Sparganosis

A hepatic sparganosis misdiagnosed as intrahepatic mass-forming cholangiocarcinoma: a case report and literature review

Hepatic sparganosis (HS) is extremely rare and has not been previously reported in Eastern China. We report the diagnosis and treatment of a patient with HS from Xuzhou City, Jiangsu Province, China. The patient was admitted due to an acute biliary tract infection, and the symptoms improved after treatment at the Gastroenterology Department. During an ultrasound examination on admission, an abnormal echo was incidentally discovered at the junction of the left and right lobes of the liver. Thereafter, upper abdominal computed tomography (CT) and magnetic resonance imaging (MRI) non-contrast and contrast-enhanced examinations, and serum tumor biomarker examination were completed. After a multidisciplinary treatment (MDT) discussion at the Department of Hepatobiliary Surgery, the patient was diagnosed with intrahepatic mass-type cholangiocarcinoma (IMCC) and surgery was recommended. The patient underwent surgical treatment, and postoperative pathology revealed HS. No signs of intrahepatic recurrence were observed during the 1-year follow-up period.

Systemic diseases affecting the breast: Imaging, diagnosis, and management

Various systemic diseases of benign or malignant etiologies can clinically manifest in the breast. Some imaging findings of breast lesions can be pathognomonic for a given condition, while others are non-specific, mimicking primary breast carcinoma and requiring tissue biopsy for definitive diagnosis. In addition to obtaining a detailed clinical history, radiologists should be familiar with the diverse clinical and imaging characteristics of these conditions to help exclude primary breast cancer and avoid unnecessary interventions. This review aims to discuss the clinical presentations, imaging features, pathologic findings, and management of systemic conditions that may affect the breast.

Efficacy comparison between long-term high-dose praziquantel and surgical therapy for cerebral sparganosis: A multicenter retrospective cohort study

Background

Sparganosis is a parasitic infection caused by the plerocercoid larvae of Spirometra mansoni in East and Southeast Asia. The plerocercoid larvae sometimes invade the encephalon, resulting in severe cerebral sparganosis. Surgical removal of the larvae is considered a standard therapy for cerebral sparganosis. In contrast, the efficacy and safety of long-term, high-dose praziquantel treatment for cerebral sparganosis have not been explored.

Methodology/Principal findings

In this multicenter retrospective study, we assessed the records of 96 patients with cerebral sparganosis who consulted at three medical centers from 2013 to 2017. Forty-two patients underwent surgical lesion removal, and the other 54 patients received long-term, high-dose praziquantel (50 mg/kg/day for 10 days, repeated at monthly intervals). The primary outcome was the complete disappearance of active lesions on cerebral magnetic resonance imaging. The secondary outcomes included the modified Rankin scale score at 90 days, incidence of seizure, eosinophil count, and serological Spirometra. mansoni antibody titer. The efficacy of praziquantel treatment was similar to that of surgical lesion removal for cerebral sparganosis with respect to both the primary outcome and secondary outcomes. Although binary logistic regression models also supported the primary outcome after adjustment for age, sex, lesion location, and loss to follow-up, some unavoidable confounders might have biased the statistical power. No significant clinical complications or laboratory side effects occurred in the praziquantel group with the exception of a relatively benign allergic reaction.

Conclusions/Significance

In this small-sample, nonrandomized, retrospective exploratory study, some patients with cerebral sparganosis were responsive to long-term, high-dose praziquantel with an efficacy similar to that of surgical lesion removal. These findings increase the treatment flexibility for this serious infection.

Sparganosis is most prevalent in developing countries in East and Southeast Asia, probably because public health strategies have not prioritized its prevention. The plerocercoid larvae of Spirometra mansoni sometimes invade the brain parenchyma, resulting in cerebral sparganosis. In general, surgical removal of the larvae is considered a standard therapy for cerebral sparganosis. One alternative treatment for sparganosis is short-term, low-dose praziquantel, which has had limited success. However, the efficacy and safety of long-term, high-dose praziquantel treatment for cerebral sparganosis have not been explored. In this study, we evaluated the effectiveness of long-term, high-dose praziquantel for treatment of cerebral sparganosis in China. We conducted a retrospective exploratory study using routinely recorded data from 96 patients at three medical centers. Forty-two patients underwent surgical lesion removal, and the other 54 patients received long-term, high-dose praziquantel. Treatment of cerebral sparganosis by long-term, high-dose praziquantel showed an efficacy similar to that of surgical lesion removal with respect to the primary outcome (complete disappearance of the active lesions on cerebral magnetic resonance imaging). However, this was a small-sample, nonrandomized retrospective study, and the results should be further confirmed by a large-sample prospective study or other studies.

CT and MR characteristics of cerebral sparganosis

BACKGROUND AND PURPOSE

Sparganosis is a rare parasitic infection in humans by a larval cestode of the genus Spirometra. Preoperative diagnosis of cerebral sparganosis in the past has been very difficult. Our objective was to evaluate the CT and MR features of cerebral sparganosis in order to make a definite diagnosis.

MATERIALS AND METHODS

We retrospectively reviewed 25 patients (13 male and 12 female; age range, 9-83 years) who proved to have cerebral sparganosis. Fifteen patients underwent MR imaging: 2 patients had CT scanning, and the remaining 8 had both CT and MR scanning. We focused on evaluating the imaging features on CT and MR.

RESULTS

All patients showed edema and degeneration of cerebral white matter. All but 1 had a unilateral lesion. Twenty-two patients had ipsilateral ventricular dilation. The new finding was a tunnel sign, approximately 4 cm in length and 0.8 cm in width, column or fusiform shaped on postcontrast coronal and sagittal MR images (n = 10). Thirteen patients showed bead-like enhancement, but solitary ring enhancement was common on the CT images (n = 2). The wall of the ring and tunnel appeared isointense or slightly hyperintense on T2-weighted images. Punctate calcifications were seen in 6 patients on CT images but only in 3 patients on the MR images. Hemorrhage was seen in 4 patients on the MR images. An intact whitish, stringlike, living worm was found (n = 5).

CONCLUSION

The most characteristic finding was a tunnel sign on postcontrast MR images. The most common finding was bead-shaped enhancement. MR is superior to CT in demonstrating the extent and number of lesions, except punctate calcifications. Combined with clinical data and enzyme-linked immunosorbent assay, the preoperative diagnosis of cerebral sparganosis could be established on MR imaging.

A case of sparganosis mimicking a varicose vein

Recent advances in radiological and serological techniques have enabled easier preoperative diagnosis of sparganosis. However, due to scarcity of cases, sparganosis has been often regarded as a disease of other etiologic origin unless the parasite is confirmed in the lesion. We experienced a case of sparganosis mimicking a varicose vein in terms of clinical manifestations and radiological findings. Sparganosis should be included among the list of differential diagnosis with the varicose vein.