Primary hydatid cyst of the neck diagnosed by aspiration cytology
A 58-year-old male farmer reported to the outpatient clinic of the Department of Surgery with a 45 × 30 mm swelling in the right posterior triangle of the neck. The patient stated that he first noticed the swelling one month back, the size of which then was that of a pea. It was gradually increasing but was painless. There was no history of fever or cough. On examination the swelling was soft and cystic with well-defined margin and was non-tender. It was also non-reducible and non-fluctuant. The overlying skin was free and was mildly hyperemic. There was no attachment to the deeper tissue. A clinical diagnosis of cold abscess was made and the patient was sent for FNAC which was performed with a 24 gauge needle attached to 10 cc syringe. The aspiration yielded 5 ml of mildly dirty fluid with some white granularity. The fluid was centrifuged, smears were made and stained with Hematoxylin and eosin (H and E) stain and May-Grunwald-Giemsa stain. The microscopic examination revealed scolices and hooks with few fragments of lamellar membrane in a dirty background of pus cells and cell debris [Figures and ]. A diagnosis of the hydatid cyst was made. The patient then underwent chest X-ray, abdominal ultrasound and computed tomography scan to rule out any other organ involvement. The complete blood counts were unremarkable. Indirect hemagglutination test for E. granulosus was positive. The results of all the other tests were negative indicating that this was a case of primary hydatid cyst in the subcutanoeus tissue of the neck. The patient was treated with oral Albendazole and the intact cyst was removed surgically with no complication. The histopathology confirmed the diagnosis. The case was followed up for 6 months and there was no recurrence.