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Severe hepatosplenic schistosomiasis: clinicopathologic study of 102 cases undergoing splenectomy.

Abstract
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.
AuthorsYuesheng Li, Dongliang Chen, Allen G Ross, Melissa L Burke, Xinling Yu, Robert S Li, Jie Zhou, Donald P McManus
JournalHuman pathology (Hum Pathol) Vol. 42 Issue 1 Pg. 111-9 (Jan 2011) ISSN: 1532-8392 [Electronic] United States
PMID20970162 (Publication Type: Journal Article, Research Support, Non-U.S. Gov't)
CopyrightCrown Copyright © 2011. Published by Elsevier Inc. All rights reserved.
Topics
  • Adolescent
  • Adult
  • Aged
  • Female
  • Hepatitis B (complications, pathology)
  • Humans
  • Liver (diagnostic imaging, pathology)
  • Liver Cirrhosis (diagnostic imaging, pathology)
  • Liver Diseases, Parasitic (diagnostic imaging, pathology, surgery)
  • Male
  • Middle Aged
  • Schistosomiasis japonica (complications, diagnostic imaging, pathology, surgery)
  • Splenectomy
  • Splenic Diseases (pathology, surgery)
  • Ultrasonography

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