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Impact of affected lymph nodes on long-term outcome after surgical therapy of alveolar echinococcosis

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Abstract

Purpose

Alveolar echinococcosis (AE) is a life-threatening helminthic disease. In humans, AE mostly affects the liver; the regional hepatic lymph nodes may be involved, indicating dissemination of AE from the liver. To achieve complete removal of the disease, enlarged hepatic lymph nodes may be resected during surgical treatment. We evaluated the frequency of affected lymph nodes by conventional microscopic and immunohistochemical analyses including detection of small particles of Echinococcus multilocularis (spem). Furthermore, we analyzed the association of resection of enlarged and affected lymph nodes with long-term outcome after surgical therapy of patients who underwent surgery with curative intent.

Materials and methods

We identified 43 patients who underwent hepatic surgery with curative intent with lymph node resection for AE. We analyzed the cohort for the manifestation of the parasite in the resected lymph nodes by conventional histology and by immunohistochemistry and compared these data with the further course of AE.

Results

Microscopically infected lymph nodes (laminar layer visible) were found in 7 out of these 43 patients (16%). In more than three quarters (25/32) of all specimens investigated, lymph nodes showed spems when stained with antibody against Em2G11, a monoclonal antibody specific for the Em2 antigen of the Echinococcus multilocularis metacestode. Most frequently, lymph nodes were resected due to enlargement. The median size of microscopically affected lymph nodes was 2 cm (range, 1.2 to 2.5 cm), the median size of immunohistochemically and non-affected lymph nodes was 1.3 cm each (range, “small” to 2.3 or 2.5 cm, respectively). Median follow-up was 8 years for all patients, 5 years for patients with lymph node resection, and 4 years for patients with infested lymph nodes. Overall, recurrent disease was seen in ten patients (10/109; 9%) after a median period of 1.5 years (range, 4 months to 4 years). None of the seven patients with conventionally microscopically affected lymph nodes suffered from recurrent disease. One patient with negative resected nodes and one patient with spems showed recurrent disease after 4 and 35 months, respectively.

Conclusions

Lymph node involvement in AE is frequent, particularly when evaluated by immunohistochemical examination of lymph nodes with the monoclonal antibody Em2G11. Affected lymph nodes tend to be larger in size. Lymph node involvement is not associated with recurrent disease and therefore warrants further analysis of the biological significance of lymph node involvement.

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Author notes

  1. Andreas Hillenbrand and Annika Beck contributed equally to this work.

Authors and Affiliations

  1. Department of General and Visceral Surgery, University Hospital Ulm, Albert-Einstein-Allee 23, 89081, Ulm, Germany

    Andreas Hillenbrand & Doris Henne-Bruns

  2. Department of Pathology, University Hospital Ulm, Ulm, Germany

    Annika Beck, Thomas F. E. Barth & Peter Möller

  3. Department of Internal Medicine, University Hospital Ulm, Ulm, Germany

    Wolfgang Kratzer, Julian Schmidberger & Beate Gruener

  4. Department of Diagnostic and Interventional Radiology, University Hospital Ulm, Ulm, Germany

    Tilmann Graeter

Authors
  1. Andreas Hillenbrand
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  2. Annika Beck
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  5. Thomas F. E. Barth
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  6. Julian Schmidberger
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  9. Beate Gruener
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Contributions

Authorship AH, DHBB, BG, WK, and TFEB contributed to the conceptualization of the study; AH, AB, JS, and BG contributed to the data curation; AH, WK, TG, TFEB, PM, DHB, and BG contributed to the analysis and interpretation of data; AH, AB, and TFEB contributed to the drafting of the manuscript; AH, AB, WK, TG, TFEB, JS, PM, DHB, and BG contributed to the critical revision of the manuscript.

Corresponding author

Correspondence to Andreas Hillenbrand.

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Conflict of interests

The authors declare that they have no conflict of interest.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed consent

Informed consent was obtained from all individual participants included in the study. There is no gender defined. We did not perform a breakdown by gender since it is not helpful. Gender-specific data can be consulted on justified request.

Electronic supplementary material

Supplement Figure 1

Negative control: section of a lymph node stained without application of primary antibody Em2G11 is completely negative. (JPG 206 kb)

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Hillenbrand, A., Beck, A., Kratzer, W. et al. Impact of affected lymph nodes on long-term outcome after surgical therapy of alveolar echinococcosis. Langenbecks Arch Surg 403, 655–662 (2018). https://doi.org/10.1007/s00423-018-1687-9

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  • DOI: https://doi.org/10.1007/s00423-018-1687-9

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