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.
Subject(s)
Cysts/pathology , Echinococcosis, Hepatic/pathology , Liver Neoplasms/pathology , Precancerous Conditions/pathology , Cysts/surgery , Diagnosis, Differential , Echinococcosis, Hepatic/surgery , Humans , Liver Neoplasms/surgery , Male , Middle Aged , Precancerous Conditions/surgery , Treatment OutcomeABSTRACT
The authors assessed three systems for diagnosing borderline personality disorder: DSM-III, the checklist criteria of Spitzer et al., and the Diagnostic Interview for Borderline Patients. In an inpatient sample of 51 patients, 43 (84%) met the criteria of at least one of these systems; analyses were carried out on 28 of these patients. Twelve (43%) of these 28 patients met criteria for all three systems, seven (25%) for two systems, and nine (32%) for only one system. Kernberg's structural criteria showed reasonable overlap with the other diagnostic criteria. Affective disorders were prominent across diagnostic measures in this sample of borderline patients.
