- Ankara Numune Education and Research Hospital, Neurosurgery Clinics, Ankara, Turkey
- Ankara University Medicine Faculty, Pathology Department, Ankara, Turkey
Ankara Numune Education and Research Hospital, Neurosurgery Clinics, Ankara, Turkey
DOI:10.4103/2152-7806.76281Copyright: © 2011 Ozdol C This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
How to cite this article: Ozdol C, Yildirim AE, Daglioglu E, Divanlioglu D, Erdem E, Belen D. Alveolar hydatid cyst mimicking cerebellar metastatic tumor. Surg Neurol Int 29-Jan-2011;2:13
How to cite this URL: Ozdol C, Yildirim AE, Daglioglu E, Divanlioglu D, Erdem E, Belen D. Alveolar hydatid cyst mimicking cerebellar metastatic tumor. Surg Neurol Int 29-Jan-2011;2:13. Available from: http://sni.wpengine.com/surgicalint_articles/alveolar-hydatid-cyst-mimicking-cerebellar-metastatic-tumor/
Background:Echinococcus multilocularis is a rare infestation in the world with a particularly increased incidence mainly in South America, Central Europe and Asia. Progression of alveolar Echinococcosis is more aggressive that can metastasize to lungs, brain and bones however brain involvement is usually rare with an incidence about 1%.
Case Description:We report a 23-year-old man with a cerebellar Echinococcosis multilocularis mimicking a metastatic cerebellar tumor. Suboccipital craniotomy was performed for gross total removal of the tumor. Histopathological specimens confirmed the diagnosis of Echinococcosis multilocularis.
Conclusion:Radical surgical excision should be recommended for single Echinococcosis multilocularis lesions particularly at infratentorial localization.
Keywords: Alveolar hydatid cysts, cerebellum, echinococcus, surgery, tumor
Hydatid disease is a parasitic infestation produced by Echinococcus granulosus (EG) and Echinococcus multilocularis (EM).[
A 23-year-old man presented with nausea, imbalance, occasional urinary and fecal incontinence and a severe headache for 1 month. The patient was a farmer with an unremarkable past experience for his relatives. Neurological examination was completely normal. Magnetic resonance imaging (MRI) demonstrated a left cerebellar mass lesion of 3×2×1.5 cm in size with marked peripheral contrast enhancement [
Albendazole (800 mg, bid, 3 cure, 28-day cycle followed by a 14-day albendazole-free interval) and cephotaxime (4 g, bid) were prescribed for postoperative treatment. A further operation was performed to resect the lesion in the lung a month after intracranial surgery. Postoperative early CT examination and MRI performed 6 months after surgery showed no recurrence.
Alveolar hydatid disease is a human infestation caused by the larval stage of EM. The natural definitive host is the canine, fox and cats while the intermediate hosts are usually small rodents and sometimes humans. The metacestode form of EM has a tendency to disseminate into other organs than liver by local spreading or hematogenous metastasis.[
The case we presented here had a left cerebellar lesion presumed to be a metastatic tumor which is quite uncommon. On the other hand, lesions in the liver and lung were misinterpreted as a primary source of metastasis which was another diagnostic conflict. The diagnosis of EM was confirmed with further histopathological examination.
Radical excision should be performed for all accessible surgical lesions. Several cycles of postoperative albendazole chemotherapy are almost always required. Gamma knife radiosurgery may be an alternative to surgery for patients with a high risk of surgery and anesthesia.[
Alveolar echinococcus should be considered in the differential diagnosis of cerebral tumors, particularly in endemic areas. Morbidity and mortality of cerebellar EM is higher than the supratentorial EM lesions due to high risk of complications. Cerebellar EM lesions should always be considered as surgical candidates due to herniation risk; however, surgical treatment for multiple cerebral lesions is usually palliative with alternative chemotherapeutics.
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