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American University of Beirut Medical Center Beirut, Lebanon
I read with interest the excellent pictorial review by Demos et al. [1] on cystic lesions of the pancreas. The gamut of pancreatic and parapancreatic cystic lesions (PPCL) is quite broad; the researchers briefly discussed parasites of the pancreas as a rare cause of PPCL. Other researchers have omitted hydatid cyst from the differential diagnosis in a review on cystic diseases of the pancreas [2].
Hydatid cyst may develop in almost any organ of the body. Hydatid cyst of the pancreas (Figs. 1A, 1B, and 1C) is rare: it has been reported to affect the pancreas in 0.25% of patients with hydatid disease [3, 4]. It is important to consider hydatid cyst in the differential diagnosis of PPCL. This is particularly true for patients living in regions where the disease is endemic, but it may be also encountered in immigrants to developed countries where the disease may not be prevalent or may not exist. In this category of patients, serologic tests and a search for scolices and hooklets by an alerted cytologist at microscopic analysis of the fine-needle aspirate may be added to the diagnostic workup of PPCL with atypical imaging features.
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References
Loyola University Medical Center Maywood, IL 60153
Thank you for your interest in our review article [1]. We did, as you indicated, include parasitic infections in the discussion of the differential diagnosis of infections that can cause cystic pancreatic lesions. A case report of Echinococcus granulosis was referenced but we have not encountered any patient with hydatid disease of the pancreas to illustrate the disease. We appreciate the contribution of your imaging studies and your admonition to consider the possibility of a hydatid cyst when a cystic pancreatic lesion is discovered on an imaging study.
Primary hydatid disease of the pancreas is indeed rare, accounting for only 1 of 357 cases of hydatid disease seen over a 20-year period in a report from Kuwait [2], as you cited in your letter. Hydatid disease, however, is a common condition worldwide and continues to be a high-incidence societal problem in many countries of all continents [3]. This is concretely indicated by the ongoing efforts of the World Health Organization Informal Working Group on Echinococcosis that was founded in 1985. This Working Group plays a central role in acting as an information exchange for research regarding the diagnosis, treatment, and prevention of disease caused by Echinococcus organisms [4].
Radiologists in any part of the world may encounter patients with this disease because of the large number of infected patients and the ever-increasing mobility of the world population. The case illustrated here further emphasizes the necessity for the radiologist to be a true consultant, confer with the referring physician, and obtain a history as well as other clinical and laboratory data when a patient is found to have a cystic lesion of the pancreas.
References
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