Kalifu Baheti, Meng Yuan, Maimaitinijiati Yusufukadier, Ma Zhi-Gang, Tian Guang-Lei, Wang Jin-Guo, Chen Xiong
Department of Hepatobiliary Surgery, People's Hospital of Xinjiang Uygur Autonomous Region, Urumqi 830001, Xinjiang Uygur Autonomous Region, China.
World J Clin Cases. 2021 Jan 26;9(3):659-665. doi: 10.12998/wjcc.v9.i3.659.
Hepatic cystic echinococcosis (CE) is an infectious zoonotic parasitic disease, and the insidious onset and slow progression of hepatic CE usually contributes to delayed diagnosis and treatment. Hepatocellular carcinoma (HCC) is the fourth most common malignant tumor. Co-existence of CE and HCC is fairly rare in clinical settings and the association between the two is still not well recognized. We report a case of hepatic CE complicated with HCC which are radically resected and raise some questions worth thinking about.
A 70-year-old man presented with upper abdominal pain. On admission, laboratory data showed that, except for hepatitis B surface antigen positivity, other indicators were normal, including alpha-fetoprotein. Computed tomography of the abdomen revealed a huge polycystic lesion in left liver lobe, without reinforcement after enhanced scanning and sized about 16.9 cm × 12.2 cm, which was considered a type II hydatid cyst. Multiple small solid lesions were also found adjacent to it, and thus it was highly suspected as a malignant tumor. After a multidisciplinary team discussion, the diagnosis of co-occurrence of hepatic CE and HCC was made. According to Romic classification, the case belongs to type IIb, and radical left hemi-hepatectomy was performed. Postoperative pathological examination revealed CE co-existence with well-differentiated HCC, consistent with the preoperative diagnosis.
With the combination of hepatitis B and obvious extrusion by large hydatid, the HCC risk of a patient might be higher.
肝囊性包虫病（CE）是一种传染性人畜共患寄生虫病，肝CE起病隐匿、进展缓慢，常导致诊断和治疗延迟。肝细胞癌（HCC）是第四大常见恶性肿瘤。CE与HCC在临床环境中并存相当罕见，两者之间的关联仍未得到充分认识。我们报告一例肝CE合并HCC病例，该病例接受了根治性切除，并提出了一些值得思考的问题。
一名70岁男性因上腹部疼痛就诊。入院时实验室检查数据显示，除乙肝表面抗原阳性外，包括甲胎蛋白在内的其他指标均正常。腹部计算机断层扫描显示左肝叶有一个巨大的多囊性病变，增强扫描后无强化，大小约为16.9 cm×12.2 cm，被认为是II型包虫囊肿。在其附近还发现多个小实性病变，因此高度怀疑为恶性肿瘤。经过多学科团队讨论，诊断为肝CE与HCC并存。根据Romic分类，该病例属于IIb型，实施了根治性左半肝切除术。术后病理检查显示CE与高分化HCC并存，与术前诊断一致。
由于乙肝合并大的包虫囊肿明显挤压，患者发生HCC的风险可能更高。
