Synchronous association of hepatocellular carcinoma and cystic echinococcosis with unusual pathology: report on diagnostic and pathological variability

Cystic hydatid disease or cystic echinococcosis (CE) is a globally endemic zoonosis caused by the larval cyst stage of the tapeworm Echinococcus granulosus. Concomitant presence of CE and hepatocellular carcinoma (HCC) is a rare clinical scenario. A 70-year-old male patient presented with acute abdominal pain to the surgical outpatient department. On evaluation, a cystic lesion with solid components and free fluid in the abdomen was observed, which led to multiple differentials in the working diagnosis. A CT showed the mass to have a delayed enhancement. Surgical exploration revealed a partially ruptured hydatid cyst with daughter cysts in the abdominal cavity and a solid-component mass lesion. We proceeded with a right partial hepatectomy. Pathological evaluation revealed a pale mass lesion with a large collapsed cyst. HCC with unusual dense fibrillar fibrosis and cystic interface with normal parenchyma was observed. This case connects the multimodal assessment of radiology, surgery and pathology.

Surgical and anesthetic management of primary dumbbell shaped spinal hydatid cyst in lumbar vertebra: A rare case report

Hydatid cyst is a very significant health problem in India. As recorded in the literature, majority of hydatid cysts are found in the liver followed by the lungs with an incidence rate of 60-70% and 10-15% respectively. Cystic hydatid disease in bones is seen in less than 4% of cases, with majority presenting in the spine. In this case report we have discussed primary intraspinal extradural hydatid cyst with paravertebral extension (dumbbell shaped) in lumbar vertebra which is a rarity. The diagnosis was established intraoperatively based on the findings with a follow up and review of literatures, along with its management.

Cystic hydatid disease (Echinococcus granulosus)

Cystic hydatid disease, caused by Echinococcus granulosus, is a zoonotic disease principally transmitted between dogs and domestic livestock, particularly sheep. Humans are infected when they ingest tapeworm eggs, with disease occurring in most parts of the world where sheep are raised and dogs are used to herd livestock. The most common clinical manifestations are cysts in the liver (typically presenting with hepatomegaly) and/or lung (presenting with cough, haemoptysis, and dyspnoea). Diagnosis is usually made on the basis of serological tests in combination with imaging techniques. Treatment options include surgery, chemotherapy with anthelminthic agents, or—for liver cysts—PAIR (puncture–aspiration–injection–reaspiration). Echinococcosis is a major public health problem in several countries. Control programmes have been aimed at educating dog owners to prevent their animals from having access to infected offal. Vaccines against sheep hydatidosis and the dog tapeworm stage are promising alternatives.

Unraveling oxidative stress response in the cestode parasite Echinococcus granulosus

Cystic hydatid disease (CHD) is a worldwide neglected zoonotic disease caused by Echinococcus granulosus. The parasite is well adapted to its host by producing protective molecules that modulate host immune response. An unexplored issue associated with the parasite’s persistence in its host is how the organism can survive the oxidative stress resulting from parasite endogenous metabolism and host defenses. Here, we used hydrogen peroxide (H2O2) to induce oxidative stress in E. granulosus protoescoleces (PSCs) to identify molecular pathways and antioxidant responses during H2O2 exposure. Using proteomics, we identified 550 unique proteins; including 474 in H2O2-exposed PSCs (H-PSCs) samples and 515 in non-exposed PSCs (C-PSCs) samples. Larger amounts of antioxidant proteins, including GSTs and novel carbonyl detoxifying enzymes, such as aldo-keto reductase and carbonyl reductase, were detected after H2O2 exposure. Increased concentrations of caspase-3 and cathepsin-D proteases and components of the 26S proteasome were also detected in H-PSCs. Reduction of lamin-B and other caspase-substrate, such as filamin, in H-PSCs suggested that molecular events related to early apoptosis were also induced. We present data that describe proteins expressed in response to oxidative stress in a metazoan parasite, including novel antioxidant enzymes and targets with potential application to treatment and prevention of CHD.