Ovarian Hydatid Cyst in Pediatric Patient Commencing as Ovarian Tumor: A Rare Site of Echinococcosis
A 12-year-old girl child admitted in emergency ward with the chief complaints of pain in right side of abdomen since 2 months, which was intermittent, dull, aching, gradually increasing and temporarily relieved by anti spasmodic drugs. Since 1 week, she had complaints of obstruction of urination without burning sensation and renal colic. There was no distension of abdomen.\nOf abdomen suggests there were not any tenderness, rigidity and organomegaly. Other systems were normal along with vital parameters.\nThere was mild anemia with Hb 10.2 mg/dl total count of 12,000/mm3 with mild eosinophilla.\nIn X-ray abdomen there was not any significant suggestive diagnostic finding. Ultrasonography (USG) abdomen revealed 4 × 6 cm sized a cystic lesion of ovary, suggestive of ovarian tumor. So, patient was referred to Onco-surgery department. They evaluated the lesion further and Computed Tomography (CT) scan was planned. Both contrast and non contrast study in CT scan revealed multiseptate cystic lesion of right ovary compressing on right sided ureter and also a part of bladder causing obstruction and there was right sided hydronephrosis and hydroureter, suggestive of ovarian hydatid cyst. Afterwards, exposure history was evaluated suggested patient's parents were shepherds and they had close association with dogs. So, further patient was referred back to pediatric surgery department.\nPatient was operated and enucleation of cyst was done by Pediatric Surgery Dept. Whole specimen containing enucleated cyst wall and cyst fluid was collected and brought to the laboratory.\nIn direct microscopy of cyst fluid scolices of hydatid cyst were seen with hooklets evaginated, as well as invaginated [Figures and ].\nHistopathological finding of H and E (Hematoxylene and Eosin) section revealed double layered membrane, outer laminated hyaline membrane and inner granular germinal layer. No scolices were found in H and E stained section.\nOn account of indirect evidence of exposure history in this patient, which was close association with dogs at home and presence of scolices in cyst fluid by direct microscopy and histopathological evidence of double layered membrane, we reached to the diagnosis that cystic ovarian lesion is none other than hydatid disease which was caused by Echinococcus spp.\nAs the USG findings confirm the diagnosis of hydatid cyst patient was put on daily Albendazole therapy twice a day. Which was continued postoperatively for one month. Patient was fully recovered and on follow-up visit, X-ray and USG of abdomen was done for any remaining particles of hydatid. It confirms the resolution of the lesion and eradication of hydatid cyst.