Hepatocellular Carcinoma Complicated by Echinococcal Cyst: A Case Report

A rare case of hepatic hydatid cyst in Somalia: a case report

Background

Echinococcosis, or hydatid disease, is caused by the larval forms of taeniid cestodes belonging to the genus Echinococcus. Echinococcus granulosus and E. multilocularis are the primary species responsible for human echinococcosis, and mostly they affect the liver. The disease course is typically slow, and the patients tend to remain asymptomatic for many years.

Case presentation

A case of 19-year-old male Somali from Medina, Saudi Arabia, was presented to the Mogadishu Somali Turkey Recep Tayyip Erdogan Training and Research Hospital with the complaint of right upper quadrant abdominal pain and dysuria for 1 month. A thorough physical examination, laboratory examination, and imaging investigations, including abdominal sonography and computed tomography (CT), were conducted.

Both ultrasound and CT scans revealed a cystic lesion in the right lobe of the liver, confirming the diagnosis of a hydatid cyst. Consequently, the patient underwent exploratory laparotomy. It was successfully managed surgically, and the definitive diagnosis was provided by the pathologist, confirming degenerated echinococcal cysts that contain abundant debris. Additionally, the patient received oral albendazole both before and after the surgery and after 7 months and is currently symptom-free.

Conclusions

Hydatid disease in the liver may persist without symptoms and often goes undiagnosed due to the slow growth of the cysts. The diagnosis needs careful history reporting, physical examination, and appropriate imaging investigations.

Coexistence of liver abscess, hepatic cystic echinococcosis and hepatocellular carcinoma: A case report

BACKGROUND

Human cystic echinococcosis (CE) is a life-threatening zoonosis caused by the Echinococcus granulosus (sensu lato). Hepatocellular carcinoma (HCC) is a leading cause of cancer-related mortality in the world. The coexistence of CE and HCC is exceedingly rare, and only several well-documented cases have been reported. In addition to this coexistence, there is no report of the coexistence of CE, HCC, and liver abscess to date. Herein, we aimed to report a case of coexistence of liver abscess, hepatic CE, and HCC.

CASE SUMMARY

A 65-year-old herdsman presented to the department of interventional therapy with jaundice, right upper abdominal distension and pain for 10 d. Laboratory test showed that he had positive results for HBsAg, HBeAb, HBcAb, and echinococcosis IgG antibody. The test also showed an increased level of alpha fetoprotein of 3400 ng/mL. An abdominal computed tomography (CT) scan revealed an uneven enhanced lesion of the liver at the arterial phase with enhancement and was located S4/8 segment of the liver. In addition, CT scan also revealed a mass in the S6 segment of the liver with a thick calcified wall and according to current guideline and medical images, the diagnoses of hepatic CE (CE4 subtype) and HCC were established. Initially, transarterial chemoembolization was performed for HCC. In the follow-up, liver abscess occurred in addition to CE and HCC; thus, percutaneous liver puncture drainage was performed. In the next follow-up, CE and HCC were stable. The liver abscess was completely resolved, and the patient was discharged with no evidence of recurrence.

CONCLUSION

This is the first reported case on the coexistence of liver abscess, hepatic CE, and HCC. Individualized treatment and multidisciplinary discussions should be performed in this setting. Therefore, treatment and diagnosis should be based on the characteristics of liver abscess, hepatic CE, and HCC, and in future clinical work, it is necessary to be aware of the possibility of this complex composition of liver diseases.

Misdiagnosis of hepatic cystic echinococcosis complicated with hepatocellular carcinoma: A case report

RATIONALE

Hepatic cystic echinococcosis (CE) is a common zoonotic parasitic disease caused by the entry of Echinococcus granulosus eggs into human body. Surgical resection is the optimal treatment choice for hepatic CE. However, Coexistence of CE and hepatocellular carcinoma (HCC) have been reported with a rare incidence rate, which led to unsatisfactory prognosis after the operation.

PATIENT CONCERNS

A 69-year-old male patient was admitted to hospital because of "Upper abdominal pain and discomfort for more than 1 month and an aggravation for 10 days."

DIAGNOSIS

An elderly male herder who was initially diagnosed as hepatic CE, and none of the preoperative imaging test revealed the existence of HCC. Co-existence of hepatic CE and HCC was confirmed by the postoperative pathological examination.

INTERVENTIONS

The patient underwent "combined hepatic segmental resection, portal vein thrombectomy, portal vein repairment, hepatic hydatid internal capsule removal and external subtotal resection, cholecystectomy".

OUTCOMES

During follow-up after discharge, the patient did not regularly review and get further treatment and died 8 months after operation.

LESSONS

May improve the clinicians' understanding of CE complicated with HCC, and reduce the misdiagnosis of similar case, as well as provide guidance for clinical treatment.

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

A coexistance of liver cystic echinococcosis (CE) and hepatocellular carcinoma (HCC) is very rare. HCC is the leading cause of cancer-related mortality worldwide, while CE is a globally endemic zoonosis caused by the cestode tapeworm Echinococcus granulosus. The association between these two diseases is still not well-defined. A preoperative diagnosis may be challenging, especially if HCC and CE present as a single lesion and if atypical imaging features are present. Herein, we present a case of the patient that was initially diagnosed as an extensive necrotic tumor in the left liver lobe and highly suspicious of being HCC associated with peritumoral hematoma. Left hemihepatectomy was performed, and the histopathological findings showed the collision of two lesions: a hydatid cyst and HCC.