Daughter cysts in a cyst of the liver: hepatic echinococcosis

A 58-year-old male from North-East China who was an immigrant worker for 4 years, presented with a cystic mass of the liver that was incidentally detected on abdominal ultrasound. Blood liver battery showed no abnormal findings and stool helminth was negative. Serologic markers for hepatitis A, B, and C virus were all negative and blood levels of tumor markers including α-fetoprotein, carcinoembryonic antigen, and carbohydrate antigen 19-9 were within normal limits. Computed tomography (Fig. 1A, coronal view) and magnetic resonance imaging (Fig. 1B, axial view) of the liver revealed an approximately 9 cm-sized non-enhancing exophytic cyst with several daughter cysts, a radiologic finding typical of cystic echinococcosis of the liver, on the left lobe lateral segment of the liver. Surgical resection was performed for complete removal. Grossly, the mass showed a 9.5 × 9.5 × 8.5 cm-sized yellow ish unilocular cyst containing several variable-sized cysts (Fig. 2A). Microscopically, a brood of capsules containing degenerated protoscolices of Echinococcus granulosus (arrows) were scattered on the laminated cystic walls (Fig. 2B). After uncomplicated postoperative recovery, the patient was discharged with albendazole 400 mg twice daily for 4 weeks, with encouragement to consume fatrich meal diet. Hepatic echinococcosis, also called hydatid disease of the liver, is a representative zoonosis that contributes to major health public problem in several countries. It usually occurs as a result of infection by larval stage of species E. granulosus, genus Echinococcus, via Daughter cysts in a cyst of the liver: hepatic echinococcosis