Page 6 - Jcog-October 2016
P. 6
rnal of Cases in
Ob s te tri cs & G yn e co l o g y
inal examination revealed a mass of around 16 weeks of Patient was taken up for exploratory laparotomy. Large
gravid uterus size, palpable in the suprapubic region with cystic mass around 10x 10 cm arising from the antero-
well defined margins, globular, cystic to firm in consisten- lateral wall of the uterus was found, which was dense-
cy, nontender with side to side mobility. There was no ev- ly adherent to the bladder and small bowel (Figure 1).
idence of free fluid in the abdomen and no organomegaly Another cystic mass around 5 cm was present in the pararec-
was present. On speculum examination cervix and vagi- tal region along with multiple sub-centric nodules all over
na were healthy and on per vaginal examination a normal the small bowel. Bilateral ovaries appeared normal as were
size retroverted uterus was present which was deviated to rest of the abdominal organs. On cut section clear fluid was
right along with it a 10x 10 cm mass felt through the an- present inside the cyst with another cyst inside and no sol-
terior fornix. Right and left fornices and pouch of Doug- id areas. On histopathological evaluation, cyst adherent to
las was free. Rectal mucosa and rectovaginal septum were the uterus and pararectal cyst along with sub-centric nod-
normal. Her haematocrit revealed raised eosinophil count ules showed an inner laminated layer along with large ar-
while, other routine investigations including ovarian tumor eas of necrosis surrounded by fibrocollagenous wall with
markers and chest x-ray were normal. On transabdominal mixed inflammatory infiltrate suggestive of parasitic cyst.
scan, liver, gall bladder, pancreas, both kidneys and blad- Patient was started on treatment of hydatid disease (al-
der were normal. Uterus was normal in size with a well de- bendazole 100 mg twice a day for 3 months) in the post
fined cystic space occupying lesion of 9.6x 9.1 cm close operative period and is presently under our follow up.
to uterus on right side. Another cyst of 4.9x 2.3 cm was
present which appeared to be arising from the left adnexa. Discussion
Figure 1. Hydatidosis can affect any part of the body but liver and
Hydatid cyst adhered to the anterolateral wall of lung are the commonest sites affected. Whenever hydatid
the uterus with daughter cyst cyst affects other organs like brain, heart, pericardium, kid-
ney, intraperitoneum, retroperitoneum, bone, soft tissue,
and breast etc., the primary diagnosis is extremely difficult
to make as it mimics other cystic pathologies affecting these
organs. Hydatid cyst of the uterus is a rare entity in gynae-
cological practice and only a high degree of clinical sus-
picion especially in patients with a prior history and those
coming from endemic areas, can direct a clinician towards
the disease in the preoperative period. Singh et al. reported
a similar case of uterine hydatidosis arising from the lateral
wall of the uterus, which was preoperatively diagnosed as
malignant ovarian mass, for which they performed a total
abdominal hysterectomy and bilateral salpingo-ophorecto-
my [3]. Similar case of uterine hydatidosis was reported by
Okumus et al. where they also performed total hysterecto-
my and the diagnosis was later confirmed by microscopic
studies [4]. Basgul et al. reported a case of uterine hydati-
dosis in a female who had prior history of hydatid cysts
of the liver, thus, was a secondary infection of the pelvis
[5]. This case adds to the existing literature wherein hydatid
cyst mimicked an ovarian neoplasm intraoperatively along
with dense adhesions to surrounding structures. Multiple
nodules reported in the present case mimicked metastasis
of the surrounding area and hence, a definitive surgery in-
116 October 2016
www.jcasesobstetgynecol.com
Ob s te tri cs & G yn e co l o g y
inal examination revealed a mass of around 16 weeks of Patient was taken up for exploratory laparotomy. Large
gravid uterus size, palpable in the suprapubic region with cystic mass around 10x 10 cm arising from the antero-
well defined margins, globular, cystic to firm in consisten- lateral wall of the uterus was found, which was dense-
cy, nontender with side to side mobility. There was no ev- ly adherent to the bladder and small bowel (Figure 1).
idence of free fluid in the abdomen and no organomegaly Another cystic mass around 5 cm was present in the pararec-
was present. On speculum examination cervix and vagi- tal region along with multiple sub-centric nodules all over
na were healthy and on per vaginal examination a normal the small bowel. Bilateral ovaries appeared normal as were
size retroverted uterus was present which was deviated to rest of the abdominal organs. On cut section clear fluid was
right along with it a 10x 10 cm mass felt through the an- present inside the cyst with another cyst inside and no sol-
terior fornix. Right and left fornices and pouch of Doug- id areas. On histopathological evaluation, cyst adherent to
las was free. Rectal mucosa and rectovaginal septum were the uterus and pararectal cyst along with sub-centric nod-
normal. Her haematocrit revealed raised eosinophil count ules showed an inner laminated layer along with large ar-
while, other routine investigations including ovarian tumor eas of necrosis surrounded by fibrocollagenous wall with
markers and chest x-ray were normal. On transabdominal mixed inflammatory infiltrate suggestive of parasitic cyst.
scan, liver, gall bladder, pancreas, both kidneys and blad- Patient was started on treatment of hydatid disease (al-
der were normal. Uterus was normal in size with a well de- bendazole 100 mg twice a day for 3 months) in the post
fined cystic space occupying lesion of 9.6x 9.1 cm close operative period and is presently under our follow up.
to uterus on right side. Another cyst of 4.9x 2.3 cm was
present which appeared to be arising from the left adnexa. Discussion
Figure 1. Hydatidosis can affect any part of the body but liver and
Hydatid cyst adhered to the anterolateral wall of lung are the commonest sites affected. Whenever hydatid
the uterus with daughter cyst cyst affects other organs like brain, heart, pericardium, kid-
ney, intraperitoneum, retroperitoneum, bone, soft tissue,
and breast etc., the primary diagnosis is extremely difficult
to make as it mimics other cystic pathologies affecting these
organs. Hydatid cyst of the uterus is a rare entity in gynae-
cological practice and only a high degree of clinical sus-
picion especially in patients with a prior history and those
coming from endemic areas, can direct a clinician towards
the disease in the preoperative period. Singh et al. reported
a similar case of uterine hydatidosis arising from the lateral
wall of the uterus, which was preoperatively diagnosed as
malignant ovarian mass, for which they performed a total
abdominal hysterectomy and bilateral salpingo-ophorecto-
my [3]. Similar case of uterine hydatidosis was reported by
Okumus et al. where they also performed total hysterecto-
my and the diagnosis was later confirmed by microscopic
studies [4]. Basgul et al. reported a case of uterine hydati-
dosis in a female who had prior history of hydatid cysts
of the liver, thus, was a secondary infection of the pelvis
[5]. This case adds to the existing literature wherein hydatid
cyst mimicked an ovarian neoplasm intraoperatively along
with dense adhesions to surrounding structures. Multiple
nodules reported in the present case mimicked metastasis
of the surrounding area and hence, a definitive surgery in-
116 October 2016
www.jcasesobstetgynecol.com
