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Z Gastroenterol 2014; 52(07): 657-662
DOI: 10.1055/s-0034-1366528
Kasuistik
© Georg Thieme Verlag KG Stuttgart · New York

Zystische Echinokokkose und hepatozelluläres Karzinom – zufällige Koinzidenz? Ein Fallbericht

Cystic Echinococcosis and Hepatocellular Carcinoma – A Coincidence? A Case Report
M. Kübeck
1   Innere Medizin V, Klinikum Wels-Grieskirchen, Grieskirchen
,
V. Stöckl
1   Innere Medizin V, Klinikum Wels-Grieskirchen, Grieskirchen
,
W. Stainer
1   Innere Medizin V, Klinikum Wels-Grieskirchen, Grieskirchen
,
T. Schermaier
2   Abteilung für Chirurgie II, Klinikum Wels-Grieskirchen, Wels
,
J. Preisinger
2   Abteilung für Chirurgie II, Klinikum Wels-Grieskirchen, Wels
,
W. Schauer
2   Abteilung für Chirurgie II, Klinikum Wels-Grieskirchen, Wels
,
U. Hochleitner
3   Institut für Pathologie, Klinikum Wels-Grieskirchen, Wels
,
W. Höbling
3   Institut für Pathologie, Klinikum Wels-Grieskirchen, Wels
,
T. F. E. Barth
4   Institut für Pathologie, Universitätsklinikum Ulm
,
B. Stadler
5   Innere Medizin I, Klinikum Wels-Grieskirchen, Wels
,
P. Knoflach
5   Innere Medizin I, Klinikum Wels-Grieskirchen, Wels
,
A. Kirchgatterer
1   Innere Medizin V, Klinikum Wels-Grieskirchen, Grieskirchen
› Institutsangaben
Weitere Informationen

Publikationsverlauf

03. Oktober 2013

15. April 2014

Publikationsdatum:
15. Juli 2014 (online)

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Zusammenfassung

Einleitung: Das gleichzeitige Auftreten einer zystischen Echinokokkose und eines hepatozellulären Karzinoms (HCC) ist eine Seltenheit. Wir berichten über einen 45-jährigen Mann, der wegen Oberbauchschmerzen und Ikterus das Krankenhaus aufsuchte.

Klinischer Befund und Diagnostik: Der Patient war fieberfrei und hatte nicht an Gewicht verloren. Palpatorisch war die Leber nicht vergrößert. Laborchemisch fanden sich deutlich erhöhte Transaminasen. Sonografisch kam in den Segmenten VI und VII eine 6 cm messende, inhomogene, zystische Raumforderung zur Darstellung. Die Echinokokkusserologie war negativ, das Alpha-Fetoprotein (AFP) deutlich erhöht. Im CT wurde eine an die zystischen Läsion angrenzende, 3,7 cm große Raumforderung festgestellt.

Therapie und weiterer Verlauf: Nach Einleitung einer anthelminthischen Therapie mit Albendazol kam es zu einem massiven Anstieg der Cholestaseparameter, weshalb die Behandlung abgebrochen werden musste. Bei Verdacht auf das gleichzeitige Vorliegen einer serologisch negativen Echinokokkuszyste und eines HCC wurde eine Leberteilresektion durchgeführt. Die Histologie bestätigte beide Diagnosen und zeigte eine Resektion im Gesunden. Fünf Monate nach Operation fand sich im CT ein multizentrisches HCC mit Befall der gesamten Leber. Eine palliative Therapie mit Sorafenib wurde begonnen.

Diskussion: Ungewöhnlich war bei unserem Patienten das Auftreten eines HCC in einer nicht zirrhotischen Leber und in relativ jungem Lebensalter bei gleichzeitigem Vorliegen einer Echinokokkuszyste. Trotz vollständiger Resektion des HCC zusammen mit der Echinokokkuszyste trat 5 Monate später ein Rezidiv in Form eines multizentrischen HCC auf. Bisher wurden nur wenige Fallberichte über das gleichzeitige Auftreten beider Erkrankungen veröffentlicht. Die Echinokokkose als Auslöser für ein HCC wurde von einigen Autoren in Erwägung gezogen, ein kausaler Zusammenhang konnte bislang nicht nachgewiesen werden.

Abstract

Introduction: The coincidence of echinococcosis and hepatocellular carcinoma (HCC) is quite rare. We report the case of a 45-year-old man who was admitted to our hospital because of abdominal pain in the right upper quadrant and jaundice.

Clinical features and diagnostics: There was no history of weight loss or fever. No abdominal mass was palpable. The laboratory reports showed increased transaminase levels. Ultrasonography revealed an inhomogenous, cystic lesion measuring 6 cm in diameter in the segments VI and VII. Serology for echinococcosis was negative, alpha-fetoprotein (AFP) was considerably increased. CT scan showed a solid mass of 3,7 cm in diameter adjacent to the cystic lesion.

Therapy and course: Anthelminthic therapy with albendazole caused a massive increase of cholestasis parameters and treatment had to be stopped. The simultaneous occurrence of serologically negative cystic echinococcosis and HCC was suspected and partial liver resection was performed. Histological examination confirmed both diagnoses and tumor resection in healthy tissue. 5 months after resection CT scan showed multicentric HCC affecting the whole liver. Palliative therapy with sorafenib was established.

Discussion: The coincidence of HCC and cystic echinococcosis in the non-cirrhotic liver of a young man is a rare event. Despite resection in healthy tissue multicentric HCC was diagnosed 5 months later. Only few cases of simultaneous occurrence of HCC and echinococcosis have been published so far. Some authors considered echinococcosis as a trigger for HCC. A causal link between both entities has not been demonstrated until now.

Schlüsselwörter

hepatozelluläres Karzinom - zystische Echinokokkose - Rezidiv - Tomografie - X-ray - Hepatektomie - differenzielle Diagnose

Key words

hepatocellular carcinoma - cystic echinococcosis - recurrence - tomography - X-ray - hepatectomy - differential diagnoses
 

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