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Table 1 Diagnostic features of human alveolar echinococcosis cohort patients in Hungary (2003–2018)

From: Emerging human alveolar echinococcosis in Hungary (2003–2018): a retrospective case series analysis from a multi-centre study

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
  1. 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
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