Table 2.
Therapeutic features of human alveolar echinococcosis cohort patients in Hungary(2003–2018)
| case no. | 1 | 2 | 3 | 4 |
|---|---|---|---|---|
| antiparasitic drug tx (duration in months) | – | ABZ (3) 10.2004–12.2004 |
ABZ (162) continuously since 07.2005 |
ABZ (12) 11.2008 – 01.2009 and 06.2016–03.2017 |
| surgery | – | – | exploration –unresectable |
exploration, fenestration, marsupialisation |
| EPI | – | – | – | PTD (2x), ERCP |
| follow-up period in months | 27 | 177 | 162 | 124 |
| radiomorphology on final control, largest diameter of AE lesion(s) in mm (date) | CT (04.2005) – pseudocystic AE lesion in left lobe 49 mm, two more AE lesions in right lobe, 35 mm and 24 mm | US (09.2014) stabilization | MRI (12.2018) stabilization | US (12.2018) residual cavity in SIV 70 mm, giant biloma in porta hepatis |
| PNM at final imaging | P1N0Mx | P1NxMx | P2N1Mx | P3N0Mx |
| complications | elevated GGT (136), ALP (621), sebi (36,3) | – | – | central biliary obstruction, cholangitis, biloma, bile-leaking |
| outcome | progression, AE unrelated death | stabilization | stabilization | progression |
| case no. | 5 | 6 | 7 | 8 |
| antiparasitic drug tx (duration in months) | – | ABZ (5) 02.2012–07.2012 | ABZ (67) continuously since 06.2013 | ABZ (24) postoperatively |
| surgery | marsupialization, drainage | extended right hemihepatectomy | – | segmentectomy |
| EPI | ERCP – biliary stent implantation, nasobiliary stent | – | – | – |
| follow-up period in months | 9 | 84 | 69 | 51 |
| radiomorphology on final control, largest diameter of AE lesion(s) in mm (date) | US (11.2011) residual cavity 45 mm, atrophy of right lobe | US (02.2018) no recurrence | MRI (10.2018) and US (10.2018), 109 mm | US (07.2018) no recurrence |
| PNM at final imaging | P4N0Mx | P0N0Mx | P4N0Mx | P0N0M0 |
| complications | central biliary obstruction, bile-leaking, bilio-peritoneal fistula, injury of bileducts during surgical manipulation, cachexia | postoperative peritonitis, haematoma, bile-leaking, Kehr-drainage | v. cava inferior compression | – |
| outcome | progression, AE related death | no recurrence | stabilization | no recurrence |
| case no. | 9 | 10 | 11 | 12 |
| antiparasitic drug tx (duration in months) | ABZ (3) lowered dose intermittently in 2016, finally ceased | ABZ (30) continuously since 07.2016 | ABZ (21) postoperatively | ABZ (3) 09.2017–11.2017 |
| surgery | – | – | segmentectomy | – |
| EPI | – | – | – | – |
| follow-up period in months | 36 | 30 | 20 | 18 |
| radiomorphology on final control, largest diameter of AE lesion(s) in mm (date) | MRI (10.2018), CT (10.2018) no progression in liver, new pulmonary micronodules (09.2017) | MRI (11.2018) SIV 70 mm, progression | MRI (06.2018), US (10.2018) no recurrence | US (07.2018) AE lesion in left lobe 65 mm, AE lesion in right lobe 44 mm |
| PNM at final imaging | P3N0Mx | P1N0Mx | P0N0Mx | P2N0Mx |
| complications | ABZ hepatotoxicity and allergic reactions, undignified pulmonary microlesions | – | – | – |
| outcome | stabilization | progression | no recurrence | progression |
| case no. | 13 | 14 | 15 | 16 |
| antiparasitic drug tx (duration in months) | ABZ (12) continuously since 01.2018 | ABZ (12) continuously since 01.2018 | ABZ (3) 06.2018–09.2018 | – |
| surgery | – | right hemihepatectomy, exstirpation of d. choledochus and cholecystectomy, hepaticojejunostomia | explorative laparotomy | right hemihepatectomy, exstirpation of d. choledochus and cholecystectomy, hepaticojejunostomia |
| EPI | – | ERCP | ERCP (2x), stent implantation (2x) | ERCP, stent implantation, PTD (2x) |
| follow-up period in months | 13 | 12 | 5 | 1 |
| radiomorphology on final control, largest diameter of AE lesion(s) in mm (date) | MRI (10.2018) AE lesion in SV 79 mm | CT (10.2018) no recurrence | US (05.2018) 120 mm AE lesion occupying left lobe, ascites, dilatated intrahepatic bileducts | – |
| PNM at final imaging | P4N0Mx | P0N1Mx | P4N1Mx | P0N0Mx |
| complications | thrombosis and parasitic infiltration of right v. portae, compression of d. hepaticus dexter | leukopenia, hairloss, haematoma in residual left lobe (32 mm) and undignified pulmonary microlesions | compression of d. hepaticus communis, peritonitis, cholangiogen sepsis | compression of d. hepaticus communis, abscessus hepatis, liver insufficiency, septic shock |
| outcome | stabilization | no recurrence | progression, AE related death | progression, AE related death |
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