Table 1.
Diagnostic features of human alveolar echinococcosis cohort patients in Hungary (2003–2018)
| case no. | 1 | 2 | 3 | 4 |
|---|---|---|---|---|
| onset of symptoms or first findings | 09.2001 | 09.2003 focal hepatic lesions during imaging studies | 10.2004 | 08.2008 |
| initial symptoms and physical findings | epigastric pain, vomitus | asymptomatic, hepatomegaly | epigastric and right hypochondriac pain | jaundice, pruritus, right hypochondriac pain |
|
liver function tests: liver enzymes (U/l); sebi (μmol/l) |
normal | – | elevated GGT (104) | elevated ALP (1254), GGT (570) and sebi (202) |
|
initial US/CT/MRI (date) radiomorphology largest diameter of AE lesion(s) in mm |
US (09.2001) – 15 mm hyperreflective area in SIV CT (03.2003) –echinococcal cysts inboth lobes, number, size, localization unknown |
US (04.2005) and CT (08.2009) – 10 typical AE lesions in SIV, SV, SVI, SVIII, 10–30 mm, largest lesion 50 mm |
US (10.2004), CT (11.2004) and MRI (06.2005) – one typical AE lesion – 100 mm –in SV, SVI, SVII, SVIII |
US (08.2008) – typical central AE lesion −110 mm – in the dichotomy of hepatic common duct, SIV, SV |
| preliminary diagnosis | echinococcosis |
liver tumor, echinococcosis |
liver tumor, HCC, liver metastasis |
liver tumor, adenocarcinoma |
| serology Westernblot (Ldbio) P3 Em | positive | positive | positive | positive |
| core biopsy/surgical sample/autopsy | – | – |
core biopsy (2x) surgical sample (1x) |
core biopsy during PTC, surgical sample |
| histopathology/IH/PCR | – | – |
histopathology and PCR |
histopathology and PCR |
| type of diagnosis | probable | probable | confirmed | confirmed |
| month.year of diagnosis | 04.2003 | 04.2004 | 07.2005 | 09.2008 |
| latency of diagnosis (in months) | 20 | 8 | 10 | 2 |
| extrahepatic localizationat the time of diagnosis | no pulmonary lesion | no pulmonary lesion |
peritoneal dissemination no pulmonary lesion |
no pulmonary lesion |
| PNM at diagnosis | PxNxMx | P1N0Mx | P2N1Mx | P3N0Mx |
| case no. | 5 | 6 | 7 | 8 |
| onset of symptoms orfirst findings |
2002 asymptomatic hepatic cyst; patient denied investigations |
11.2011 | 12.2012 | 11.2012 |
| initial symptoms andphysical findings |
right hypochondriac pain, vomitus, anasarca, palpable liver tumor (12.2010) |
right hypochondriac pain, weightloss, hepatomegaly |
asymptomatic, mild hepatomegaly |
asymptomatic |
|
liver function tests: liver enzymes (U/l); sebi (μmol/l) |
AST (177), ALT (177), GGT (920), ALP (1152), sebi (16) |
GGT (105), ALP (543), sebi (7,1) |
GGT (335), ALP (999), sebi (7,3) |
normal |
|
initial US/CT/MRI (date) radiomorphology largest diameter of AE lesion(s) in mm |
US (12.2010) and CT (01.2011) two interconnected pseudocystic AE lesionsin both lobes – 130 mm and 120 mm – dilatated intrahepatic bileducts |
US (11.2011) and CT (12.2011) typical AE lesion in SV, SVI −83 mm – and some smaller lesions |
CT (04.2013) typical AE lesion in right lobe, 135 mm, periportal biliary and vascular involvement (right v. portae, v. hepatica intermedia) |
CT (11.2012) and MRI (08.2014) multiplying small calcified lesions in SV, SVI, SVII, SVIII |
| preliminary diagnosis | metastasis, tumor, CE | hemangioma, tumor, CE |
cholangiocellular carcinoma |
liver metastasis |
| serology Westernblot (Ldbio) P3 Em | positive | equivocal | positive | negative (postoperatively 2x) |
| core biopsy/surgical sample/autopsy | parasitology and cytology from lesion fluid (FNAB) negative | corebiopsy | corebiopsy | corebiopsy and surgical sample |
| histopathology/IH/PCR | – | histopathology | histopathology | histopathology andIH |
| type of diagnosis | probable | confirmed | confirmed | confirmed |
| month.year of diagnosis | 03.2011 | 01.2012 | 04.2013 | 10.2014 |
| latency of diagnosis (in months) | 111 | 1 | 5 | 24 |
| extrahepatic localizationat the time of diagnosis | no pulmonary lesion | no pulmonary lesion |
undignified pulmonary lesions |
no |
| PNM at diagnosis | P4N0Mx | P2N0Mx | P4N0Mx | P1N0M0 |
| case no. | 9 | 10 | 11 | 12 |
| onset of symptoms or first findings | 10.2013 | 04.2012 | 02.2017 | 03.2017 |
| initial symptoms and physical findings | right hypochondriac pain, urticaria | right hypochondriac pain, hepatomegaly | epigastric pain, vomitus | right hypochondriac pain |
|
liver function tests: liver enzymes (U/l); sebi (μmol/l) |
ALP (125), GGT (86) | normal | normal | elevated ALP |
|
initial US/CT/MRI (date) radiomorphology largest diameter of AE lesion(s) in mm |
MRI (12.2015) and CT (01.2016) 2 typical AE lesions in the dichotomy of hepatic veins; in SV/SIVB 55 mm; in SVIII/IVA 53 mm |
CT (04.2012) and MRI (10.2012) typical AE lesion in SIV 42 mm |
US (02.2017), CT (02.2017) and MRI (03.2017) two AE lesions in SVIII 44 mm and in SVII 12 mm |
US (05.2017), CT (05.2017) multiplex AE lesions in both lobes, 40 mm |
| preliminary diagnosis | atypical rare malignancy liver metastasis | hemangioma, adenoma, liver tumor |
hemangioma cholangiocellular carcinoma, fibrolamellar carcinoma |
liver metastasis, sarcoidosis, granulomatous hepatitis |
| serology Westernblot (Ldbio) P3 Em | positive | positive | Echinococcus genus P5 | positive |
| core biopsy/surgical sample/autopsy | – | – | (FNAB) and surgical sample | corebiopsy (2x) |
| histopathology/IH/PCR | – | – | IH | histopathology |
| type of diagnosis | probable | probable | confirmed | confirmed |
| month.year of diagnosis | 01.2016 | 06.2016 | 05.2017 | 07.2017 |
| latency of diagnosis (in months) | 28 | 50 | 4 | 5 |
| extrahepatic localizationat the time of diagnosis | no | no | no | no |
| PNM at diagnosis | P3N0M0 | P1N0M0 | P1N0M0 | P2N0M0 |
| case no. | 13 | 14 | 15 | 16 |
| onset of symptoms orfirst findings | 09.2017 | 09.2016 | 04.2008 | 2008 |
| initial symptoms and physical findings |
right hypochondriac pain, hepatomegaly |
asymptomatic | asymptomatic |
right hypochondriac pain |
|
liver function tests: liver enzymes (U/l); sebi (μmol/l) |
elevated liver enzymes | GGT (115) | – | – |
|
initial US/CT/MRI (date) radiomorphology largest diameter of AE lesion(s) in mm |
US (10.2017), CT (10.2017) typical AE lesion in SV 80 mm |
MRI (09.2016) 15 mm wide hypodens area in right lobe, CT (09.2017) and MRI (11.2017) 75 mm typical AE lesion in SV and SVIII, dilatation of intrahepatic bileducts |
US (04.2008), CT (07.2008) typical AE lesion in SV – 54 mm –and three small calcified lesions |
US (2008) 20 mm hyperechoic liver lesion, CT (10.2016) and MRI (06.2017) 120 mm typical AE lesion in right lobe (SV-VI-VIII) |
| preliminary diagnosis | liver tumor | cholangiocellular carcinoma, Klatskin tumor | atypical hepatic cyst | hemangioma, cystadenocarcinoma |
| serology Westernblot (Ldbio) P3 Em | positive | positive | positive | positive |
| core biopsy/surgical sample/autopsy | -(FNAB 2x) | surgical sample | surgical sample autopsy | surgical sample |
| histopathology/IH/PCR | – | histopathology | histopathology | histopathology |
| type of diagnosis | probable | confirmed | confirmed | confirmed |
| month.year of diagnosis | 12.2017 | 01.2018 | 05.2018 | 08.2018 |
| latency of diagnosis (in months) | 4 | 17 | 122 | 115 (+ 12) |
| extrahepatic localizationat the time of diagnosis | no pulmonary lesion | subphrenic abscess, peribiliar vascular invasion, no pulmonary lesion | falciform ligament, no pulmonary lesion | no pulmonary lesion |
| PNM at diagnosis | P4N0M0 | P4N1Mx | P4N1Mx | P4N0Mx |
E.m Echinococcus multilocularis, AE alveolar echinococcosis, CE cystic echinococcosis, v vena, d ductus, AST aspartate aminotransferase, ALT alanine aminotransferase, GGT gamma-glutamyltransferase, ALP alkaline phosphatase, sebi serum bilirubin, US ultrasound, CT computer tomography, MRI magnetic resonance imaging, IH immunohistochemistry using monoclonal antibody mAbEm2G11, PCR polymerase chain reaction, tx treatment, EPI endoscopic and percutaneous interventions, ERCP endoscopic retrograde cholangiopancreatography, PTC percutaneous transhepatic cholangiography, PTD percutaneous transhepatic drainage, FNAB fine needle aspiration biopsy, S liver segment, ABZ albendazole, HCC hepatocellular carcinoma