Successful multimodal management of a large hepatocellular carcinoma in a non-cirrhotic liver: a case report.

peer reviewed[en] BACKGROUND: Hepatocellular carcinoma (HCC) found in a non cirrhotic liver represents a minority of HCC cases and remains poorly studied. Due to its specific characteristics and evolution, this tumour requires a different management compared to HCC in a cirrhotic liver. CASE REPORT: The authors describe the case of a 68-year-old man diagnosed with a large giant and only mildly symptomatic HCC in a non-cirrhotic liver. The 23 cm HCC was discovered when a thoracoabdominal computed tomography was performed following mild abdominal pain. After a multidisciplinary discussion the tumour was judged to be borderline, but potentially resectable after neoadjuvant therapy and preparation for surgery. The patient underwent selective internal radiation therapy radioembolization of the right hepatic artery lobe with 5,5 GBq of 90Y-labeled glass microspheres. It was followed by extended right hepatectomy after preparation by embolization of the right portal and the right hepatic veins. Thirty months after surgical resection the patient showed neither clinical, radiological nor biological signs of HCC recurrence. DISCUSSION: HCC in non-cirrhotic liver is less common than in cirrhotic liver but has a better prognosis, thanks to a greater opportunity for surgical resection. The symptoms often emerge late and are unspecific, thus delaying the HCC diagnosis. Advances in surgical resection by laparotomy or laparoscopy, and neoadjuvant therapy in preparation for surgery, have proven to be effective. However, high mortality persists due to late diagnosis linked to the inability of identifying groups at risk of HCC in the non-cirrhotic population and inadequate screening

Alveolar echinococcosis is increasing in Southern Belgium: a report of the Belgian National Reference Laboratory for Echinococcosis (BNRLE) and clinical experience of ECHINO- Liege

peer reviewedIntroduction Alveolar echinococcosis (AE) is endemic in Southern Belgium where up to 50% of the red foxes might be infected and spread Echinococcus eggs in the environment. In humans, the primary target organ of AE is the liver, in which AE grows as a parasitic tumor and might later develop in other organs as a malignancy and be lethal. In response to the increasing number of AE cases, a multidisciplinary group (ECHINO-Liege) was created in CHU Liege to improve AE management and to discuss the AE cases. In addition, on the top of a retrospective AE registry, ECHINO-Liege is prospectively building a database (ECHINO-Base) and a biobank (ECHINO-Bank) of AE patients managed in CHU Liege, after EC approval and informed consent. Finally, since 2021, the Belgian National Reference Laboratory for Echinococcosis (BNRLE) is based in the department of Clinical Microbiology of CHU Liege. Aim The aim of this study was to report the actual epidemiological and clinical situation on AE in Belgium, using the BNRLE data and the clinical experience of ECHINO-Liege. Methods All Belgian clinical laboratories were asked to fill epidemiological forms on AE cases detected in 2021 and 2022. All cases confirmed by serology (immunoblot) and/or PCR and/or histology (proved cases) or without microbiological confirmation (probable and possible cases) were included. These cases were added to the retrospective series already published in 2018 and to the cases discussed during the regular meetings of ECHINO-Liege. Results AE was newly diagnosed and reported to BNRLE in 16 patients in the time-period of 2 years, added to the 36 patients previously registered (total: 52 patients, 29M/23F) (mean age: 60y, 19-89). Most patients were born and lived in Wallonia or the Brussels area. All cases but 2 are considered contracted in Belgium (1 in France and 1 in Luxembourg). 31 patients underwent liver resection and 1 liver transplantation. Conclusions AE appears to be spreading in Southern Belgium. The authorities should be aware of this public health issue. The radiologists and gastroenterologists should be informed of this diagnosis possibility in case of liver tumor. A national multicentric survey will be soon initiated as a collaboration between the different hospitals in the whole country