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