MEDizzy - A 26-year-old presents with right upper quadrant abdominal

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Gastrointestinal System

A 26-year-old presents with right upper quadrant abdominal pain and is found to have a large cyst in the right lobe of his liver. X-rays reveal the cyst to have a calcified wall. The cyst is then surgically excised. Examination of this tissue histologically reveals a thick, acellular, laminated eosinophilic wall. The fluid within the cyst is found to be granular and contain numerous small larval capsules with scoleces (“brood capsules”). Which of the following is the most likely diagnosis?

ExplanationThere are numerous organisms other than viruses that can cause infections of the liver and result in liver disease. Bacteria may cause nonsuppurative or supportive infections. The latter can result in the formation of pyogenic liver abscesses, which clinically cause high fever, right upper quadrant abdominal pain, and hepatomegaly. There are several parasites that can cause hepatic disease. Infection with the ova of Echinococcus granulosus may produce a hydatid cyst within the liver, which is characterized by a thick, acellular, laminated eosinophilic wall (seen on x-ray as a calcified wall). The fluid within the cyst is granular and contains numerous small larval capsules with scoleces, called “brood capsules.” Spillage of this cyst fluid at the time of surgery may produce anaphylactic shock and be deadly. Amebic trophozoites of Entamoeba histolytica reach the liver from the colonic submucosa and produce multiple, small amebic liver abscesses that coalesce to form large cysts with thick “anchovy paste” inside. Trophs of Entamoeba can be found within the wall of the cyst. Schistosomiasis (Schistosoma mansoni in the Middle East and Schistosoma japonicum in the Far East) can cause liver disease, as the adult worm lives in the intestinal venous plexus and eggs may reach the liver via the portal vein. Acute disease results in granulomas, while chronic infection produces a characteristic “pipe stem” fibrosis.