Hydatid Cyst of the Adrenal Gland: Is Radical Surgery Necessary for Recurrent Hydatid Disease?

Abstract

Hydatid cyst disease caused by E. granulosus is a zoonotic disease that may involve many body tissues and organs, mainly liver. Adrenal glands are rarely involved even in regions where hydatid cyst disease is endemic. A limited number of studies have been reported on adrenal gland involvement by hydatid cyst disease. Herein, we aimed to report a recurrent case of adrenal hydatid cyst that was misdiagnosed as a hepatic hydatid cyst. A 16-year-old boy with a history of partial cyst excision and evacuation for perforated adrenal hydatid cyst disease three years ago presented to our outpatient clinic with nonspecific abdominal pain. Ultrasonography and computed tomography showed a lesion with an approximate size of 70 × 70 mm compatible with a hydatid cyst, which originated from the segment 5-6 of the liver and extended to the posterior-inferior direction. A surgical intervention was scheduled after a 2-week prophylactic albendazole treatment. During laparotomy using the old incision, it was noted that the cystic lesion that reportedly located in liver was actually a recurrent right adrenal cyst. As dense adhesions existed, the cystic lesion was excised en bloc with the right adrenal gland. As the lesion was totally removed without getting ruptured, albendazole was not administered at the postoperative period. No recurrence was observed at one-year follow-up.

Comment on: Primary hydatid cyst of the adrenal gland: A case report and a review of the literature

“…The third point that we would like to emphasize is about the errors regarding the ages and gender of the patients given in Table-1. The study by Akbulut and colleague [ 4 ] reported a patient who was 16 years old but was stated as 64 years old in the Table-1. On the contrary, the study by Seidel and colleagues [ 5 ] states that the patient was 64 years old but was reported as 16 years old in Table-1.…”

“…In the study by Zouari and colleagues and also other researchers, there is no clear message to give the readers regarding the treatment of AHC disease. In our experience, the treatment of AHC is determined by factors such as the presence of other organs of interest that is affected by the hydatid disease, the size of the AHCs, the involvement of the adjacent organs, radiologic stage, and the complications of the AHC disease (such as rupture, fistulization, hypertension, pheochromocytoma and related symptoms) [ 4 , 9 ].…”

“…In cases with an indication for surgical management, radical (pericystectomy, en-bloc adrenalectomy with cystectomy) or conservative (partial cystectomy) surgical options can be performed according to the experience of the center [ 4 , 9 ]. However, the choice of best surgical option is still controversial.…”

“…However, the choice of best surgical option is still controversial. Some authors suggest that any large sized AHC causes a destruction in the adrenal gland parenchyma and therefore, recommend that en-bloc resection of the gland together with the cyst should be performed [ 4 , 9 ]. The authors that favor radical approach favor en-bloc resection of the adrenal gland together with the cyst because there is often a lack of clear cut borders of the cyst from the adrenal glands.…”

“…On the other hand, some authors emphasize the importance of steroid hormones and favor adrenal gland sparing partial cystectomy. If the adhesions between the AHC and the surrounding tissue is too dense to allow any conservative surgery or if the disease recurred following a conservative surgical approach; than a radical operation can be performed provided that the contralateral gland is fully functional [ 4 , 9 ].…”