Primary hydatid cyst of the supraspinatus muscle: complete removal of the germinal layer and cytodiagnosis by fine-needle aspiration.

Primary hydatid disease of the skeletal muscle without systemic involvement is rare. The purpose of this report is to document the novel clinical presentation and the interesting facets of fine-needle aspiration in a case of hydatid disease. It was a case of primary hydatid cyst of the left supraspinatus muscle in an Indian woman living in Kuwait, which was clinically diagnosed as a lipoma. Fine-needle aspiration (FNA) yielded 2 ml of clear fluid with white particulate material. The cytocentrifuged smears prepared from the aspirated fluid showed many scolices, occasional laminated cyst wall fragments and numerous hooklets. The laminated cyst wall and scolices were PAS positive. Trichrome staining imparted a demon-head-like appearance to the scolices. The cytodiagnosis of hydatid cyst was corroborated by histopathological examination of an excised whitish membrane and an irregular cystic fragment, which showed parallel laminations without germinal layer, and skeletal muscle with granulomas and a dense eosinophilic infiltration, respectively. Quantitative serological (indirect hemagglutination) test on blood sample collected 9 days after the excision of the cyst showed insignificant antibody titer to Echinococcus sp. and after 6 weeks the antibodies were completely absent. CT scan of the chest and abdomen performed 7 weeks after removal of cyst showed no evidence of visceral hydatid cyst.