S. Dieboldberger et al., CYTOLOGIC DIAGNOSIS OF ISOLATED PANCREATIC ALVEOLAR HYDATID-DISEASE WITH IMMUNOLOGICAL AND PCR ANALYSES - A CASE-REPORT, Acta cytologica, 41(4), 1997, pp. 1381-1386
BACKGROUND: Alveolar hydatid disease (AHD) is a rare and severe parasi
tic infection caused by the larval stage of the fox tapeworm, Echinoco
ccus multilocularis. AHD mainly involves the liver, and although it ma
y extend progressively to the pancreas, isolated pancreatic localizati
on has not been reported previously. CASE: A 68-year-old white female
presented with a multicystic mass in the pancreas. Fine needle aspirat
ion showed some protoscolices, free hooklets and fragments of laminate
d layer, which are pathognomonic features of echinococcosis. Serologic
analyses by an enzyme-linked immunosorbent assay using Em2plus antige
n showed high antibody reactivity of the patient's serum, which is ind
icative of an infection with E multilocularis. Diagnosis was finally c
onfirmed by molecular and immunologic analyses of the cytologic materi
al by polymerase chain reaction and direct immunofluorescence. CONCLUS
ION: This case illustrates the value of cytology in the identification
of echinococcosis, particularly when if involves extrahepatic sites,
where the risk of misdiagnosis may be related to its extremely rare oc
currence. Precise parasitologic typing of E multilocularis in endemic
areas is important.