Pancreatic hydatid cyst as an incidental finding

Hydatidosis is a zoonosis caused by Echinococcus granulosus. Characteristically hydatid disease is seen as a solitary cyst in the liver or lungs spreading via portal bloodstream after the intestinal invasion. Pancreatic involvement is a bizarre location of hydatidosis (1). A 35-year-old woman suffering from dull, constant lower abdominal pain for last two months, admitted through gynecology outpatient clinics. Laboratory findings indicated a mild leukocytosis with neutrophilia (Total WBC: 14/µl, neutrophil: %72) and increased serum C-reactive protein level (7,7 mg/dL) with slightly increased serum lipase (107U/L) and alkaline phosphatase levels (218U/L). During sonographic assessment; an approximately 6x5.5 cm adnexal mass was detected. An abdominal magnetic resonance imaging (MRI) scan was performed to evaluate the ovarian lump. MRI showed a right adnexal mass, estimated as a cystic teratoma, and eventually, initial diagnosis was pathologically confirmed. There was also another cystic lesion, 5x5.5 cm in diameter, confined to the pancreatic tail, discovered incidentally. This pancreatic cyst had a round shape with a smooth surface, multiple septations, and markedly enhanced thick walls and not communicated with the Wirsung duct. Preoperatively, indirect hemagluttination (IHA) test for hydatid cyst and 18F -FDG PET/CT was scheduled. IHA results for hydatid cyst were negative. Physiological tracer uptake was seen on PET/ CT (Figure 1). During the removal of the right adnexal mass, a distal pancreatectomy procedure was performed. Gross appearance of the circumscribed cyst, removed surgically, was encapsulated, multiloculated and mucin containing. Histomorphologic findings, such as acellular eosinophilic material, scolexes, and outer cuticular membrane, corroborate the diagnosis of hydatid disease of the pancreas (Figure 2).Postoperatively, ELISA tests from cyst fluid also verified hydatidosis.