Hydatid Cyst Treatment and Management in Retroperitoneal Organs; Is Percutaneous Drainage an Option?

PURPOSE: To evaluate patients who cyst hydatid (CH) in their retroperitoneal space and organs in order to determine a standard treatment option for CH. MATERIALS AND METHODS: The files of 56 patients who were treated for CH in our clinic were evaluated retrospectively. All patients underwent either percutaneous drainage (PD) or surgery. Patients were divided into two groups as PD (Group one) and surgery groups (Group two). Preoperative and postoperative results were compared statistically. RESULTS: 31 of 56 patients were male. Mean age of the patient was 39.7 (10-85). 16 patients had been treated with PD and 40 with different surgical interventions such as total cystectomy, partial cystectomy, partial nephrectomy, total nephrectomy, surrenalectomy, and laparoscopic partial surrenalectomy. Patients' followed up was 18 months (6-38m). Relapse was seen in 1 patient who underwent PD. On comparing the results, hospitalization period was prolonged in the surgical group with enlarged cyst presence. CONCLUSION: CH presence in the retroperitoneal area is rare. PD, a minimally invasive method, has the potential to be the standard treatment option as it can be performed safely in selected patients. However, currently surgical treatment is considered as the first treatment option after CH diagnosis.

Successful percutaneous treatment of extrahepatic cystic echinococcosis through PAIR and single puncture catheter techniques.

PURPOSE: To demonstrate the successful percutaneous treatment of extrahepatic cystic echinococcosis as an alternative to surgical procedures. MATERIALS AND METHODS: A total of 27 extrahepatic hydatid cysts in 12 patients, the spleen in 8 patients, muscles and soft tissues in 3 patients each and right adrenal gland in 1 patient were treated with PAIR (puncture, aspiration, injection, respiration) or single puncture catheterization methods. As a scolicidal and sclerosing agent, alcohol was used in all patients. RESULTS: Of 27 extrahepatic lesions of hydatid cysts, 24 (88.9%) were Gharbi type 1 (WHO CE 1), and 3 (11.1%) were Gharbi type 2 (WHO CE 3A). Of hydatid cystic lesions, 20 with PAIR and 7 with single puncture catheterization methods were treated. No major complications developed in any patients. Abscesses were detected in two patients (16.6%). Mean total hospital stay was calculated between 1 and 14 days (mean 2.3 days). Follow-up periods ranged between 10 and 62 months (mean 22.3 months). CONCLUSION: Percutaneous treatment for extrahepatic hydatid cystic lesions is an important alternative to surgical procedures because of the high therapeutic success rate, lower rate of complications and shorter hospital stays.

Alveolar echinococcosis of the right adrenal gland: a case report and review of the literature.

BACKGROUND: Extrahepatic manifestations of Echinococcus multilocularis are very rare, especially in the adrenal glands. To the best of our knowledge, only seven cases of adrenal alveolar echinococcosis have been reported, all from the Far East. All of these occurred exclusively in the right adrenal gland. CASE PRESENTATION: We report a rare case of an extrahepatic alveolar echinococcosis in an asymptomatic 78-year-old white man with an incidentaloma of his right adrenal gland. After surgical resection and medical treatment with albendazole no recurrence of the disease appeared at 1-year follow-up. CONCLUSIONS: As the occurrence of Echinococcus multilocularis in Europe increases, alveolar echinococcosis should be included in the differential diagnosis of cystic adrenal incidentalomas.

Primary hydatid cyst in the adrenal gland.

An elderly man presented with a 2-year history of refractory hypertension. His medical history, physical examination and laboratory findings were unremarkable. On subsequent ultrasound study for the evaluation of renal artery stenosis, a large mass obliterating the adrenal gland containing internal cystic structures was identified. A CT study confirmed the diagnosis of primary adrenal gland hydatid cyst. Following surgical resection, the patient's hypertension resolved and medications to control blood pressure were discontinued.

Morphological changes and parasite load of the adrenal from dogs with visceral leishmaniasis.

The objective of this study was to analyze morphological changes and parasite loads in the adrenal gland from 45 dogs with visceral leishmaniasis (VL). The animals were from the Zoonosis Control Center of Araçatuba, state of São Paulo, which is an endemic region for the disease. These animals were euthanized due to positive diagnoses of VL. The dogs were classified into asymptomatic, oligosymptomatic and symptomatic groups. The parasite load was determined by immunohistochemistry, using VL-positive dog hyperimmune serum. Nine dogs showed an inflammatory infiltrate composed, predominantly, of plasma cells and macrophages. However, only eight dogs showed macrophages with amastigote forms of the parasite, immunolabeled in the cytoplasm. The medullary and reticular layers were the most affected areas, possibly due to a favorable microenvironment created by hormones in these regions. The density of parasites in the glandular tissue was not associated with clinical signs of VL (P > 0.05). However, the presence of the parasite was always associated with the presence of a granulomatous inflammatory infiltrate. This gland may not be an ideal place for the parasite's multiplication, but the presence of injuries to the glandular tissue could influence the dog's immune system, thus favoring the parasite's survival in the host's different organs.

Morphological changes and parasite load of the adrenal from dogs with visceral leishmaniasis / Alterações morfológicas e carga parasitária da adrenal de cães com leishmaniose visceral

The objective of this study was to analyze morphological changes and parasite loads in the adrenal gland from 45 dogs with visceral leishmaniasis (VL). The animals were from the Zoonosis Control Center of Araçatuba, state of São Paulo, which is an endemic region for the disease. These animals were euthanized due to positive diagnoses of VL. The dogs were classified into asymptomatic, oligosymptomatic and symptomatic groups. The parasite load was determined by immunohistochemistry, using VL-positive dog hyperimmune serum. Nine dogs showed an inflammatory infiltrate composed, predominantly, of plasma cells and macrophages. However, only eight dogs showed macrophages with amastigote forms of the parasite, immunolabeled in the cytoplasm. The medullary and reticular layers were the most affected areas, possibly due to a favorable microenvironment created by hormones in these regions. The density of parasites in the glandular tissue was not associated with clinical signs of VL (P > 0.05). However, the presence of the parasite was always associated with the presence of a granulomatous inflammatory infiltrate. This gland may not be an ideal place for the parasite's multiplication, but the presence of injuries to the glandular tissue could influence the dog's immune system, thus favoring the parasite's survival in the host's different organs.

O objetivo deste estudo foi analisar as alterações morfológicas e a carga parasitária da glândula adrenal de 45 cães com leishmaniose visceral (LV). Os animais eram provenientes do Centro de Controle de Zoonoses (CCZ) de Araçatuba (SP), região endêmica para a doença. Esses animais são submetidos à eutanásia, devido ao diagnóstico positivo para LV. Os cães foram classificados nos grupos assintomático, oligossintomático e sintomático. A determinação da carga parasitária foi feita por imuno-histoquímica, com utilização de soro hiperimune de cão positivo para LV. Em nove cães, verificou-se um infiltrado inflamatório, composto predominantemente por plasmócitos e macrófagos. Entretanto, apenas oito cães apresentaram macrófagos com formas amastigotas do parasito imunomarcadas em seu citoplasma. As camadas medular e reticulada foram as mais afetadas, possivelmente por um microambiente favorável criado pelos hormônios nestas regiões. A densidade de parasitos no tecido glandular não foi relacionada com os sinais clínicos de LV (P > 0,05). No entanto, a presença do parasito sempre esteve associada à presença de infiltrado inflamatório granulomatoso. Possivelmente, essa glândula não é um sítio ideal para a multiplicação do protozoário, mas a presença de injúrias no tecido glandular poderia influenciar o sistema imune do cão, favorecendo a sobrevivência do parasito nos diferentes órgãos do hospedeiro.

[Primary hydatid cyst of the adrenal gland in a patient with situs inversus. A one-case report]. / Kyste hydatique primitif de la glande surrénale chez une patiente porteuse de situs inversus. À propos d'une observation.

Primary hydatid cyst of the adrenal gland remains an exceptional localization. The adrenal gland is an uncommon site even in our country in which echinococcal disease is endemic. We report the case of a 38-year-old woman who consulted for left back pain. The CT scan showed a cystic mass in the left retroperitoneal area with a calcified wall. The patient underwent surgery which confirmed a diagnosis of hydatid cyst of the left adrenal gland. The surgical treatment consisted on a total resection of the cyst, without rupture of the cystic wall and preserving the gland. The diagnosis was confirmed on macroscopic and histological examination of the resected piece. The postoperative course was uneventful. No recurrence had occurred after 36 months of follow-up.

Complications of extrahepatic echinococcosis: fistulization of an adrenal hydatid cyst into the intestine.

Echinococcal cysts are usually found in liver and lungs, but any other organ can potentially be involved. Extrahepatic disease due to hydatid cyst may develop in the abdominal and pelvic cavity, aside from in other less common locations, which may make both diagnosis and treatment more complex. We present a rare case of extrahepatic echinococcosis in a 70-year old patient with a 4-d history of dull abdominal pain, anemia within the transfusion range and fever. She underwent surgery for left renal hydatid cysts 30 years ago. After non operative treatment, imaging studies showed a calcified hydatid cyst in a retrogastric location communicating with a proximal jejunal loop. En-block resection of the mass together with the adrenal gland was performed including closure of the enteric fistula. Anatomic pathology confirmed the diagnosis of a calcified hydatid cyst of left adrenal origin. Surgery is the treatment of choice and most authors recommend removal of cyst and adrenal gland.

Adrenal infections.

Adrenal infections are an important but under-recognized clinical entity. The adrenal gland can be infected by a myriad of pathogens including fungi, viruses, parasites, and bacteria. Infection can directly or indirectly cause tissue damage and alteration in endocrine function. Direct damage occurs via microbial replication and local production of toxic compounds, such as endotoxins. Indirect damage results from alterations in the regulation of a host's immunologic and endocrine mediators in response to damage by a microbe at a distant site. Variations in pathogen tropism, adrenal anatomy, and host immune integrity contribute to the progression of active disease and discernable adrenal dysfunction. Early recognition and intervention in the case of adrenal infection can significantly improve outcome, demonstrating the need for increased clinical suspicion in the appropriate clinical setting.

Primary hydatid cyst in adrenal gland: a case report.

The hydatid cyst of the adrenal gland is extremely rare pathology of the adrenal gland; here we report an adrenal hydatid cyst that presented as a solitary renal tumor.

[Primary hydatid cyst of adrenal gland. Report of two cases]. / Kyste hydatique primitif de la surrénale. A propos de deux cas.

Primary hydatid cyst of adrenal gland is still an exceptional localization. The adrenal gland is an uncommon site even in our country in which echinococcal disease is endemic. We report two cases of primary hydatid cyst of adrenal gland presented with isolated abdominal pain. The diagnosis was based on CT-scan, which showed a cystic mass of respectively the right and left adrenal gland with a calcified wall. The echinococcal immunologic test (Elisa) was positive in one case. The surgical treatment consisted on a total resection of the cyst, without rupture of the cystic wall and preserving the gland. The diagnosis was confirmed on the macroscopic examination of the resected pieces. In the first case the cyst was multilocular filled with daughter cysts and in the second case the cyst was unilocular filled with hydatid membrane and clear fluid. In the two cases, the postoperative course was uneventful. No recurrence had occurred respectively after 24 months and 36 months of follow up.

Hydatid cysts of the adrenal gland: review of nine patients.

Adrenal cysts are very rare lesions, especially with parasitic origin. But with the wider application of ultrasonography (US) and computed tomography (CT) more adrenal cysts are detected incidentally. To gain more insight into this entity, the records of nine patients with hydatid cysts of adrenal gland seen at our department from January 1980 till January 2002 are reviewed. There were four men and five women, and their ages ranged from 15 to 80 years (median: 41 years). All of the patients had unilateral cysts. Seven cysts were located on the right and two on the left side. Five of the cysts were primary and four were secondary. In three patients the cysts were found incidentally. The most common presenting symptom was pain, which was present in six patients. An indirect hemagglutination (IHA) test was positive in six cases. In all patients, US and CT successfully imaged all cysts, but the definitive diagnosis was made by macroscopic and microscopic examination of the cyst's content. The patients were treated surgically. In all patients adrenal glands with the cystic masses were removed. The median follow-up period was 16 months (range: 6-64 months). No evidence of recurrence was found in any patient. It should not be forgotten that cystic masses of the upper abdomen might also originate from the adrenal gland. The etiology and nature of the cyst should be well researched, and appropriate treatment should be given as soon as possible. Surgical excision of the gland, including the cyst is the treatment of choice.

Hydatid disease in a very unusual location: the adrenal gland. A case report.

Hydatid cysts are most often located in the liver and lungs (55-90%), while their location in the adrenal gland is very rare (0.5%). We observed a patient with a hydatid cyst in the adrenal gland, the diagnosis of which was incidental during ultrasonography and computed tomography. The experience acquired in Sicily where hydatid disease is endemic makes serological tests unnecessary, also because they often require a lengthy waiting period and are expensive. The patient had undergone surgery for the treatment of hepatic hydatid cysts. The adrenal localization may be explained as a consequence of secondary dissemination via the blood stream. The cyst developed inside the gland and caused atrophy of the glandular tissue. The surgical treatment called for adrenalectomy as the adrenal gland was entirely occupied by the cyst.

[Hydatid cyst of the adrenal gland. A case report]. / Kyste hydatique de la surrénale. A propos d'un cas.

The hydatid cyst of the adrenal gland is still an exceptional localization. Only eleven cases have been described in the literature. A new case of isolate suprarenal hydatidosis is reported in one 28 years old patient, that the signs consisted in pains of the right flank and vomiting. The diagnosis has been based on the imagery, particularly the computed tomography associated to the hydatid serology, confirmed during the operation and by the pathologic examination of the resected piece. The treatment consisted in a simple cystectomy with conservancy of the gland, the operative sequelae have been simple. The interest of this cases lies in the rare feature of this hydatid localization that the diagnosis is difficult. Among the various suggested surgical methods, the simple resection of the cyst is still the best treatment that permits to keep the gland.

Isolated visceral leishmaniasis presenting as an adrenal cystic mass.

A 69-year-old woman presented with a large left retroperitoneal suprarenal mass. Radical resection of the left kidney and the mass revealed a cystic adrenal tumor with a weight of 1500 g. Histologic examination showed that the cyst was composed mostly of partially organized clotted blood. The periphery of the mass consisted of a thin rim of cortical and medullary adrenal tissue with superimposed granulomatous chronic inflammation. The infectious nature of the process was manifested by the scattered intracellular and extracellular Leishmania amastigotes that were found throughout the lesion. The differential diagnosis of cystic adrenal masses and the unusual presentation of visceral leishmaniasis are discussed in this context.

Hydatid disease: a rare cause of adrenal cyst.

A case of hydatid cyst in the adrenal gland is presented. Eight cases have been previously reported. The diagnosis of an adrenal cyst is usually incidental, and the diagnosis of hydatid cyst is seldom made preoperatively. Surgical excision of the gland including the cyst is the treatment of choice.

[Solitary adrenal gland hydatid cyst]. / Quiste hidatídico suprarenal solitario.

Presentation of one case of solitary suprarenal hydatid cyst. Clinical diagnosis was made from a right lumbar pain, achieving identification of the parasitic disease by radiological and biological means. Treatment combined mebendazole and surgery. Both therapeutical options are discussed.