Suspected Regional Lymph Node Metastasis in Hepatic Alveolar Echinococcosis: A Case Report

Abstract

There is no direct evidence to support the existence of regional lymph node metastatic routes in hepatic alveolar echinococcosis, and only a few literature have been reported. There was a case of hepatic alveolar echinococcosis suspected of metastasis of regional lymph node in Clinical Center for Hydatidosis, Qinghai Province, China. The patient was a 24-yr-old male from pastoral area of Seda County, Sichuan Province, China in 2018. He was admitted to the hospital for physical examination and had no special discomfort. Preoperative examination showed liver occupancy and regional lymph node enlargement in the space between liver and stomach. Hepatectomy and lymph node resections were performed. Postoperative pathological results showed that both primary and metastatic lesion were of alveolar echinococcosis. Recovery of patient was good without complications and recurrence. In this case, metastasis was considered because the liver lesion was not directly connected to the lymph node. However, the case was still suspected due to the lack of pathological examination of other lymph nodes in the lymphatic return pathway. Regional lymph node metastasis may be one of the metastatic ways of alveolar echinococcosis.

Treatment of Complicated Hepatic Alveolar Echinococcosis Disease With Suspicious Lymph Node Remote Metastasis Near the Inferior Vena Cava-Abdominal Aorta: A Case Report and Literature Review

“…Lymph node metastasis may be one of the metastatic pathways of HAE, but there is no direct evidence for this, and the prevailing view is now that alveolar echinococcosis destroys the lymphatic vessels in the interstitial tissues of the liver lobules, invades the microlymphatic vessels and then falls off and drains to the local lymph nodes with lymphatic fluid. In 2019, one case of suspected regional lymph node metastasis of hepatic alveolar echinococcosis was treated in our centre ( 6 ). From the peripheral sinuses, it proliferates and differentiates to destroy the lymph nodes in the form of spores and eventually forms metastatic lesions of echinococcosis ( 9 ).…”

“…There have been a large number of literature reports on imaging studies of HAE and extrahepatic blood metastasis at home and abroad ( 5 ), but currently, there are few reports on the imaging characteristics of lymph node metastasis. The metastatic mechanism of HAE is still unclear ( 6 ). In particular, the enlarged lymph nodes are located between the inferior vena cava and adjacent to the abdominal aorta, and close to the kidneys and vertebral bodies; However, common enlarged lymph node are mostly located next to the hepatoduodenal ligament clinically.…”