The Winner of this week’s Blog is Dr. Jigar Patel, PGY1
CONGRATULATIONS!!! Answers are below—
Winner of $25 gift card
Qustions Courtesy American College of Gastroenterology
Answer Qs 1:
It is a calcified Hydatid Cyst
E. Continued observation with serial cross-sectional imaging to assess for stability
Explanation: This patient presents with an incidentally-noted, large, calcified cystic lesion of the liver. Echinoococcus is endemic to large parts of the Middle East, China and Latin America. The presence of daughter cysts as seen on the ultrasound strongly suggests the diagnosis of echinococcal (hyatid) liver cysts. Humans are accidental hosts and do not play a role in the life-cycle of the organism.
The natural history of hepatic echinococcal cysts is variable, with some patients having stable or slow-growing cysts and others presenting with spontaneous rupture and anaphylaxis. Calcification in the wall of the cyst suggests an inactive cyst. Asymptomatic calcified cysts frequently remain symptom free and treatment is not indicated unless there is evidence of growth (suggesting cyst activity) or the patient develops symptoms.
Ultrasound-guided aspiration (choice A) is incorrect because simple aspiration can lead to cyst content spillage and anaphylaxis. Oral metronidazole (choice B) is the therapy of choice for amebic liver abscesses caused by Entamoeba histolytica. Oral albendazole (choice C) is indicated for patients with inoperable cysts or for cysts in multiple organs. Medical therapy is not indicated for patients with calcified cysts. Surgical resection (choice D) is not indicated for patients with calcified cysts.
Qs 2:
MALT Lymphoma
December 31, 2009 at 2:51 am
Having suffered from lymphoma, this was good to see. Thank you for this.
August 6, 2009 at 4:17 pm
good job Patel
August 3, 2009 at 10:27 am
The diagnosis is Hydatid Cyst also known Echinococcos Granulosum, my recom is that surgery remains the primary treatment and the only hope for complete cure.
HD cysts are very common in this patient population. I will obtain a surgery consult for either a cyst aspiration or depending on the extend / aggressiveness a hepatectomy.
Even though patient is not symptomatic, at this point if cysts burst chances for anaphylactic shock are high. So Ill go with
d. Surgical consultation for right partial hepatectomy
Question 2:
MALTOMA, like Dr.Patel states the association with autoinmune disease is paramount.
August 1, 2009 at 8:38 pm
1) surgical resection
treatment is needed
multiple hydatic cysts with all the family not a option for percutaneous drainage
chemotherapy is ok in small cyst, mostly adjuvant, but this is large7-8 cm
2)MALT
August 1, 2009 at 8:34 pm
1. Echinococcus Granulosus causing hydatid disease as humans are intermidiate hosts to the tapeworm.
Treatment is surgical removal of the cysts and then oral Albendazol for 3-6 months (c).
2. Autoimmune atrophic gastritis.
August 1, 2009 at 12:08 am
A.1 ( E ) Continued observation with serial cross-sectional imaging to assess for stability.
The USG shows Hydatid cyst (caused by the parasite Echinococcus Granulosus).
Simple aspiration would be catastrophic since the cyst fluid is extremely allergenic and can cause an anaphylactic reaction. Extreme caution has to be taken even during surgical removal of the cyst so that the cyst fluid does not spill over into the body. Usually, calcified cysts are inactive and treatment is not indicated unless the patient has some symptoms.
A.2 It can a MALT lymphoma or chronic lymphocytic gastritis. MALT lymphomas are probably associated with chronic autoimmune diseases like vitiligo, Hashimoto’s thyroiditis, Sjogren’s syndrome.