Fine Needle Aspiration Biopsy of Hydatid Cysts

Until very fine aspiration needles became available, the percutaneous aspiration of fluid from hydatid cysts was generally regarded as extremely unwise because of the risk of anaphylactic reactions and possible dissemination of the disease. However, experience with unintended biopsies, where the diagnosis of hydatidosis was not suspected, has shown that complications, if they occur, are usually minor (urticaria, asthmatic symptoms, rash); anaphylactic shock can usually be medically controlled if the operator is prepared for this rare possibility. Today, careful fine needle aspiration biopsy (FNAB) can be recommended, especially in patients where a precise pathological diagnosis is crucial, and can be combined with treatment (Figs. 3.149, 3.150, 3.151, 3.152). Dissemination can be prevented by prophylactic medication with mebendazole or albendazole at least 12 hours, or preferably for 2 to 4 days, prior to biopsy.

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Fig. 3.149 Diagnostic parasitic material recovered by fine-needle aspiration biopsy (FNAB) from hydatid cysts. (A) A cluster of hydatid scolices (X200). (B) Pieces of laminated parasitic membrane (arrows). (H&E X200). (C) Fresh living embryo demonstrating invaginated head with crown of hooklets (X300). (Courtesy of Dr. von Sinner et al and Acta Radiologica, 1995).

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Fig. 3.150 A 55-year-old Saudi man admitted with mistaken diagnosis of bronchogenic carcinoma in the left upper lobe. (A) CT of chest during biopsy of the left upper lobe mass containing pockets of air. FNAB X3 showed pus but no evidence of malignant cells, suggesting a lung abscess. (B) After a second look the FNAB sample revealed pathognomonic hooklets (arrows) for hydatid disease (H&E X300). (Courtesy of Dr. von Sinner et al and Acta Radiologica, 1995).

Fig. 3.151 A 50-year-old Saudi man with a mass destroying the lumbar spine with extension to the spinal canal and paravertebral area; the mass contains daughter cysts. FNAB showed hydatid material. (Courtesy of Dr. von Sinner et al and Acta Radiologica, 1995).

Fig. 3.152 Flow chart for the use of FNAB in suspected cystic hydatid disease. (Courtesy of Dr. von Sinner et al and Acta Radiologica, 1995).

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