Severe hepatosplenic schistosomiasis: clinicopathologic study of 102 cases undergoing splenectomy

• Published in: Human pathology Vol. 42; no. 1; pp. 111 - 119
• Main Authors: Li, Yuesheng, MD, PhD, Chen, Dongliang, MD, Ross, Allen G., MD, PhD, Burke, Melissa L., PhD, Yu, Xinling, MD, Li, Robert S., MSc, Zhou, Jie, MD, McManus, Donald P., PhD, DSc
• Format: Journal Article
• Language: English
• Published: New York, NY Elsevier Inc 2011; Elsevier; Elsevier Limited
• Subjects: Adolescent; Adult; Aged; Biological and medical sciences; Classification; Confidence intervals; Diseases caused by trematodes; Family medical history; Female; Gastroenterology. Liver. Pancreas. Abdomen; Helminthic diseases; Hepatic fibrosis; Hepatic histopathology; Hepatitis B - complications; Hepatitis B - pathology; Hepatitis B virus; Hepatitis C virus; Hepatosplenic schistosomiasis; Hospitals; Humans; Infectious diseases; Investigative techniques, diagnostic techniques (general aspects); Liver - diagnostic imaging; Liver - pathology; Liver cirrhosis; Liver Cirrhosis - diagnostic imaging; Liver Cirrhosis - pathology; Liver Diseases, Parasitic - diagnostic imaging; Liver Diseases, Parasitic - pathology; Liver Diseases, Parasitic - surgery; Liver. Biliary tract. Portal circulation. Exocrine pancreas; Male; Medical sciences; Middle Aged; Morbidity; Mortality; Other diseases. Semiology; Parasitic diseases; Pathology; Pathology. Cytology. Biochemistry. Spectrometry. Miscellaneous investigative techniques; Schistosoma; Schistosomiases; Schistosomiasis japonica; Schistosomiasis japonica - complications; Schistosomiasis japonica - diagnostic imaging; Schistosomiasis japonica - pathology; Schistosomiasis japonica - surgery; Splenectomy; Splenic Diseases - pathology; Splenic Diseases - surgery; Surgery; Tropical diseases; Ultrasonography; Veins & arteries; China; Splenectomy; Hepatic fibrosis; Hepatosplenic schistosomiasis; Schistosomiasis japonica; Hepatic histopathology; Ultrasonography; Digestive system; Liver; Trematode disease; Hepatic disease; Parasitosis; Helminthiasis; Infection; Schistosomiasis; Symptomatology; Anatomic pathology; Histopathology; Echography; Digestive diseases; Severe
• ISSN: 0046-8177; 1532-8392
• DOI: 10.1016/j.humpath.2010.05.020

Summary We present the preoperative findings of 102 patients who underwent successful splenectomy for advanced schistosomiasis japonica. All patients were symptomatic for schistosomiasis and had splenomegaly greater than or equal to II according to the Hackett criteria. Before surgery, all patients underwent clinical examination including full blood count; fibrinogen and serum protein levels; liver function tests; and serology for hepatitis B, C, and D. Ultrasound examination of the liver and spleen and liver histology for evidence of pathology were also undertaken. Ninety patients had a treatment history for schistosomiasis. Fifty-six patients were seropositive for hepatitis B virus antibody, and 6 patients were seropositive for hepatitis C virus antibody. Immunohistochemical testing of the liver samples confirmed that 45 patients were positive for hepatitis B virus surface antigen, thereby indicating active infection. A total of 66.7% of patients had fibrosis stages II to III by ultrasound; and 76.5% of patients had portal vein inner diameter greater than 12 mm, indicating portal vein hypertension. A total of 83.2% of patients showed various stages of esophageal varicosis via x-ray, and 81.4% had fibrotic stages III to IV by liver biopsy. Coinfection with hepatitis B virus accelerated the development of liver fibrosis. There was moderate concordance between the fibrosis assessed by ultrasonography and histopathology, indicating that ultrasound underestimates the true pathology. Combined assessment is needed to improve the diagnosis of clinical hepatic fibrosis.