S Hashemzadeh, K Mamaghani, A Daryani, K Nejad
echinococcosis, laparotomy, liver mass
S Hashemzadeh, K Mamaghani, A Daryani, K Nejad. Alveolar Echinococcosis: A Case Report. The Internet Journal of Surgery. 2009 Volume 23 Number 1.
Human alveolar echinococcosis is a rare and potentially fatal infestation caused by echinococcus multilocularis that usually involves the liver (1). It is geographically widespread from Canada and United States to Europe and from Eurasia to Japan (2). Alveolar echinococcosis has an invasive nature and it may manifest as a tumor lesion that could mislead the physicians. In this study, we report a case of hepatic echinococcosis multilocularis that resembled a malignant liver tumor through imaging and preoperative examinations.
A 55-year-old woman from the North-West of Iran referred to our hospital with a history of epigastric and right upper abdominal pain for one year. In addition, she complained of anorexia, weight loss and flatulence. However, she mentioned to have normal bowel habits without any fever. Physical examinations revealed a weak old woman. In addition, through abdominal palpation, a firm and partially tender hepatomegaly with a hepatic mass was perceived that was extending to the epigastrium. Initial laboratory results presented a mildly elevated alanine aminotransferase and aspartate aminotransferase. Abdominal ultrasonography illustrated a large liver mass with heterogeneous echogenicity and irregular borders. Moreover, computed tomography scan revealed an irregular, hypodense mass that occupied most of the left liver lobe. In order to diagnose a malignant liver tumor, the patient underwent a laparotomy to resect the hepatic mass by left lateral segmentectomy. During the operation, a large and adhesive liver mass was localized with some regions of white band-like lesions (fibrosis). Pathologic examination of the specimen demonstrated hepatic alveolar echinococcosis.
Hepatic echinococcus multilocularis infestation has to be in the list of differential diagnosis of solid liver masses. Alveolar echinococcosis is a rare occurrence that resembles a malignant liver tumor in radiological and physical examinations. The incidence of alveolar echinococcosis is about 2.5 and 7.2 cases per year in Austria and Switzerland, respectively (3). Actually, due to the infrequency of this infestation, we suggest that physicians consider alveolar echinococcosis as a possible etiology of malignant-appearing liver masses, particularly in the areas where this infestation is endemic.