|LETTER TO THE EDITOR
|Year : 2013 | Volume
| Issue : 1 | Page : 78-79
Primary hydatid cyst in biceps brachii muscle
G Anandam, Srikanth Shastry
Department of Pathology, Prathima Institute of Medical Sciences, Karimnagar, Andhra Pradesh, India
|Date of Web Publication||13-Mar-2013|
Department of Pathology, Prathima Institute of Medical Sciences, Karimnagar, Andhra Pradesh
Source of Support: None, Conflict of Interest: None
|How to cite this article:|
Anandam G, Shastry S. Primary hydatid cyst in biceps brachii muscle. J NTR Univ Health Sci 2013;2:78-9
Hydatid disease, which is a zoonotic infection caused by larvalforms (metacestodes) of tapeworms of the genus Echinococcus found in the small intestine of carnivores, still remains animportant health problem in endemic regions. , Two ofthe four recognized species of Echinococcus: Echinococcus granulosus and Echinococcus multilocularis, cause cystic Echinococcos is, and alveolar Echinococcos is in humans, respectively. The eggs of these tapeworms excreted by carnivores may infect humans as natural intermediate host.  Hydatid cysts, which generally involve the liver and the lungs, are uncommonly found in muscles; even in endemic zones.  Exclusive involvement of the muscles is extremely uncommon, because implantation at this site would require passage through the filters of the liver and lung. Here, we present a rare case of primary hydatidcyst in biceps brachii muscle.
A 60-year-old female presented with soft swelling in the lateral aspect of upper posterior aspect of left arm of 2 years duration, which was gradually increased to the present size of 11 cm × 5 cm × 3 cm. There was no history of pain or trauma. Initially, it was diagnosed as lipoma, however, with ultrasonography revealed to be a cystic swelling suggestive of hydatiddisease originating from biceps brachii muscle [Figure 1]. The swelling was removed enbloc. Cut section showed multiple daughter cysts [Figure 2]. Histopathologicaly it was confirmed the diagnosis hydatidcyst [Figure 3] and [Figure 4].
|Figure 1: Ultrasonography showing multiple cystic swellings of varying sizes originating from muscle tissue|
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|Figure 3: Section showing cyst wall comprising of outer chitinous and inner germinative layer along with scolices and hooks. Adjacent to these there is cellular eosinophilic laminated membranous structures seen (H and E, ×10)|
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|Figure 4: Section showing scolices and hooks of varying sizes (H and E, ×40)|
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Musculoskeletal hydatid disease may either be secondary or primary. In secondary disease, there is primary location of hydatid cyst in liver, lung or spleen that has been operated or not operated.
Primary hydatid disease of the skeletal muscle is rare, as the parasite has to cross pulmonary and hepatic barriers to reach the muscles.  The high lactic acid level in muscle tissue is considered unfavorable for the survival of parasite. 
This patient had not been operated for hydatid disease previously and investigations did not revealed any hydatid cyst in brain, liver, lung or spleen. So, this patient was diagnosed, having primary hydatid disease of musculoskeletal system.
Muscular hydatidosis is a very rare and can cause difficulty indiagnosis, especially, in the absence of typical radiological findings. The possibility of hydatid disease should always be kept in mind in the differential diagnosis of a cystic mass in the muscle, especially, in endemic areas to avoid fine-need leaspiration and the consequences of spillage of cyst contents.
Muscular hydatosis resembles a benign neoplasm in many ways. In order to prevent serious complications, it should be diagnosed before any therapeutic intervention. The diagnosis is based on the history of exposure in an endemic area and US, computed tomography findings. The diagnosis can be supplemented by specific Immunoglobulin G(IgG), complement fixation, indirect fluorescent, and enzyme linked immuno sorbent assay tests.
Enbloc resection alone is curative for intramuscular hydatiddisease. , In this patient, we were able to remove whole of the cyst in Toto.
present this caseas primary hydatidcyst, involving the biceps muscle is unusual and muscle hydatidosis is usually secondary in nature and inregions where hydatidosis is endemic, hydatid cyst shouldbe included in the differential diagnosis of any unusual muscularmass.
| References|| |
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[Figure 1], [Figure 2], [Figure 3], [Figure 4]