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Image of the Month| Volume 11, ISSUE 6, P930-932, June 01, 2016

Pulmonary Hydatid Cyst Mimicking a Lung Cancer

  • Maher Abouda
    Correspondence
    Corresponding author. Address for correspondence: Maher Abouda, MD, University of Tunis El-Manar, Respiratory Department, Interior Security Forces Teaching Hospital, Rue Taher Ben Achour, Marsa, TN 2070, Tunisia.
    Affiliations
    Respiratory Department, Faculty of Medicine, Interior Security Forces Teaching Hospital, University of Tunis El-Manar, El-Manar, Tunisia
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  • Senda Turki
    Affiliations
    Respiratory Department, Faculty of Medicine, Interior Security Forces Teaching Hospital, University of Tunis El-Manar, El-Manar, Tunisia
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  • Mehdi Charfi
    Affiliations
    Radiology Department, Faculty of Medicine, Interior Security Forces Teaching Hospital, University of Tunis El-Manar, Tunisia
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  • Miriam Triki
    Affiliations
    Respiratory Department, Faculty of Medicine, Interior Security Forces Teaching Hospital, University of Tunis El-Manar, El-Manar, Tunisia
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Open ArchivePublished:February 17, 2016DOI:https://doi.org/10.1016/j.jtho.2015.12.112
Pulmonary Hydatid Cyst Mimicking a Lung Cancer
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      A 54-year-old, previously healthy, male smoker was admitted with a 3-month history of cough and hemoptysis. The physical examination results were normal. Chest radiography revealed a right upper lobe (RUL) consolidation. Laboratory examinations showed an elevated erythrocyte sedimentation rate and C-reactive protein level. The result of the sputum smear examination for acid-fast bacilli was negative. Computed tomography (CT) of the chest showed a cavitating mass in the RUL with moderate enhancement after administration of contrast (Figs. 1A and B). Abdominal ultrasound and CT scan did not detect any liver lesions.
      Figure thumbnail gr1
      Figure 1CT of the chest (A) shows a cavitating mass in the right upper lobe (B) that was markedly enhanced after administration of contrast. After bronchoscopic extraction of the hydatid cyst, CT of the chest (C and D) showed a marked reduction of the lesion with a persistent residual cavity.
      Bronchoscopy revealed a whitish gelatinous material protruding from the RUL bronchus that disintegrated during a biopsy attempt (Fig. 2). The distal portion of the material was grasped gently by the biopsy forceps and the RUL was pulled out, causing coughing and expulsion of a large transparent membranous structure (Figs. 3A and B). The histological examination of the structure revealed laminated membrane that appeared as fragments of a cellular eosinophilic material with delicate parallel striations (hematoxylin and eosin staining; magnification, ×40) (Fig. 4). Immediate bronchoscopic control showed total removal of the material and cleaning of the RUL bronchus (see the Supplementary Video).
      Figure thumbnail gr2
      Figure 2Bronchoscopic view of whitish gelatinous material protruding from the right upper lobe bronchus.
      Figure thumbnail gr3
      Figure 3(A) A gelatinous and (B) transparent membranous structure expulsed from the right upper lobe bronchus.
      Figure thumbnail gr4
      Figure 4Isolated fragments of laminated membrane appearing as a cellular eosinophilic material with delicate parallel striations that is surrounded by inflammatory cells (hematoxylin and eosin staining; magnification, ×40).
      The diagnosis of pulmonary hydatid cyst was made and antiparasitic treatment with albendazole was initiated and continued for 3 months. CT control, performed 1 month later, showed a marked reduction of the lesion with a persistent residual cavity (Figs. 1C and D). There was no recurrence after a 2-year follow-up period.
      Hydatid disease is a widespread zoonotic parasitic disease caused by the larval stage of Echinococcus. Humans can accidently act as intermediate hosts, with a hydatid cyst developing mainly in the liver and the lungs.
      • Bagheri R.
      • Haghi S.Z.
      • Amini M.
      • et al.
      Pulmonary hydatid cyst: analysis of 1024 cases.
      Gen Thorac Cardiovasc Surg. 2011; 59: 105-109
      Clinical presentations of pulmonary hydatid cysts are variable. Nonruptured pulmonary hydatid cysts are frequently found incidentally; however, in a ruptured cyst, symptoms such as productive cough, expectoration of cystic contents, cough, hemoptysis, and chest pain are frequent.
      • Arinc S.
      • Kosif A.
      • Ertugrul M.
      • et al.
      Evaluation of pulmonary hydatid cyst cases.
      Int J Surg. 2009; 7: 192-195
      In endemic zones such as Mediterranean countries, diagnosis of the disease on the basis of radiological findings is generally easy, especially if a coexisting liver cyst is found.
      • Arinc S.
      • Kosif A.
      • Ertugrul M.
      • et al.
      Evaluation of pulmonary hydatid cyst cases.
      Int J Surg. 2009; 7: 192-195
      In complicated forms, the clinical and radiological findings are atypical and may mimic those of a lung tumor.
      • Kilinç O.
      • Döskaya M.
      • Sakar A.
      • et al.
      Three atypical pulmonary hydatidosis lesions mimicking bronchial cancer from Turkey.
      New Microbiol. 2009; 32: 229-233
      In such cases, bronchoscopic visualization with a biopsy can help to establish the diagnosis. Bronchoscopy usually shows a whitish endobronchial lesion that can rarely be confused with necrotic bronchial carcinoma.
      • Taha A.S.
      Diagnosis of ruptured pulmonary hydatid cyst by means of flexible fiberoptic bronchoscopy: a report of three cases.
      J Thorac Cardiovasc Surg. 2005; 130: 1196-1197
      In exceptional cases, bronchoscopy can be contributive to treatment.
      • Burgess C.
      • Masters I.B.
      • Francis P.
      • et al.
      Flexible bronchoscopy in managing a child with pulmonary hydatid disease.
      Pediatr Pulmonol. 2012; 47: 1140-1142
      Usual treatments include surgical removal of the cyst and chemotherapy with benzimidazoles.

      Supplementary Data

      References

        • Bagheri R.
        • Haghi S.Z.
        • Amini M.
        • et al.
        Pulmonary hydatid cyst: analysis of 1024 cases.
        Gen Thorac Cardiovasc Surg. 2011; 59: 105-109
        View in Article
        • Arinc S.
        • Kosif A.
        • Ertugrul M.
        • et al.
        Evaluation of pulmonary hydatid cyst cases.
        Int J Surg. 2009; 7: 192-195
        View in Article
        • Kilinç O.
        • Döskaya M.
        • Sakar A.
        • et al.
        Three atypical pulmonary hydatidosis lesions mimicking bronchial cancer from Turkey.
        New Microbiol. 2009; 32: 229-233
        View in Article
        • Taha A.S.
        Diagnosis of ruptured pulmonary hydatid cyst by means of flexible fiberoptic bronchoscopy: a report of three cases.
        J Thorac Cardiovasc Surg. 2005; 130: 1196-1197
        View in Article
        • Burgess C.
        • Masters I.B.
        • Francis P.
        • et al.
        Flexible bronchoscopy in managing a child with pulmonary hydatid disease.
        Pediatr Pulmonol. 2012; 47: 1140-1142
        View in Article

      Article Info

      Publication History

      Published online: February 17, 2016
      Accepted: December 15, 2015
      Received in revised form: October 15, 2015
      Received: September 5, 2015

      Footnotes

      Disclosure: The authors declare no conflict of interest.

      Identification

      DOI: https://doi.org/10.1016/j.jtho.2015.12.112

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      © 2016 International Association for the Study of Lung Cancer. Published by Elsevier Inc.

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