Alveolar echinococcosis of the liver with initially suspected intrahepatic cholangiocarcinoma: case report - the significance of preoperative serological diagnostics

Cysts of the liver pose a significant differential-diagnostic problem, considering that the etiology of which can be various. Until recently, alveolar echinococcosis (AE) of the liver in a differential diagnostic analysis of cystic liver lesions with a solid component had little significance in the Vojvodina region. The Syrmia area of Vojvodina is an endemic zone of multilocular echinococcus among wildlife, and the first case of human AE was documented in April 2023. In order to denote the significance of preoperative serological AE diagnostics, we will present a case of AE of the liver initially suspected to be cholangiocarcinoma. A patient from the Syrmia area of Vojvodina, reports in November 2023, after the appearance of icterus and epigastric pain. Laboratory results display slightly increased proinflammatory markers, while hepatogram results indicate cholestasis with reactive hepatitis. MRI of the abdomen indicates a focal lesion in the S5/S8 segment of the liver of primarily infiltrative MRI characteristics, which may indicate cholangiocarcinoma. Total body CT scan excludes other lesions. Patient has undergone extended right hepatectomy and the PH results proved the presence of multilocular echinococcus. Despite epidemiological risks, diagnosis of infiltrative cystic focal lesions of the liver does not include testing for echinococcus. The reported case indicates the necessity of testing all focal lesions of the liver for AE. The awareness of the epidemiological situation in the region where the patient resides must be raised in order to add serological testing of focal lesions of the liver for multilocular echinococcus to guidelines.