Recurrent primary isolated hydatid cyst of spleen with giant splenic lipoma mimicking liposarcoma: A case report.

INTRODUCTION: Splenic hydatid cysts account for approximately 1 % of all cases, and represent 0.5 % to 4 % of abdominal hydatid cysts. Reported recurrence rates vary across the literature, ranging from 4.6 % to 22 %. Primary hydatid cyst of spleen is rare even in endemic areas, comprising only 2 % of all splenic hydatid cyst. A Concurrent recurrent primary isolated splenic hydatid cyst with a giant splenic lipoma has never been reported in the literature till date.

CASE PRESENTATION: A 50-year-old female, with a history of splenic hydatid cyst enucleation 4.5 years back, presented with complaints of pain in left upper quadrant of abdomen for the past 2 weeks. Clinical examination revealed mild tenderness over left hypochondrium, with no organomegaly or palpable lump. Contrast Enhanced Computed Tomography (CECT) of the abdomen and pelvis revealed a splenic hydatid cyst along with a lesion suggestive of either lipoma or liposarcoma, for which total splenectomy was done.

DISCUSSION: Microscopic spillage of viable parasites or failure to remove the cyst completely during index surgery is responsible for the recurrence of hydatid cyst. A negative serology does not exclude the diagnosis, as only 54.8 % of patients with early or inactive cysts exhibit a positive serological reaction. Similarly, the distinction between giant lipoma and well differentiated liposarcoma, radiologically, is a diagnostic dilemma.

CONCLUSION: Although splenic hydatid cysts can be managed with either total splenectomy or spleen-preserving procedures, total splenectomy remains the definitive treatment in cases of recurrence or when associated with other splenic pathologies.