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Analysis of clinical, imaging, and pathological features of osseous echinococcosis
Maiweilidan Yimingjiang1, Xuelian Pang2, Yi Shi2
1Pathology Department, the First Affiliated Hospital of Xinjiang Medical University; State Key Laboratory of Pathogenesis, Prevention and Treatment of High Incidence Diseases in Central Asia, Urumqi, Xinjiang, PR China.
Objective:
To investigate the clinical, imaging, and pathological features of osseous cystic echinococcosis (CE) and osseous alveolar echinococcosis (AE) to enhance diagnostic accuracy and differential diagnosis capabilities.
Methods:
A retrospective analysis of 58 pathologically confirmed osseous echinococcosis cases was conducted, collecting demographic, clinical, imaging, and histopathological data.
Results:
Of 58 patients, 49 (84.5%) had osseous CE and 9 (15.5%) had osseous AE. Both types predominantly affected farmers/herdsmen. The spine was the most commonly affected site (CE: 70.4%, AE:44.4%), and multi-site involvement was common (CE: 71.4%, AE: 88.9%). Osseous CE showed multilocular cystic hypodense lesions (58.0%) on CT and ``grape-cluster-like'' lesions with long T1/T2 signals (90.2%), with ring-like enhancement of the cyst wall and septa sometimes on MRI. Osseous AE presented heterogeneous density with calcifications (50.0%) on CT, and MRI showed mixed signals, with calcifications and fibrous components showing low signals on T2WI. Histopathologically, osseous CE specimens contained "laminated membrane"-like material (68.4%); powder-stained plate-like stratum corneum was observed under the microscope (100%). Osseous AE displayed necrotic debris (70.0%); honeycomb-like microcysts were seen within the necrotic background (100%).
Conclusion:
Osseous CE and AE share overlapping Clinical features, but exhibit differences in CT/MRI and pathological characteristics. Compared to osseous CE, osseous AE demonstrated broader site distribution, more frequent multisystem involvement, and a more aggressive clinical course with shorter disease duration prior to diagnosis. Mastering the key features is essential for accurate diagnosis.
