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

Abstract

Echinococcosis is a human-animal parasitic disease caused by Echinococcosis tapeworm larvae in humans. From a global perspective, it is mainly prevalent in the mid-high latitudes of the Northern Hemisphere, and it is a widespread infectious disease. Its form, host and release areas are slightly different. In clinical practice, Echinococcus granulosus (hepatic cystic echinococcosis) is the most common. Its growth mode is swelling growth and its metastasis is more common in implanted metastasis; However, hepatic alveolar echinococcosis (HAE) is rare. It has been reported that HAE can metastasize through the blood or lymph nodes, and its invasive growth pattern is known as “carcinoma”. At this time, it may be accompanied by invasion of the portal vein and inferior vena cava(IVC)or metastasis to distant organs outside the liver (such as lung, brain, lymph nodes). Most patients are in the middle or late stages, making treatment complicated. World Health Organization guidelines recommend radical resection of HAE; However, there is no consensus on lymph node dissection. To date, there have been no reports of cases of HAE accompanied by inferior vena cava-para-abdominal aortic suspected lymph node metastasis and infection. This article reports a clinical case of a complex HAE treated by the surgical method of “middle liver resection + abdominal enlarged lymph node resection + inferior vena cava repair”, and histological examination was performed to illustrate the differences in microscopic pathology of alveolar echinococcosis invading the liver and lymph nodes at different magnifications. This article reviews the relevant literature on HAE and derives the latest treatment methods for HAE to provide a reference for future clinical cases of similar alveolar echinococcosis and maximize the benefits of patients.

Fifty-five cases of hepatic alveolar echinococcosis combined with lymph node metastasis: A retrospective study

“…AE almost originates in the liver and is often diagnosed in the intermediate or advanced stage due to early insidious clinical symptoms. The growth characteristics of hepatic AE are aggressive and infiltrative, similar to malignant tumours, and can metastasise to surrounding tissues or distant organs via haematological and lymphatic pathways[ 17 - 19 ]. The incidence of lymph node metastasis is low (8.8% in this study), and its mechanism is unclear.…”

“…In addition, lymph node metastasis generally occurs in para-hepatoduodenal ligament, and it can further metastasise to the posterior pancreatic head, para-common hepatic artery, or the celiac trunk, and subsequently to the para-inferior vena cava and para-aorta abdominalis lymph nodes. Pancreatic head invasion and biliary obstruction occur as a result of rapid lymph node growth that metastasises to the posterior pancreatic head[ 17 ], thereby increasing the surgical difficulty and the risk of bleeding, biliary leakage, and pancreatic fistula. Therefore, the lymph nodes are cautiously stripped by the surgeon while clearing them in strict accordance with the anatomical approach.…”

Effect and mechanism of reactive oxygen species-mediated NOD-like receptor family pyrin domain-containing 3 inflammasome activation in hepatic alveolar echinococcosis

“…There is no doubt that choosing the correct treatment is key to improving the outcome of HAE. From previous studies[ 79 , 80 ], we have accumulated experience in the surgical treatment of HAE, and patients with blood vessel invasion (hepatic vein, portal vein, or inferior abdominal vein) and lymph node metastasis were still given the opportunity to undergo surgery. Similar to liver cancer lesions, HAE lesions are usually characterised by milky white surfaces.…”

The “serpent sign”—A classical sign in a nonclassical location: A case report of breast hydatid cyst

“…This rare zoonosis occurs mostly in endemic areas namely, the Mediterranean regions, Central Asia, China, North and East Africa, Australia, and South America [1] . The most common form found in humans is cystic hydatid disease, which is caused by Echinococcus granulosus [3] . Humans, as accidental hosts, get infected following the ingestion of echinococcal larvae.…”