Primary pancreatic echinococcosis: A rare mimicking of choledochal cyst

      A 32-year-old female presented with epigastric pain, post-prandial fullness, nausea and weight loss for 6 months. Examination revealed mild pallor. Her hemoglobin was 11 gm%, absolute eosinophil count was elevated, but LFTs were normal. Abdominal ultrasound abdomen showed a prominent common bile duct (CBD), a mildly dilated main pancreatic duct (MPD), and a 5.5 × 5.3 cm cystic lesion in the head of the pancreas compressing the portal vein (PV). CT of the abdomen showed a thin-walled hypodense lesion (4.8 × 4.1 × 4.7 cm) in the head of pancreas with dilated MPD and compression of PV and proximal duodenum (Fig. 1A). MRI of the abdomen with MRCP revealed a prominent CBD, dilated MPD with side branch dilatation and a well defined capsulated cystic lesion (4.4 × 4.6 × 4.0 cm) occupying thepancreatic head (Fig. 1B,C). Ultrasound guided FNAC from the pancreatic lesion revealed numerous fragments of Echinococcal scolices, hooklets, and calcareous corpuscles (Fig. 2A–C). Her hydatid serology (IgG) was strongly positive. She was started on oral albendazole and referred to the surgical gastroenterology department for definitive management.
      Fig 1
      Fig. 1(A) CT abdomen showing cystic lesion (arrow) in head of pancreas with compression of PV and proximal duodenum (arrowhead), (B)(C) MRI abdomen with MRCP showing prominent CBD, dilated MPD (arrow) with side branch dilatation and a well defined capsulated cystic lesion (thick arrow) occupying pancreatic head.
      Fig 2
      Fig. 2FNAC smears from pancreatic head lesion showing Echinococcal scoleces (thick arrows), row of hooklets (star), individual hooklets (arrows) and calcareous corpuscles (arrowhead) on (A) Haematoxylin and eosin stain (400x), (B) Giemsa stain (400x), and (C) PAP stain (200x).
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        • Wu Y.
        • Gong J.
        • Xiong W.
        • Yu X.
        • Lu X.
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