Revista de citología e histología

Intraoperative Finding of Hepatic Hydatid Cyst with Fine Needle Aspiration: A Case Study with AFB and GMS Special Stains Highlighting the Echinococcal Hooklets

Abstract

Ozlem Fidan-Ozbilgin, Stefan E Pambuccian, Swati Mehrotra and Güliz A Barkan

We report a case of an incidentally detected calcified liver lesion that was diagnosed as a hydatid cyst using fineneedle aspiration. The aspirated fluid from the thickened calcified cystic hepatic mass was clear. The cell block sections showed laminated membranes Echinococcus hooklets on the Hematoxylin and Eosin (H&E) stain as well as the AFB and GMS special stains. While needle aspiration may not indicated in cases of suspected hydatid disease, it may serve as a valuable diagnostic tool in cases of tumoral masses in which there is no clinical and radiological suspicion on this diagnosis. Awareness of the fact that the hooklets stain with AFB and GMS stains can facilitate the identification of the characteristic hooklets, which may be rare and can otherwise require painstaking search under lighting conditions that increase their refractivity. Similarly, awareness of the fact that PAS, AFB and GMS stains highlight the laminated membrane fragments, which may otherwise be missed or misinterpreted as mucus or artifacts, facilitates their recognition and orients the diagnosis towards the correct diagnosis.