Radu Virgil COSTEA, Hasuna MOHSEN, Octavia Cristina RUSU, Alexandru CHIRCA and Stefan Ilie NEAGU

ABSTRACT

Hydatid disease is caused by an infestation with the tapeworm Echinococcus. Each parasite can produce thousands of eggs with oncospheres that can migrate to the liver or lungs and rarely to other sites, including muscles. The aim of this case study is to describe a rare case of a patient with an atipical hydatid cyst location and to raise awareness of this condition. We present the case of a 28-year-old female patient admitted in our clinic with a lump in her right calf who underwent surgical excision, hydatid cyst being suspected due to the aspect of the thin cyst wall membrane, confirmed by hystopathological examination. The post-operative course was uneventful and the patient was discharged five days later with medical treatment with albendazole. In conclusion, hydatid disease must be kept in mind as a differential diagnosis when facing a muscle cystic mass, even though it is very rare, and a good medical and surgical management may determine a permanent cure.

Keywords: echinococcus, muscle hydatid cyst, albendazole

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Octavia Cristina RUSU, Radu Virgil COSTEA, Cristian Constantin POPA, Andreea ILIESIU, Adrian DUMITRU, Gabriel BECHEANU and Stefan Ilie NEAGU

ABSTRACT

Introduction: Neuroendocrine tumors are derived from cells that have the unique ability to synthesize, store and secrete a variety of metabolically active substances, peptides and amines, characteristic of the tissue of origin, which can cause distinct clinical syndromes.

Material and methods: We present the case of a 58-year-old patient diagnosed and surgically treated in January 1996 for stage III inferior rectal cancer, who was readmitted after 18 years presenting persistent diarrheic syndrome and asthenia. Investigations performed (abdominal CT) showed multiple liver metastases, initially suspected as being related to the rectal cancer. Biopsy of liver metastases and pathological and immunohistochemical analysis demonstrated the neuroendocrine origin (moderately differentiated neuroendocrine tumor). Seven months after the identification of liver metastases and after initiation of oncological therapy with Interferon and Somatostatin, the patient presented severe hypoglycemia (serum glucose 13-70 mg/dl) proved to be due to insulin-like factors (serum insulin level 64.9 μU/ml) secreted by metastases. Due to the aggressive evolution of neuroendocrine tumor, with multiple episodes of severe hypoglycemia, resistant to treatment, the patient died approximately one month after the occurrence of hypoglycemic episodes.

Conclusions: Despite comprehensive tests (abdominal CT scan, colonoscopy, bone scintigraphy and PET/CT), the primary site of the neuroendocrine tumors remained unknown.

Keywords: rectal cancer, neuroendocrine tumor, insulin-like factors, severe hypoglycemia

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