PRIMITIVE HYDATIC CYST OF THE THIGH IN A YOUNG WOMEN:CASE REPORT AND LITERATURE REVIEW

A. Soleh, M. Haddou, E. Zim, M.A Benhima, I. Abkari and H. Saidi Service of Orthopedic Surgery and Traumatology, CHU Mohammed VI, Marrakesh, Morocco. ...................................................................................................................... Manuscript Info Abstract ......................... ........................................................................ Manuscript History Received: 25 March 2020 Final Accepted: 30 April 2020 Published: May 2020

Muscular hydatidosis is a rare condition that accounts for less than 1% of all hydatid cysts cases, its asymptomatic character and its slow evolution are the main cause behind delayed diagnosis. The use of imaging modalities such as MRI contributes significantly to the diagnosis. The Treatment is based on the surgical excision of the cyst.We report a rare case of30-year-old women with a primitive hydatid cyst of thethigh revealed byprogressive swelling.

Introduction:-
Hydatid disease is a common parasitic infection in endemicareas including North Africa, the Middle East, and South America, where it's considered apublic health problem. It's a zoonotic disease caused by tapeworms of the genus Echinococcus, transmitted accidentally to human by ingesting the parasite eggs [1]. Muscular localization is uncommon, its incidence is less than 0.5% of all cases. this can be explained by the presence of lactic acid in muscle tissue and oxygen deficiency preventing implantation and scolex development [2,3].
The silent evolution of the disease and the asymptomatic character lead to delayed diagnosis, discovery can be made accidentally or after complications [4].
We report the case of a primary hydatid cyst in 30-year-old women revealed by swelling of the medial compartment of the thigh.

Case presentation:
A 3O year-old housewife,without known pathological history, with notion of contact with dogs since childhood,presents for a mass of the internal face of the right thigh gradually increasing in volume for the past 6 months.Clinical examination found a patient in good general condition, apyretic, with a voluminous masse in the proximal part of medial compartment of the right thigh, measuring 13*6 cm, painless, without local inflammatory signs, fixed to the deep plan with homolateral subcentimetricinguinallymphadenopathies without signs of vascular or nervous compression ( fig.1). The abdominal and respiratory examination were normal.

Discussion:-
Echinococcosis is a cosmopolitan antropozoonosis common to humans and many mammals owing to the development of the larval or hydatic form of a dog tapeworm called ECHINOCOCCUS GRANULOSUS [5,6].
The muscle constitutes an environment unfavorable for the development of the larva. Hexacanth embryos arriving in the digestive tract are most often stopped by the liver and lungs acting as physiological filters. A very small number of embryos arrive in the large circulation where they spread throughout the body [7].Several muscle locations have been described, with the predominant involvement of the neck, trunk,and limbs, particularly those of the lower limb (quadriceps; sartorius and gluteus)[8].
Clinically, the symptomatology of muscular hydatidosis is not specific. It is usually a soft tissue tumor, with very slow evolution making the diagnosis challenging. symptoms are more manifest on occasion ofcomplications (bacterial infectionorrupture) [6,8].
The role of MRI is indisputable in the exploration of hydatid disease, it aids in the proper analysis of the mass (characteristics, dimensions, reports ...),MRI also helps to eliminate possible differential diagnoses and support a precise assessment of lesions before surgery [9,10].
Hydatid serology allows to retain diagnosis when it's positive, however, false negative results shows up in 80% of confirmed cases.Hyperosinophilia is usually absent except when a rupture occurs [7].
total pericystectomyremains the treatment of choice in the management of muscular hydatidosis,thesurgeonmust be careful to avoid intraoperative rupture of the cyst.The use of surgical gauze swabs immersed in scolicidal agent or hypertonic solution helps to prevent the spread of the parasite and reduce the risk of soiling, contamination and diseaserecurrence [4,11].
The use of albendazole has not been shown to be effective in cases of hydatid muscular cyst,despite this, it keeps an indication in inoperable patients or in recurrencecases. [12] Conclusion:-Muscular localization in hydatid disease is exceptional even in endemic countries, with insidious and non-evocative symptoms at the origin of frequently delayed diagnosis. The diagnosis relies essentially on MRI, while biology provides additional elements. The best treatment remains prevention and early diagnosis.