hydatid cyst and to emphasize that with increasing globalization, physicians must maintain a high index of clinical suspicion for parasitic etiologies in patients with hepatic cysts.

Diagnostics in cystic echinococcosis: Serology versus ultrasonography

“…Calcified cysts with thick cyst walls also significantly compromise the probability of reliable immunological diagnostics (33). In 10%-20% of cases, no echinococcus-specific antibodies are produced, which leads to false-negative serological findings (34). Reports in the literature describe sensitivities of 50%-100% for IHA (35).…”

“…False-positive serological results may also be returned in non-active disease stages, during pregnancy, and in patients with autoimmune or malignant diseases (34). Finally, women seem to be more frequently affected by E. granulosus infections (38).…”

“…Inadequate standardization is a further problem limiting the reliability of immunological diagnostics, as variations between laboratories may lead to incorrect results (34). At the present time, one immunological method employing new, recombinant proteins and synthetic antigens shows great potential for enhancing the sensitivity and specificity of these methods (39), though a final assessment of its value will require further studies.…”

Seroprevalence of human cystic echinococcosis and risk factors in animal breeders in rural communities in Denizli, Turkey

“…The presence of a specific antibody alone does not confirm diagnosis, as individuals may be seropositive for a number of reasons, such as previous exposure to the parasite without progressive disease or cross-reactivity with other conditions. False-positive results occur because of cross-reactions with helminth species (such as Taenia, Fasciola, Schistosoma, and Toxocara) or non-infectious conditions, such as cancer, pregnancy, or autoimmune diseases [21,22]. Furthermore, small cysts in the very early stages are not easily detectable by radiological examination [21].…”

Perkütan Karaciger Kist Hidatik Tedavisi

“…granulosus, köpek bağırsağında larva olarak ve doğada ise kist formlarında bulunan bir parazit olup, köpekler ana konakçı, insanlar ara konakçıdır. Parazitin insandaki siklusu, oral yolla alınan kistlerin bağırsakta açılması ile başlar ve daha sonra parazit larvaları portal sistem ile kan dolaşımına katılarak başta karaciğer olmak üzere hedef organlara yerleşir [1]. Diğer sık yerleşim bölgeleri akciğer, böbrek, dalak ve beyin olup bu lezyonlara genellikle karaciğer lezyonları eşlik eder.…”