Evaluation of intrahepatic manifestation and distant extrahepatic disease in alveolar echinococcosis

Background The main endemic areas of alveolar echinococcosis (AE) are in central Europe and western China. The infiltration of intrahepatic vascular and bile ducts as well as extrahepatic disease can lead to complications and may increase morbidity in AE. Purpose To evaluate the vascular/biliary involvement of hepatic alveolar echinococcosis (HAE) and distant extrahepatic disease at each of four locations in Germany, France, and China. Material and Methods Contrast-enhanced abdominal magnetic resonance imaging (MRI) scans of patients with HAE, 200 in total, were evaluated by five examiners. AE liver lesions were classified according to Kodama’s classification. Furthermore, distant extrahepatic manifestations were documented with additionally performed imaging modalities. Vascular/biliary involvement of hepatic manifestations as well as the presence of extrahepatic manifestations were correlated with the respective Kodama type of the liver lesion. Results Distant extrahepatic AE manifestations were significantly more frequent in China than in Europe (12/100 vs. 3/100; Fisher’s exact test: P=0.0286). A significant relationship exists between presence of distant extrahepatic disease manifestation and size of the AE liver lesion (132.53 ± 48.65 vs. 92.49 ± 50.06; P = 0.0030). Vascular/biliary involvement is significantly more frequent in China than in Europe (86/100 vs. 65/100; χ2 = 11.92; P = 0.0006). Vascular/biliary involvement depends on lesion size (111.10 ± 47.44 vs. 47.36 ± 24.36; P<0.0001). Different types of AE liver lesions are associated with differences in vascular/biliary involvement and extrahepatic manifestations. Conclusion Vascular/biliary involvement and presence of distant extrahepatic manifestations depend on size of the HAE lesions and are more frequently detected in China. Different MRI morphological patterns influence vascular/biliary involvement and the occurrence of distant extrahepatic manifestations.

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Turbidimetric Estimation of Serum Colloids in Extrahepatic Disease

Gastroenterology ◽

10.1016/s0016-5085(49)80123-5 ◽

1949 ◽

Vol 12 (3) ◽

pp. 409-418 ◽

Cited By ~ 2

Author(s):

Frank T. Maher ◽

Frank D. Mann

Keyword(s):

Extrahepatic Disease

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Surgical treatment of alveolar echinococcosis: a single centre experience and systematic review of the literature

Perspectives in Surgery ◽

10.33699/pis.2019.98.4.167-173 ◽

2019 ◽

Vol 98 (4) ◽

pp. 167-173

Keyword(s):

Case Report ◽

Echinococcus Multilocularis ◽

Alveolar Echinococcosis ◽

Lymphatic System ◽

Surgical Intervention ◽

Clinical Symptoms ◽

Safety Margin ◽

Surgical Removal ◽

Single Centre Experience ◽

Therapeutic Procedures

Introduction: Alveolar echinococcosis (AE) is a zoonosis caused by Echinococcus multilocularis. AE is primarily localised in the liver. Echinococcus multilocularis imitates tumour-like behaviour. It can metastasise through blood or lymphatic system to distant organs. Echinococcosis often remains asymptomatic due to its long incubation period and indistinct symptoms. Clinical symptoms are determined by the parasite’s location. Diagnosis of echinococcosis is based on medical history, clinical symptoms, laboratory tests, serology results, imaging methods and final histology findings. Surgical removal of the cyst with a safety margin, followed by chemotherapy is the therapeutic method of choice. Case report: We present a case report of alveolar echinococcosis in a thirty-year-old female patient in whom we surgically removed multiple liver foci of alveolar echinococcosis. The disease recurred after two years and required another surgical intervention. Conclusions: Alveolar echinococcosis is a disease with a high potential for a complete cure provided that it is diagnosed early and that the recommended therapeutic procedures are strictly adhered to.

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Clinical and Imaging Findings in the Alveolar Echinococcosis

Current Medical Imaging Formerly Current Medical Imaging Reviews ◽

10.2174/157340509789000615 ◽

2009 ◽

Vol 5 (3) ◽

pp. 190-195 ◽

Cited By ~ 1

Author(s):

Dilek Emlik ◽

Kemal Odev ◽

Demet Kiresi ◽

Serdar Karakose ◽

Mehmet Gok

Keyword(s):

Alveolar Echinococcosis ◽

Imaging Findings

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Metastases of Alveolar Echinococcosis to the Skin, Pleura, Ribs, and the Xiphoid Process: A Case Report

Archivos de Bronconeumología (English Edition) ◽

10.1016/j.arbr.2020.02.010 ◽

2021 ◽

Vol 57 (3) ◽

pp. 228

Author(s):

Adem Karaman ◽

ímer Araz ◽

Ahmet Koru

Keyword(s):

Case Report ◽

Alveolar Echinococcosis ◽

Xiphoid Process

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Severe hypernatremia in children after surgical resection of hepatic echinococcosis: a rare and potentially fatal complication

BMC Pediatrics ◽

10.1186/s12887-021-02607-1 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Kewei Li ◽

Yijun Liu ◽

Xiaolong Xie ◽

Rongxing Zhou ◽

Bo Xiang

Keyword(s):

Alveolar Echinococcosis ◽

Disease Free Survival ◽

West China Hospital ◽

Free Survival ◽

West China ◽

Neurologic Sequelae ◽

Scolicidal Agent ◽

Hepatic Echinococcosis ◽

Disease Free

Abstract Background Using effective scolicidal agents intraoperatively is essential to lessen the recurrence rate of hepatic echinococcosis. However, severe hypernatremia may occur after hypertonic saline (HS) has been applied as the scolicidal agent. The aim of this study is to report on pediatric patients with severe hypernatremia after hepatic echinococcus surgery. Methods Patients who presented to West China Hospital between January 2010 and February 2017 were retrospectively analyzed. Children under 16 years with echinococcosis treated by resection were included in the study. Results A total of 26 children were enrolled in this study, including 16 boys and 10 girls with a median age of 8 (2–16). 24 (92.3 %) cases were cystic echinococcosis (CE) and two (7.7 %) were alveolar echinococcosis (AE). According to Clavien-Dindo classification of surgical complications, the complication rate of all 26 patients was 19.2 %, among which three cases belonged to Grade I, one to Grade III b and 1 to Grade IV. Two children encountered severe hypernatremia (sodium: 155.3 mmol/L and 190.0mmol/L). Data showed classic clinical features of severe hypernatremia: profound and persistent bradycardia, hypotension and coma. After treatment, they recovered well without any neurologic sequelae. All patients were followed up regularly for a median time of 38 months (range 4–89 months); the overall disease-free survival was 100.0 %. Conclusions HS irrigation of intra-abdominal echinococcosis may cause acute hypernatremia and severe consequences. Diagnostic suspicion and early intervention are vital tools for avoiding morbidity and mortality.

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PET/CT helps to determine treatment duration in patients with resected as well as inoperable alveolar echinococcosis

Parasitology International ◽

10.1016/j.parint.2021.102356 ◽

2021 ◽

pp. 102356

Author(s):

Lars Husmann ◽

Urs J. Muehlematter ◽

Felix Grimm ◽

Bruno Ledergerber ◽

Michael Messerli ◽

...

Keyword(s):

Treatment Duration ◽

Alveolar Echinococcosis ◽

Pet Ct

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Impact of Extrahepatic Metastases on Overall Survival in Patients with Advanced Liver Dominant Hepatocellular Carcinoma: A Subanalysis of the SORAMIC Trial

Liver Cancer ◽

10.1159/000510798 ◽

2020 ◽

Vol 9 (6) ◽

pp. 771-786

Author(s):

Kerstin Schütte ◽

Regina Schinner ◽

Mathias P. Fabritius ◽

Melina Möller ◽

Christiane Kuhl ◽

...

Keyword(s):

Hepatocellular Carcinoma ◽

Median Survival ◽

Pulmonary Metastases ◽

Study Entry ◽

Extrahepatic Disease ◽

Advanced Hepatocellular Carcinoma ◽

Significant Difference ◽

Distant Organ ◽

Extrahepatic Metastases ◽

The Impact

Introduction: Extrahepatic spread is reported as a prognostic factor in patients with advanced hepatocellular carcinoma (HCC) receiving systemic therapy. However, clinical studies have reported conflicting results for the clinical impact of the pattern of tumor progression during treatment and the role of new extrahepatic metastases in length of survival. Objective: To evaluate the impact of extrahepatic metastases on survival in patients with HCC treated with sorafenib or with a combination of sorafenib and selective internal radiation treatment (SIRT). Methods: SORAMIC is a randomized, controlled trial comprising diagnostic, local ablation, and palliative cohorts. In the palliative cohort, patients not eligible for transarterial chemoembolization (TACE) were randomized 11:10 to SIRT plus sorafenib (SIRT + sorafenib) or sorafenib alone. This exploratory subanalysis evaluated the impact of extrahepatic metastases on survival. Results: In the intent-to-treat cohort, 216 patients were randomized to SIRT + sorafenib and 208 to sorafenib alone. Seventeen patients with distant organ metastases (bone, n = 11; adrenal glands, n = 5; peritoneum, n = 1) and 262 without distant metastases at study entry were analyzed in this substudy. Patients with (Group A) and without (Group B) distant organ metastases at study entry presented with a median survival of 11.3 and 14.8 months, respectively (p = 0.2807). During follow-up of patients with no organ metastases at baseline, extrahepatic disease progression occurred in 50 patients (19.1%). No statistically significant difference in survival was observed between patients without extrahepatic progression and those with new extrahepatic disease during treatment (14.8 vs. 14.9 months; p = 0.6483). Development of new pulmonary metastases during treatment significantly shortened median survival (7.6 vs. 15.0 months, p = 0.0060). Conclusions: This subanalysis of the SORAMIC trial suggests that in patients with liver-dominant advanced HCC, metastases to distant organs with the exception of pulmonary metastases do not in general exert a negative impact on patient prognosis. The choice of palliative treatment should incorporate a personalized analysis of the pattern of tumor distribution.

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