Echinococcus granulosus (sensu lato), a cestode that is endemic in Egypt, causes cystic echinococcosis (CE), a significant but neglected zoonotic disease that is prevalent throughout the world. Infected hydatid cysts are classified as fertile or non-fertile based on the presence of protoscoleces; nevertheless, the mechanism of non-fertile CE cysts remains unknown. The study aimed to assess whether granzyme B (GrB) expression and CD4 + /CD8 + could be related to the induction of non-fertile CE cysts. A total of fifty-eight individuals diagnosed with visceral hydatid cysts were selected, and they were further divided according to cyst fertility into fertile and non-fertile. Immunohistochemistry for CD4, CD8, and GrB was done. According to the results, hydatid cysts are common in adults and have no gender preference. The same clinical and laboratory data were shared by patients with fertile and non-fertile cysts ( p = 0.186). GrB expression was not impacted by the fibrous deposition inside the hydatid cyst wall ( p = 0.85); however, GrB was significantly correlated with the inflammatory density ( p = 0.005). GrB expression was also found to be significantly higher in non-fertile cysts ( p = 0.04). GrB expression is positively correlated with CD4 and CD8 expression. In conclusion, the expression of GrB in hydatid cysts may exacerbate the inflammatory response and impede cyst fertility while not affecting the fibrous deposition in the cyst wall.

Abstract Background Hepatocellular carcinoma (HCC) remains a major health problem despite the emergence of several preventive and therapeutic modalities. HCC has heterogeneous and wide morpho-molecular patterns, resulting in unique clinical and prognostic criteria. Therefore, we aimed to study the clinical and pathological criteria of HCC to update the morpho-molecular classifications and provide a guide to the diagnosis of this disease. Methods Five hundred thirty pathologically analyzed HCC cases were included in this study. The clinical and survival data of these cases were collected. Results Hepatitis C virus is still the dominant cause of HCC in Egypt. Post-direct-acting antiviral agent HCC showed an aggressive course compared to interferon-related HCC. Old age, male gender, elevated alpha-fetoprotein level, tumor size, and background liver were important prognostic parameters. Special HCC variants have characteristic clinical, laboratory, radiological, prognostic, and survival data. Tumor-infiltrating lymphocytes rather than neutrophil-rich HCC have an excellent prognosis. Conclusions HCC is a heterogenous tumor with diverse clinical, pathological, and prognostic parameters. Incorporating the clinicopathological profile per specific subtype is essential in the treatment decision of patients with HCC. Trial registration This was a retrospective study that included 530 HCC cases eligible for analysis. The cases were obtained from the archives of the Pathology Department, during the period between January 2010 and December 2019. Clinical and survival data were collected from the patients’ medical records after approval by the institutional review board (IRB No. 246/2021) of Liver National Institute, Menoufia University. The research followed the guidelines outlined in the Declaration of Helsinki and registered on ClinicalTrials.gov (NCT05047146).

We report a case of hepatic lymphoepithelioma-like carcinoma-hepatocellular carcinoma subtype (LEL-HCC) in a 41-year-old man with chronic hepatitis C virus (HCV) infection. The patient presented with abdominal pain and further assessment revealed a hypoechoic mass on ultrasonography. Serum alpha-fetoprotein (AFP) was 13·6 ng/dl. The patient was diagnosed as hepatocellular carcinoma based on the established triphasic computed tomography (TCT) diagnostic criteria and he underwent a surgical resection of the mass. Microscopic examination showed sheets and cords of malignant epithelial cells intermixed with heavy lymphoid infiltrate, with more than 100 tumor-infiltrating lymphocytes (TILs) per 10 high-power-field (HPF). Based on immunohistochemical studies, the malignant cells were positive for Hep Par 1 and glypican 3, focally positive for cytokeratin 7 (CK7), and negative for cytokeratin 20 (CK20). TILs were diffusely positive for cluster of differentiation 3 CD3 with an approximately equal CD4/CD8 ratio. The patient was recurrence free at 25 months after surgery, as evident by CT and serum alpha-fetoprotein level. LEL-HCC is a rare variant of HCC with a relatively better prognosis. Exploring the potential for immune modulator-based therapy in this subset of tumors is highly recommended.

Background Bile leakage is a common and serious complication after hepatic resection. It is important to prevent it by early detection and repair of leaking points intraoperatively and hence minimizing postoperative leaks. In this study, the authors prospectively compared the effect of transcystic intralipid injection versus saline test and then cholangiography on biliary complications in different cases of liver resection. Patients and methods This is a prospective randomized clinical trial in which we compared between the use of the White test and the use of saline test followed by cholangiography for the intraoperative detection of bile leakage in patients who underwent liver resection with cholecystectomy. The 52 cases were carried out in the National Liver Institute from May 2019 till March 2021. Results The incidence of postoperative bile leakage in both groups was compared. Bile leakage occurred in nine (34.6%) patients in the conventional saline and then cholangiography and in three (11.5%) patients in the White test group; this was statistically significant (P=0.048). In addition, the White test detected intraoperatively a significantly larger number of bile leakage sites (seven cases) compared with the saline and then cholangiography group (two cases). Conclusion Based on the results of this study, the authors strongly recommend using the white test to saline test and then cholangiography as the bile leak test of choice in minimizing posthepatectomy bile leak.

Background Anatomical variation of biliary anatomy is the cornerstone for the procedure of living donor liver transplantation (LDLT). Aim The aim was to study the effect of donor’s biliary variant anatomy on the procedure of adult LDLT. Participants and methods A retrospective study was conducted using the data of all donors and recipients of LDLT (June 2013–December 2017) in HPB Department and Liver Transplant Surgery. A total of 120 potential donors were assessed preoperatively by MRCP to evaluate the biliary anatomy of the liver and classified into four types according to Varotti and colleagues. Results Of 120 donors, 13 (10.8%) were excluded from donation before surgery owing to various causes; six (46.1%) of them were excluded owing to donor’s biliary anatomical variation. According to the classification of Varotti and colleagues, biliary variations were seen in 27 (25.2%) of 107 donors (five of type 2, 14 of type 3a, and eight of type 3b); type 1 with short stump was seen in 25 (23.1%) cases. Biliary complications (BCs) occurred in 53 (49.5%) of 107 recipients, including bile leak in 40 (37.5%) cases, biliary strictures in 13 (12.1%) cases, and concomitant biliary stricture and leak in 17 (15.9%) cases. There was a statistically significant correlation between the presence of donor’s right hepatic duct (RTH) duct (type 1 with short stump) and BCs in their recipients (P=0.04). There was a statistically significant between the occurrence of BCs in recipient and hospital stay (P=0.046). BCs presented in eight (7.4%) donors, where six (5.6%) of them had bile leak and two (1.8%) had a biliary stricture. Anatomical biliary variations were a risk factor for potential donor exclusion (P=0.021). Conclusions There was a statistically significant difference between donor’s RTH (type 1 with short stump) and BCs in their recipients, and between the occurrence of BCs in recipient and hospital stay. Donor biliary anatomical variations had a statistically significant effect for potential donor’s exclusion.

Castleman's disease (CD) is a primary lymphoproliferative disorder of the lymph nodes with rare extra-nodal primary affection. Presentation of case: Here we present a case of primary hepatic CD associated with hepatocellular carcinoma (HCC). Discussion: Sixty-two years old, male received direct-acting antiviral agents (DAAs) for HCV infection. Follow up revealed sustained virologic response; however, three hepatic focal lesions were accidently discovered. Triphasic CT confirmed the HCC nature of two masses while the other mass remained undiagnosed. Surgical intervention was the treatment of choice, and pathological examination showed a fairly circumscribed mass formed of angiolymphoid hyperplasia displayed atrophic germinal center, expanded mantle zone, and variable hyalinization. The radiological evaluation of lymph nodes was unremarkable. The patient is 40 months alive after resection, with no further management advised. Conclusion: The immune-modulatory effect of DAAs may induce hepatic CD development in a cirrhotic patient, necessitating further studies. A new radiologic finding was observed in the present case in the form of vessels traversing through the lesion with no attenuation or occlusion. Pathology remains the gold standard in the diagnosis of CD.