Multiple Schwannomas Masquerading as a Disseminated Hydatid Disease in a Female- A Diagnostic Dilemma-A Case Report

Abstract

Context: Hydatid disease or Cystic echinococcosis (CE), is caused by infestation with larva of Echinococcus granulosus, a ~2–7 mm long tapeworm found in dogs (definitive host) cattles and pigs (intermediate host) [1]. Disseminated abdominal hydatidosis, is a rare presentation of hydatid disease [3]. Secondary peritoneal disease is a consequence of either traumatic or iatrogenic rupture, as in case, of a primary hepatic or splenic cyst [2]. Schwannomas are neurogenic tumours originating from many different organs throughout the body, but rarely in the gastrointestinal tract [8]. Schwannomas are usually benign, only occasionally malignant [11]. Unlike most of the tumours, making pathologic differential diagnosis of schwannoma from other benign conditions is an exceedingly difficult endeavour preoperatively. Confirmation of diagnosis of schwannoma is by pathological and immunohistochemical examination of resected surgical specimens. Case Presentation: A 40-year-old woman who was initially diagnosed clinically and radiologically as case of multiple hydatid cysts with cholelithiasis underwent surgery and it was later found to be cholelithiasis with multiple schwannomas treated successfully with complete excision. Individually both diseases are themselves an uncommon entity separately. To the best of our knowledge multiple intra-abdominal Schwannomas mimicking as disseminated hydatid disease has never been reported in literature. We herein present such a case. Conclusion: Hydatid disease needs be kept in the differential diagnosis of all cystic masses in all anatomic locations, more so in areas where the disease is considered endemic. The ideal treatment is the complete excision of the cyst without any spillage undercover of anti-helminthic. But concomitantly high index of suspicion must also be kept for other cystic or solid lesions in cases of unusual presentations or atypical findings on imaging studies and histopathological studies must be undertaken to confirm the diagnosis, as in this case which was found to be multiple Schwannomas.