Radical resection of hepatic polycystic echinococcosis complicated with hepatocellular carcinoma: A case report

Abstract

BACKGROUND Hepatic cystic echinococcosis (CE) is an infectious zoonotic parasitic disease, and the insidious onset and slow progression of hepatic CE usually contributes to delayed diagnosis and treatment. Hepatocellular carcinoma (HCC) is the fourth most common malignant tumor. Co-existence of CE and HCC is fairly rare in clinical settings and the association between the two is still not well recognized. We report a case of hepatic CE complicated with HCC which are radically resected and raise some questions worth thinking about. CASE SUMMARY A 70-year-old man presented with upper abdominal pain. On admission, laboratory data showed that, except for hepatitis B surface antigen positivity, other indicators were normal, including alpha-fetoprotein. Computed tomography of the abdomen revealed a huge polycystic lesion in left liver lobe, without reinforcement after enhanced scanning and sized about 16.9 cm × 12.2 cm, which was considered a type II hydatid cyst. Multiple small solid lesions were also found adjacent to it, and thus it was highly suspected as a malignant tumor. After a multidisciplinary team discussion, the diagnosis of co-occurrence of hepatic CE and HCC was made. According to Romic classification, the case belongs to type IIb, and radical left hemi-hepatectomy was performed. Postoperative pathological examination revealed CE co-existence with well-differentiated HCC, consistent with the preoperative diagnosis. CONCLUSION With the combination of hepatitis B and obvious extrusion by large hydatid, the HCC risk of a patient might be higher.

Hepatocellular Carcinoma Complicated by Echinococcal Cyst: A Case Report

“…After a comprehensive database search, we found that there are 25 patients with HCC combined with hepatic hydatid disease (11). This patient is the 26th case, and the follow-up time is the longest after the operation of all cases.…”

Hepatocellular Carcinoma Presenting Simultaneously with Echinococcal Cyst Mimicking a Single Liver Lesion in a Non-Cirrhotic Patient: A Case Report and Review of the Literature

“…Although both HCC and CE are common liver lesions with high incidence rates in the general population, their synchronous occurrence is very rare in clinical practice, especially in a non-cirrhotic liver [ 6 , 7 , 8 , 9 ]. Thus, in a recent study among 3300 patients with CE, the concomitant presence of HCC was found in only 13 cases (0.39%) [ 8 ].…”

“…Thus, in a recent study among 3300 patients with CE, the concomitant presence of HCC was found in only 13 cases (0.39%) [ 8 ]. To our knowledge, there are 26 cases reported in the literature, with only four cases where HCC and CE presented as a single lesion [ 6 , 10 , 11 ]. Furthermore, in all previously reported cases where HCC and CE presented as a single lesion, CE had typical preoperative imaging findings and mostly presented as CE1 or CE2 lesions.…”

“…There is an increasing number of studies indicating that there might be a possible connection between Echinoccocus granulosus infection and malignant tumor development [ 6 , 12 , 13 ]. The procancerogenic effect of an echinococcus infestation related to the modulation of the host immune response has been pointed out in a few stuides [ 6 , 12 , 13 ].…”

“…With the popularization of tourism and migration of the population, CE is no longer just an endemic disease, but it has become a global health problem worldwide [ 4 ]. Even though both HCC and liver echinococcosis are common diseases, their coexistence, especially in the form of a coalescent lesion in a non-cirrhotic liver, is very rare in clinical practice [ 6 , 7 , 8 , 9 , 10 , 11 ]. The association between these two diseases is still not well-defined, with many contradictory reports in the previous literature [ 12 , 13 , 14 ].…”