Fine Needle Aspiration Biopsy of Hydatid Cysts

Abstract

Fine needle aspiration biopsy (FNAB) was performed in 31 patients with hydatid disease by 15 operators in 41 biopsy events during the period 1983-93. The FNABs were unintentionally done without prior clinical suspicion of hydatid cysts (HCs) in 18 patients and intentionally (with prior clinical suspicion of HC) in 13 patients for pathologic confirmation required for specific therapy. The FNABs were performed with the guidance of fluoroscopy (n=7), CT (n= 14) or ultrasonography (n= 10). The material included both closed, open and ruptured HCs from different locations such as abdomen, thorax, spine and bone. Pathologic confirmation of HC was achieved by recovering and demonstrating parasitic material in the specimen. In only 7 of 31 patients were the specimens diagnostic at the initial interpretation. This emphasizes the importance of alerting the pathologist about the possibility of hydatid disease.In 25 of 31 patients (81%) no biopsy reactions occurred. In 5 patients minor allergic reactions occurred and 3 had filling of air into intrathoracic cysts not requiring therapy. One patient, with a FNAB of a liver HC, had a sudden severe drop in blood pressure, which required anti-shock therapy with subsequent recovery without sequelae. All complications occurred with non-intentional biopsy of HC. Suggestions for diagnostic and therapeutic management of patients with HC and advice to avoid or limit potential complications or spread of disease are given where a planned biopsy is necessary for appropriate and effective therapy.

Musculoskeletal hydatid disease: A report of 13 cases

“…The multilocular lesion with several daughter cysts inside the mother cyst is characteristic, but not pathognomonic of hydatid disease (Martin et al 1993, Essadki et al 1996. Endovesicular daughter cysts, present in most of our cases, are regarded as unusual in musculoskeletal cystic echinococcosis by some authors (Von Sinner et al 1995, Guthrie et al 1996, Merkle et al 1997. MR images were obtained in 4 of our patients before diagnosis, and were highly suggestive of hydatid disease.…”

Canadian‐Acquired Hydatid Disease: A Case Report

“…In the past, percutaneous aspiration of hydatid cysts was believed to be contraindicated because of the risk of anaphylaxis and spillage of scolices, resulting in peritoneal seeding and dissemination (2,5,8,17,18). Von Sinner et al (22) suggested the use of fine needle aspiration biopsy to evaluate suspected hydatid cysts having nonspecific signs in medical imaging and negative serology. Salama et al (23) reported the use of percutaneous cyst puncture followed by in-stillation of hypertonic saline in the treatment of 45 patients with hepatic hydatid disease.…”

Spinal hydatid disease

“…The authors advocate that with adequate prophylaxis against anaphylaxis and dissemination, CT guided aspiration of spinal hydatid cysts with hypertonic saline irrigation and subsequent chemotherapy may be an alternative to surgical therapy in selected cases. 39,41 Other minimally invasive techniques such as endoscopic evacuation of cyst material has been reported in the literature. 31 We think that minimally invasive methods may be of value in selected patients with localized spinal disease, in whom surgical therapy is contraindicated.…”

“…39,41 This technique however is usually avoided in spinal disease due to the risk of cyst rupture and severe anaphylaxis. 13 In the single reported case, Spektor et al 41 described the successful decompression of an extradural cervical spinal hydatid cyst by CT guided ®ne needle aspiration with complete resolution of quadriplegia.…”

“…1,2,12,21,29,38,39,40 Up to 40% of patients are reported to have recurrent symptomatology within 2 years of initial operation. 2,17,21,29 In recurrent lesions the major goal is restoration and preservation of neurological status and spinal stability.…”