Echinococcus multilocularis: Diagnostic problem in a liver core biopsy

Česká verzia

Authors: Alena Chlumská ¹; Petr Mukenšnabl ^1,2; Jana Němcová ^1,2; Lenka Nedbalová ³; Petr Hrabal ⁴; Miroslav Ryska ⁵; Květa Michalová ^1,2
Authors place of work: Bioptická laboratoř s. r. o., Plzeň ¹; Šiklův ústav patologie LF UK v Plzni a FN, Plzeň ²; Centrum IBD a gastroenterologie KNL Liberec – Turnov a. s. ³; Oddělení patologie ÚVN – Vojenská FN Praha ⁴; Chirurgická klinika 2. LF UK a ÚVN, Praha ⁵
Published in the journal: Čes.-slov. Patol., 56, 2020, No. 1, p. 32-34
Category: Původní práce

Summary

Echinococcus multilocularis causes an aggressive form of hydatidosis whose histomorphological picture is generally not well recognized. We report a case of 39-year-old women presenting with poorly circumscribed nodules in the right hepatic lobe. Owing to the clinical suspicion of focal nodular hyperplasia and hepatocellular adenoma, a core biopsy was performed. The histological findings of necrotic fibrous tissue infiltrated by narrow epithelial cords and small cysts containing cytokeratin positive material were in concordance with the diagnosis of cholangiocarcinoma. Subsequent examination of the surgically resected necrotic nodules with a vital tissue at the periphery corresponded to a reparative fibrosis accompanied by a striking ductular proliferation. Serological and molecular genetic work-up led to the diagnosis of Echinococcus multilocularis. The aim of this report is to point out the unusual histological features of the solid foci of alveolar hydatidosis, which consisted of necrotic fibrous tissue with ductular reaction. Such findings in a core biopsy may simulate regressively altered carcinoma.

Keywords:

immunohistochemistry – Echinococcus multilocularis – liver – core biopsy

Zdroje

1. Farrokh D, Zandi B, Rad MP, Tavakoli M. Hepatic Alveolar Echinococcosis. Case Report. Arch Iran 2015; 18: 199-202.

2. Georges S, Villard O, Filisetti D et al. Usefulness of PCR Analysis for Diagnosis of Alveolar Echinococcosis with Unusual Localisations: Two Case Studies. J Clin Microbiol 2004; 17: 5954-5956.

3. Kolářová L, Matějů J, Hrdý J et al. Human Alveolar Echinococcosis, Czech Republic, 2007-2014. Emerg Infect Dis 2015; 21: 2263-2265.

4. Vávra P, Třeška V, Ostruszka P et al. Chirurgické řešení komplikované jaterní echinokokózy u dvou bulharských občanů na dvou pracovištích v České republice. Rozhl Chir 2012; 91: 381-387.

5. Hozáková-Lukáčová L, Kolářová L, Rožnovský L et al. Alveolární echinokokóza – nově se objevující onemocnění? Čas Lék čes 2009; 148: 132-136.

6. Prokopič J, Štěrba J, Neubauer L. Human Hydatidosis in South Bohemia. Folia Parasitol 1983; 30: 123-129.

7. Stojkovic M, Mickan C, Weber TF, Junghanss T. Pitfalls in diagnosis and treatment of alveolar echinococcosis: a sentinel case series. BMJ Open Gastro 2015; 2: 1-6.

8. Graeter T, Ehing F, Oeztuerk S et al. Hepatobiliary complications of alveolar echinococcosis: A long-term follow-up study. World J Gastroenterol 2015; 21: 4925-4932.

9. Frei P, Misselwitz B, Prakash MK et al. Late biliary complications in human alveolar echinococcosis are associated with high mortality.World J Gastroenterol 2014; 20: 5881-5888.

10. Taxy JB, Gibson WE, Kaufman MW Echinococcosis. Unexpected Occurrence and the Diagnostic Contribution of Routine Histopathology. Am J Surg Pathol 2017; 41: 94-100.

11. Arnason T, Borger DR, Corless C et al. Biliary Adenofibroma of Liver. Morphology, Tumor Genetics, and Outcomes in 6 Cases. Am J Surg Pathol 2017; 41: 499-505.