CYTOLOGIC DIAGNOSIS OF ISOLATED PANCREATIC ALVEOLAR HYDATID-DISEASE WITH IMMUNOLOGICAL AND PCR ANALYSES - A CASE-REPORT

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.