Hepatic damage in experimental and clinical paragonimiasis

[Case of Abdominal Colicky Pain Caused by Hepatic Paragonimiasis]

In Korea, the prevalence of paragonimiasis has decreased markedly since 1970 and is now rarely encountered. Although the lung is the primary site of paragonimiasis, ectopic infestation can occur in other sites. The central nervous system is the most commonly involved ectopic site, accounting for only approximately 1% of all paragonimiasis patients. Therefore, the liver is an extremely rare site of ectopic infestation. The authors experienced the case of a 55-year-old female with hepatic paragonimiasis who presented with abdominal colicky pain.

Hepatic paragonimiasis: a single-center retrospective analysis of 32 cases in Mainland China

Background

In paragonimiasis, the lungs and pleural cavity are the major target organs, and the central nervous system can also be affected. The liver is an organ in which ectopic paragonimiasis rarely occurs. Because the symptoms and examinations in hepatic paragonimiasis (HP) are not typical, the disease is often misdiagnosed in the clinic.

Methods

From February 2008 to March 2015, our department accepted 32 patients who presented with a liver mass upon ultrasound and computed tomography imaging and in whom the source of the mass could not be identified upon numerous further diagnostic tests. We ultimately obtained surgical biopsies of their lesions for pathological examination. We analysed the clinical data of these cases, along with their disease characteristics, the diagnostic strategies employed and their treatment experiences. Additionally, we performed patient follow-up for a period of 6–12 months.

Results

All patients underwent half/partial hepatectomy and were diagnosed with HP upon pathological examination. They recovered well after surgery and their original symptoms were markedly improved without recurrence. The liver functions of the patients reached normal levels before discharge and no additional liver lesions were found upon diagnostic imaging.

Conclusion

The diagnosis of HP based on clinical manifestations, laboratory tests or image examination is difficult and only pathologic analysis of biopsies could confirm HP. Surgical treatment not only removes lesions, but also allows for pathologic biopsy. This study encompasses the largest number of HP patients to date, but the surgical outcomes require further research and long-term follow-up.

Feasibility of laparoscopic major hepatectomy for hepatic paragonimiasis: two case reports

BACKGROUND

Though accumulated evidence proved that laparoscopic major hepatectomy was technically feasible, it remains a challenging procedure and is limited to highly specialized centers. Paragonimiasis is one of the most important food-borne parasitic zoonoses caused by the trematode of the genus Paragonimus. Although hepatic paragonimiasis is rare, the previous studies had investigated hepatic paragonimiasis from different perspectives. However, the safety and feasibility of laparoscopic major hepatectomy for hepatic paragonimiasis have not yet been reported in the literature.

METHODS

We here present 2 cases of hepatic paragonimiasis at the deep parts of the liver with treatment by laparoscopic major hepatectomy. One case is a 32-year-old male patient who was admitted to the hospital due to upper abdominal discomfort without fever for 1 month. The clinical imaging revealed that there was a lesion about 5.9 × 3.7 cm in the boundary of right anterior lobe and right posterior lobe of the liver with rim enhancement and tract-like nonenhanced areas. The other one is a 62-year-old female patient who was referred to the hospital for 1 month of right upper abdominal pain and fever. The ultrasonography showed that there was a huge hypoechoic mass (about 10.8 × 6.3 cm) in middle lobe of the liver with tract-like nonenhanced areas. Both patients were from an endemic area of paragonimiasis and the proportion of eosinophil in the second case was increased.

RESULTS

The preoperative diagnosis of the first case was ambiguous and the hepatic paragonimiasis was considered for the second case. The first case underwent laparoscopic extended right posterior lobe hepatectomy and the other case underwent laparoscopic extended left hemihepatectomy. Both operations went very well and the operation times for the 2 cases were 275 minutes and 310 minutes, respectively. The 2 patients' postoperative recovery was smooth without major postoperative complications (such as, bleeding, bile leakage, and liver failure). Moreover, the 2 patients were discharged on the 6th day and 7th day after surgery, respectively. The postoperative histopathological examination manifested hepatic paragonimiasis in both patients.

CONCLUSION

This study suggests that the laparoscopic approach may be safe and technically feasible for hepatic paragonimiasis.

Pancreatic paragonimiasis mimics pancreatic cystic-solid tumor--A case report

Paragonimiasis is frequently misdiagnosed owing to its various and complicated clinical manifestations. Although paragonimiasis has diverse manifestations, there is no report of paragonimiasis involving the pancreas. Herein we report the first case of pancreatic paragonimiasis, which was misdiagnosed as pancreatic cystic-solid tumor by CT scan. The pancreatic lesion was finally proved to be pancreatic paragonimiasis by pathological examination and serum antibody detection. The clinical manifestations and imaging features of this patient were analyzed. Pancreatic paragonimiasis should be an important differential diagnosis for pancreatic cyst-solid lesions.

CT evaluation of hepatic paragonimiasis with simultaneous duodenal or splenic involvement

Paragonimiasis is a parasitic infection caused by the genus Paragonimus and usually leads to pulmonary disease. Hepatic paragonimiasis is rare, but duodenal and splenic involvement of this disease has not yet been reported in the literature. Herein, we report two rare cases of hepatic paragonimiasis with simultaneous duodenal or splenic involvement, respectively, and described their CT features. Both patients were lifelong residents of an endemic area of paragonimiasis and were confirmed clinicopathologically.

Characteristic MR and CT imaging findings of hepatobiliary paragonimiasis and their pathologic correlations

BACKGROUND

Hepatobiliary paragonimiasis (HP) is not commonly encountered and may be confused with hepatobiliary tumors; however, computed tomography (CT) and magnetic resonance imaging (MRI) features of HP allow this entity to be distinguished from other diseases.

PURPOSE

To present the CT and MRI findings in patients with HP and to describe some specific imaging findings along with their pathological correlations.

MATERIAL AND METHODS

Imaging and clinical findings of 21 patients (9 boys/men and 12 girls/women; age range 3-67 years; mean age 40 years) who were diagnosed with HP were retrospectively evaluated. Among these patients, 16 underwent CT examination only, two had MR examination only, and three underwent both CT and MR. All patients underwent surgery, and the HP diagnosis was confirmed by the surgical and histopathologic results.

RESULTS

Chronic abdominal pain or back pain was reported by 14 patients, severe abdominal pain with acute onset was reported by one patient, and six patients were asymptomatic and were discovered incidentally. Peripheral eosinophilia was present in 14 patients (14/21, 66.7%), and abnormal liver function tests were found in 16 patients (16/21, 76.2%). Of the 19 patients who underwent CT imaging, 17 patients showed multiple mixed hypodense lesions or multiple cysts with inlaying septation with separate irregular rims or circular enhancement on post-contrast CT images. Tunnel-shaped microabscesses and necrotic cavities were found in the lesions of 12 of those 17 patients. The other two patients showed smaller cystic masses. MRI showed faveolate T1 hypointense and T2 hyperintense areas in the liver parenchyma with rim or peripheral enhancement. Nodular or circular hyperintense materials were found scattered in the lesions on T1-weighted imaging.

CONCLUSION

CT and MRI can reveal the radiological-pathological features of HP. Together with laboratory findings, MRI and CT findings may provide diagnostic clues, especially in endemic areas, that are very important for the selection of treatment methods.

Correlations between MDCT features and clinicopathological findings of hepatic paragonimiasis

AIM

To illustrate the MDCT features of hepatic paragonimiasis and correlate the results with clinicopathological findings.

MATERIALS AND METHODS

Eighteen patients (8 male, 10 female; mean age 37years) with hepatic paragonimiasis were included in this study. MDCT features of their hepatic lesions were retrospectively reviewed and correlated with clinicopathological findings.

RESULTS

All patients were lifelong residents in endemic areas of paragonimiasis, especially Paragonimiasis skrjabini variety. Abdominal pain or discomfort, fever and high eosinophil percentage were the predominant clinical features. In total, 21 lesions were detected on MDCT images, 18 (85.7%) directly contacted the hepatic capsule and 3 (14.3%) were adjacent to the capsule. Segment V (26%), VIII (26%) and VI (18.5%) were the most commonly involved sites. Sixteen lesions (76%) were conglomerated cystic or multilocular and 5 (24%) were solid. On plain MDCT scan, the margin and internal detail of the lesions were not clear except for one cystic variety, while they were clearly demonstrated on enhanced images. Single or multiple cysts with different diameters were commonly detected in the non-solid lesions, and some of them were mutually connected with tortuous tract formation. Among the solid lesions, 2 and 3 showed tubular and homogeneous enhancement, respectively.

CONCLUSION

Peripherally distributed lesions, mutually connected cysts with tortuous tract formation, and tubular enhancement, which may be closely associated with the infection route and migration of the worm, could be seen as the main MDCT features of hepatic paragonimiasis.

Imaging findings of hepatic paragonimiasis : a case report

Hepatic paragonimiasis is a rare form of ectopic infestation caused by Paragonimus. We experienced a case of hepatic paragonimiasis that showed characteristic imaging findings. CT and MR images showed a cluster of small cysts with rim enhancement in the subcapsular area of the liver. This finding seems to be characteristic for hepatic paragonimiasis, considering imaging findings in paragonimiasis involving other organs.

Severe pleuropulmonary paragonimiasis 8 years after emigration from a region of endemicity

A Laotian man who had resided only in the north-central United States for 8 years sought care for an acute, progressive syndrome of severe dyspnea, chest pain, bilateral pneumothoraces, lung and liver nodules, and marked peripheral blood eosinophilia. He habitually ate raw crabmeat imported pickled or frozen from Southeast Asia; he denied eating local crustaceans. Ova consistent with the lung fluke Paragonimus westermani were identified in a bronchoalveolar lavage specimen, and the eosinophilia and pulmonary symptoms resolved with praziquantel therapy.

Paragonimiasis and the genus Paragonimus

The review concentrates on literature that has appeared since the 1960s. Since then, numerous species of Paragonimus have been described, mainly from Asia but also from Africa and the Americas. Some of these cause disease in humans. Recent information on life cycles and routes of transmission is summarized. All described species and their hosts are listed, with synonyms where known. For well-known species such as Paragonimus westermani, subspecific taxa and strains are reviewed and genetic studies discussed. Paragonimiasis in humans and experimental animals is discussed with emphasis on clinical manifestations and pathology, diagnosis, immune interactions with the host, treatment and public health issues.

Ultrastructural observation of Charcot-Leyden crystals in mechlorethamine-treated cutaneous lesions of histiocytosis X

We were recently able to observe, by electron microscopy, Charcot-Leyden crystals in the cutaneous lesions of histiocytosis X (Letterer-Siwe disease) that had been treated by local applications of mechlorethamine. The occurrence of Charcot-Leyden crystals in skin lesions is infrequent; so far, these structures have been observed only in cases of facial (Lever's) eosinophilic granuloma and in incontinentia pigmenti. Although Charcot-Leyden crystals can at times be formed spontaneously in tissue lesions, the possibility that their formation was favored by the local action of mechlorethamine is considered.