Cytodiagnosis of hydatid disease presenting with Horner's syndrome - A case report

BACKGROUND: The diagnosis of echinococcosis is based on clinical, radiologi c and serologic findings. Fine needle aspiration (FNA) is useful hi evaluat ing the lesion when the presentation is atypical. We report a case of hydat id cyst at the lung apex in which the diagnosis was made on FNA, with no ad verse reaction to the aspiration. CASE: A 30-year-old male, a chronic smoker, presented with pain radiating t o the medial two fingers of the right hand for two years. He also had miosi s and ptosis of the right eye and anhidrosis of the right side of the face. There was wasting of small muscles in the right hand. Magnetic resonance i maging revealed a hyperintense mass at the apex of the right lung, thoracic inlet and adjacent vertebral bodies. A clinical diagnosis of Horner's synd rome due to pancoast tumor was rendered. Ultrasound-guided FNA showed proto scolices, scattered hooklets and bits Of acellular laminated membrane, char acteristic of echinococcosis. Surgical excision Of the Cyst Was done. Gross and histopathologic examination of the excised cyst confirmed the diagnosi s. CONCLUSION: FNA, though traditionally contraindicated, is a highly desirabl e, rapid, noninvasive diagnostic mode for echinococcosis. In view, of its p athognomonic cytomorphologic features and numerous reports on cytodiagnosis in the literature, it is time to evaluate the diagnostic benefits and weig h the risks against the advantages of the technique.