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CASE REPORT
Year : 2001  |  Volume : 18  |  Issue : 1  |  Page : 94-96
 

Hydatid cyst of testis: An unusual presentation of hydatid disease - case report and review of literature


Departments of Urology, Radiodiagnosis and Pathology, SK Institute of Medical Sciences, Srinagar, India

Correspondence Address:
Abrar A Wani
P.O. Box 974, GPO, Srinagar - 190 001
India
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Source of Support: None, Conflict of Interest: None


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   Abstract 

Hvdatid disease is a parasitic disease usually caused by Echinococcus granulosus. It usually presents with liver involvement and uncommonly lungs and rarely other organs are involved. A rare case of hydatid testis is reported that was provisionally diagnosed as testicular tumor.


Keywords: Echinococcus; Hydatid; Testis.


How to cite this article:
Singh B, Wani AA, Ganai AA, Singh M, Baba K. Hydatid cyst of testis: An unusual presentation of hydatid disease - case report and review of literature. Indian J Urol 2001;18:94-6

How to cite this URL:
Singh B, Wani AA, Ganai AA, Singh M, Baba K. Hydatid cyst of testis: An unusual presentation of hydatid disease - case report and review of literature. Indian J Urol [serial online] 2001 [cited 2019 May 21];18:94-6. Available from: http://www.indianjurol.com/text.asp?2001/18/1/94/37471



   Introduction Top


Infestation with Echinococcus is usually endemic in various areas like Central Asia, Central Europe and the Middle East. Man gets infested by taking foods contaminated by the eggs or proglottid-containing faeces of definitive hosts, viz. dog, fox, or by contact with the infected animals. Usually it is the liver which is involved and uncommonly lungs and brain are involved.[1] Rarely involvement of organs like long bones, spine, breast, kidneys and testis[2],[3],[4],[5],[6],[7] has been reported in literature. We here present rare case of hydatid disease of testis, alongwith review of literature about the same.


   Case Report Top


A 22-year-old man was admitted in our institute for evaluation of right testicular swelling which was of two years duration. The mass was growing slowly over this period of time and was not associated with pain. Past history revealed that the patient had been operated for hydatid cyst of liver two and a half year back. On examination a firm to hard swelling was noted in right testis and one could go above the swelling. The swelling did not show transillumination and had no fluid thrill. Thorough clinical examination revealed no other significant finding and clinical impression of testicular tumor was made.

Laboratory investigations were done which revealed normal blood counts. Hydatid serology was done which was positive. Radiographs of chest, spine and long bones were done and all were normal. Abdominal ultrasound examination was done which revealed presence of small hydatid cyst in liver. Sonographic examination of testis was done which revealed the presence of right testicular mass which was cystic in nature [Figure - 1]. Patient was subjected to high inguinal orchidectomy as diagnosis was not absolutely clear and the specimen sent for histopathological examination. On sectioning the specimen revealed whitish hydatid cyst. with a hard fibrotic wall. [Figure - 2]

Microscopic examination revealed the presence of a typical laminated membrane of hydatid cyst. [Figure - 3]


   Discussion Top


Echinococcus granulosus is a small cestode tapeworm approximately 3-6 mm in length when fully mature. The tape worm lives as an intestinal parasite firmly attached to the mucosa of small intestines of dogs and less commonly in other carnivores. Following infection by peroral ingestion of protoscolices originating from fertile hydatid cysts, sexual maturity of adult stage tape worms is reached within 4-5 weeks. After this period there is a shedding of eggs or gravid proglottides (each containing hundreds of eggs) into the faeces of definitive hosts. Such eggs are infective for intermediate hosts. Following ingestion of echinococcus eggs by susceptible intermediate animal hosts and humans. an early stage larva, the oncosphere, is released from the egg envelope. The oncosphere penetrates through the intestinal epithelium into the lamina propria and the corresponding blood vessels, it is subsequently transported passively through the blood or lymph vessels to the target organs; where oncosphere matures into a vesicle which grows passively by concentric enlargement. The final result is a fully mature metacestode or hydatid cyst. This is usually a fluid filled, unilocular cyst, but multiple, communicating chambers also occur. The cyst consists of an inner germinal and nucleated membrane supported externally by a tough. elastic, acellular laminated membrane. surrounded by a host produced fibrous adventitial layer. In many cases, especially where large cysts may develop, daughter cysts can form within primary cyst. The endogenous formation of brood capsules and protoscolices is a prerequisite for termination of life cycle. Protoscolices will grow into adult stage once ingested by a definitive host.' Besides Echinococcus granulosus. other species like Echinococcus multilocularis, E. vogeli and E. oligarthus (rare) are also etiological agents in some cases.

Liver is the main site of involvement of hydatid disease, sometimes the pathogen manages to cross the liver (first filter) and enters lungs (second filter) and occasionally it crosses this filter as well and enters general systemic circulation to reach any part of body viz. brain.[1] spine,[1],[2] bone.[1] breast,[3] heart[4] spleen[5] pancreas[5] and rarely testis.[6],[7] In literature we could find only two case reports of hydatid disease of testis.

In 1987 Kumar et al described hydatid cysts of testis[6] in one of their patients whom they had provisionally diagnosed as testicular tumor but later on histopathology proved it as testicular hydatid. Later on Walter L et al in 1990 described a case of alveolar echinococcosis with involvement of ureter and testis overshadowing the liver manifestations. This patient had unusual presentation of hydronephrosis of solitary kidney due to ureteral stricture for which Boar's flap plasty was performed. Later on the patient presented with nodule in epididymis. microscopic examination of which revealed a gi anulomatous lesion and patient was put on antitubercular drugs. Later on after 1 year patient presented with testicular swelling and orchiectomy was done. Histopathological findings revealed granulomatous inflammation with small cysts containing caseous necrosis similar to those found in previous ureteral and epididymal specimens, but this time histological findings indicated alveolar echinococcosis as cysts were positive for P.A.S. (Periodic Acid Schuff) and this was confirmed by serological examinations.

In our patient too, patient was diagnosed provisionally as testicular tumour till histopathology proved it as hydatid testis.

So in all patients being provisionally diagnosed as testicular tumor, hydatid cyst of testis although rare, should be kept in differential diagnosis.

 
   References Top

1.Gottstain B, Reichen J. Echinococcosis / Hydatidosis. In: Manson's tropical diseases. 20th ed. Bath Press, Aron Inc. 1996; 1486-1508.   Back to cited text no. 1    
2.Weber M, Vespignani H, Jacquier P et al. Neurological manifestations of alveolar echinococcosis. Rev Neurol (Paris) 1988; 144:104-112.  Back to cited text no. 2    
3.Onedraogo EG. Hydatid cyst of the breast. 20 cases. J Gynecol Obstet Biol Reprod (Paris) 1986; 15: 187-194.  Back to cited text no. 3    
4.Shields DA. Multiple emboli in hydatid disease. BMJ 1990; 301: 213-214.  Back to cited text no. 4    
5.Macpherson CNL, Romig T. Zeyhte E, Craig PS, Watschinger H. Observations on human echinococcosis (hydatidosis) and evaluation of transmission factors in the Maasai of Northern Tanzania. Ann Trop Med Parasitol 1989; 83: 489-497.  Back to cited text no. 5    
6.Kumar PVN, Jahanshahi SH. Hydatid cyst of testis: A case report. J Urol 1987; 137: 511-512.  Back to cited text no. 6    
7.Strohmaier WL, Bichler KH, Wilbert DM, Seitz HM. Alveolar echinococcosis with involvement of the ureter and testis. J Urol 1990: 144: 733-744.  Back to cited text no. 7    


    Figures

  [Figure - 1], [Figure - 2], [Figure - 3]



 

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    Abstract
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    Case Report
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    References
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