ABSTRACT Schistosomiasis affects approximately 207 million people in 76 countries. The association between hepatocellular carcinoma and Schistosoma mansoni infection has been investigated. Studies using animal models suggest that the parasite may accelerate the oncogenic process when combined with other factors, such as hepatitis C virus infection or exposure to a carcinogen. Herein, we report a case series of six hepatocellular carcinoma patients from Northeast Brazil, with negative serology for both hepatitis B and C virus, submitted to liver transplantation, whose explant showed evidence of schistosomal liver fibrosis. Since all patients enrolled in this study were submitted to liver transplantation, we were able to access the whole explanted liver and perform histopathological analysis, which is often not possible in other situations. Although 50% of them showed signs of liver failure, no cirrhosis or any liver disease other than schistosomal fibrosis had been detected. These uncommon findings suggest that Schistosoma mansoni infection might predispose to hepatocellular carcinoma development, regardless of the absence of other risk factors.

Em ambos os hospitais universitários de Pernambuco, o tratamento de escolha para portadores de esquistossomose hepatoesplênica (EHE) com antecedente de hemorragia digestiva alta (HDA) por rotura de varizes de esôfago (VE) é a esplenectomia associada à ligadura da veia gástrica esquerda (ELGE); porém, o impacto desta cirurgia sobre a pressão das VE, provavelmente, o parâmetro que melhor se correlaciona com o risco de recidiva hemorrágica, ainda não foi estudado. Com a introdução, em nosso meio, de técnica não-invasiva de medição da pressão das VE, isto tornou-se possível, com mínimos riscos, tomando-se o objetivo do presente estudo. A ELGE foi empregada em vinte portadores de EHE com antecedentes de HDA. A pressão das VE foi medida através do método endoscópico não-invasivo do balão pneumático, antes da cirurgia, e estes valores comparados com novas medições realizadas cinco a oito dias após. A pressão nas VE no pré-operatório variou entre 20,0 e 28,7mmHg (média de 24,35± 2,36 mmHg). Não houve correlação da pressão com o calibre das VE. No pós-operatório (PO), observou-se uma queda significante na pressão das VE, que variou entre 14,6 e 21,5 mmHg (média 17,29± 1,75 mmHg, p<0,001). Os resultados do presente trabalho confirmam as idéias que fundamentam a indicação da ELGE em portadores de EHE com antecedente de HDA. Esta cirurgia determina, pelo menos a curto prazo e na ampla maioria dos casos, uma redução na pressão das VE reduzindo o risco de recidiva de HDA.

Although splenectomy associated to left gastric vein ligature (SLGL) has been the standard procedure for the treatment of patients with hepatosplenic schistosomiasis (HSS) and previous upper digestive tract bleeding (UDB) originated from rupture of esophageal varices (EV) in both university hospitals in Pernanbuco, the effects of this procedure over the EV pressure, what is probably the parameter that offers the best correlation with bleeding recurrence, has not been studied yet. SLGL was performed in 20 patients with HSS and previous UDB. EV pressure was measured before surgery by the non-invasive endoscopic pneumatic balloon method. Pre-operative EV pressure values were compared with the new measurements performed 5 to 8 days after surgery. Pre-operative measurements of EV pressure ranged from 20.0 to 28.7 mmHg (average 243±52.36). No correlation between EV pressure and varices diameter was found. Post-operatively a significant decrease in EV pressure was observed (p<0.001), with measurements ranging from 14.6 to 21.5 (average 17.29±1.75). The results shown in this study ratify the idea of using SLGL in HSS patients with previous UDB as the standard procedure. SLGL induces, at least during a short period of time after surgery and in most of the cases, a reduction in EV pressure leading to a reduced risk of UDB recurrence.