Giant isolated splenic hydatidosis
A 30-year-old female patient presented with complaints of fever, breathlessness, dull-aching, continuous pain, and dragging sensation on the left side of the abdomen since 3 months. Also, there was history of loss of weight and appetite. Past history was insignificant. On examination, abdomen was slightly distended with a palpable mass reaching up to the umbilicus, 6-7 cm from the left costal margin. The mass was tender, firm, irregular and fingers could not be insinuated below the ribs. A systemic examination was normal. Routine investigations revealed leucocytosis (Total leukocyte count=12,000/mm3) with eosinophilia (7%, absolute eosinophil count=840/mm3) and raised erythrocyte sedimentation rate (ESR) (35 mm in first hour). An X-ray study of both abdomen and chest was found to be normal. Ultrasonography of the abdomen showed enlarged spleen with multiple cystic areas, together measuring 18×15×11 cm. []. A computed tomography (CT) scan showed a large mass measuring 17.5×15×10 cm, containing air fluid levels and heterogeneous contents with predominant low-density areas, elevating left dome of the diaphragm []. Other abdominal organs were found to be normal. Therefore, the clinical diagnosis of the cystic lesion of spleen was made.\nLeft subcostal exploratory laparotomy was performed revealing huge cystic mass occupying lower pole of spleen. Splenectomy was performed and sent for HPE. Tab. Mebendazole 200 mg/kg/day was started on fifth post operative day and continued after surgery for three months.\nGrossly, the splenectomy specimen measured 17×14×10 cm. The posterior aspect showed a cystic cavity having a white and smooth cyst wall, filled with multiple, variable-sized daughter cysts in a flower-shaped arrangement []. The hematoxylin and eosin (H and E)-stained slides showed a cyst wall comprising of three layers []. The cystic contents consisted of mixture of multiple infolded membranes, fragmented hooklets, and debris which were part of hydatid sand. Multiple scolices of Echinococcus granulosus were also seen []. Definitive diagnosis of a hydatid cyst was, hence, made.