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      Primary ovarian hydatid cyst in a postmenopausal woman: A rare case report

      case-report

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          Highlights

          • Primary hydatid cysts of the ovaries represent a very rare entity that may be diagnosed incidentally.

          • Ultrasound is the gold standard diagnostic method for ovarian hydatid cysts.

          • Medical treatment may be successful in small asymptomatic cysts, however surgical management with removal of the intact cyst is the preferred method for large cysts.

          Abstract

          Introduction

          Hydatid cysts of the female reproductive system represent a rare entity. We report a case of a primary hydatid cyst of the right ovary of a postmenopausal woman that was diagnosed incidentally.

          Presentation of the case

          A 72-year old overweight woman with history of three vaginal deliveries was referred due to uterine prolapse. During clinical examination of the patient, preoperative pelvic ultrasound revealed an ovarian cyst with benign characteristics. After oncology review, a laparoscopically assisted vaginal hysterectomy with bilateral salpingo-oophorectomy was conducted; the histopathology of the cyst revealed a hydatid cyst. Postoperative abdominal computed tomography identified no other sites of infection, indicating the ovary as the primary site of infection. During follow-up no recurrence occurred.

          Discussion

          Hydatid cysts usually have a low progression and tend to be asymptomatic. Medical treatment may be successful in small asymptomatic cysts, however a close follow-up is needed after antihelminthic treatment. Surgical management with removal of the intact cyst is the preferred method for large cysts.

          Conclusion

          We report a rare case of ovarian hydatid cyst that was effectively removed intact during a laparoscopically assisted vaginal hysterectomy with no recurrence during follow-up.

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          Most cited references16

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          Terms, definitions and measurements to describe the sonographic features of adnexal tumors: a consensus opinion from the International Ovarian Tumor Analysis (IOTA) Group.

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            Guidelines for treatment of cystic and alveolar echinococcosis in humans. WHO Informal Working Group on Echinococcosis.

            WHO (1995)
            Summarized in this article are recent experiences in the treatment of human cystic echinococcosis (CE) and alveolar echinococcosis (AE) of the liver caused by the metacestode stages of Echinococcus granulosus and E. multilocularis, respectively. For CE, surgery remains the first choice for treatment with the potential to remove totally the parasite and completely cure the patient. However, chemotherapy with benzimidazole compounds (albendazole or mebendazole) and the recently developed PAIR procedure (puncture-aspiration-injection-re-aspiration) with concomitant chemotherapy offer further options for treatment of CE cases. Chemotherapy is not yet satisfactory: cure can be expected in about 30% of patients and improvement in 30-50%, after 12 months' follow-up. AE is generally a severe disease, with over 90% mortality in untreated patients. Radical surgery is recommended in all operable cases but has to be followed by chemotherapy for at least 2 years. Inoperable cases and patients who have undergone nonradical resection or liver transplantation require continuous chemotherapy for many years. Long-term chemotherapy may significantly prolong survival, even for inoperable patients with severe AE. Liver transplantation may be indicated as a life-saving measure for patients with severe liver dysfunction, but is associated with a relatively high risk of proliferation of intraoperatively undetected parasite remnants. Details of indications, contraindications, treatment schedules and other aspects are discussed.
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              Randomised controlled trial of efficacy of albendazole in intra-abdominal hydatid disease.

              The efficacy of albendazole in hydatid disease is still unclear, because there has been no study that assessed the status of the parasite after treatment. The significance of albendazole-induced echographic changes in the cyst therefore cannot be judged. We did a prospective, controlled, randomised, open study of albendazole in patients with liver hydatid disease, and assessed parasite viability after treatment. 18 patients received no albendazole treatment (controls), 18 received albendazole (10 mg/kg daily) for 1 month (group A), and 19 received the drug for about 3 months (group B). Echography was done before and during treatment; all patients underwent surgery on completion. Parasite (protoscolex viability and development of cysts in mice) and ultrastructure studies were done for all cysts removed. 8 (50%) of cysts in the control group, 13 (72%) in group A, and 16 (94%) in group B were non-viable (p = 0.015). Protoscolex and cyst viability were significantly (p = 0.039 and p = 0.018, respectively) lower in treated patients than in controls. Treatment was also significantly associated with total cyst membrane disintegration. 68% of cysts treated for 3 months showed echographic changes, and only 1 of 20 cysts showing echographic changes during treatment was judged viable. The efficacy of albendazole at a dose of 10 mg/kg daily for 3 months suggests that it is a suitable alternative to surgery in uncomplicated hydatid liver disease, as initial treatment.
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                Author and article information

                Contributors
                Journal
                Int J Surg Case Rep
                Int J Surg Case Rep
                International Journal of Surgery Case Reports
                Elsevier
                2210-2612
                2210-2612
                07 March 2020
                2020
                07 March 2020
                : 68
                : 221-223
                Affiliations
                [a ]Department of Obstetrics and Gynaecology, Interbalkan Medical Center of Thessaloniki, Greece
                [b ]Third Department of Obstetrics and Gynaecology, Faculty of Medicine, Aristotle University of Thessaloniki, Greece
                Author notes
                [* ]Corresponding author at: Konstantinoupoleos 49, 54642, Thessaloniki, Greece. igtsakir@ 123456auth.gr
                Article
                S2210-2612(20)30147-4
                10.1016/j.ijscr.2020.03.006
                7078442
                32193140
                dbcb5f19-b9f5-4a2d-a00f-8291a0a6cc68
                © 2020 The Author(s)

                This is an open access article under the CC BY license (http://creativecommons.org/licenses/by/4.0/).

                History
                : 28 December 2019
                : 16 February 2020
                : 2 March 2020
                Categories
                Article

                echinococcus,hydatid cyst,primary,ovary
                echinococcus, hydatid cyst, primary, ovary

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