الفهرس 
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Abstract
Human schistosomiasis is a major chronic disease in endemic areas. In the past, it
was the most important public health problem in Egypt. It causes chronic morbidity, where
infected people may develop a variety of pathological characteristics ranging from mild
cercarial dermatitis to severe tissue inflammation. The overall prevalence of
schistosomiasis in Egypt fell to <3% because of effective control programs. However,
there are still hot spot transmission foci: Kafr El-Sheikh is one of these high transmission
areas.
HCC is the 5th most common neoplasm and the 3rd most frequent reason of cancer
related death, causing approximately one million deaths per year around the globe.
This work was designed to study the different factors (demographic, hepatitis C
virus, hepatitis B virus, alpha-fetoprotein) that were implicated in the relationship of S.
mansoni with hepatocellular carcinoma in Kafr El Sheikh governorate.
The present study was carried out on 90 HCC patients from Kafr El Sheikh and
Gharbia governorates who attended or were admitted to Kafr El Sheikh Liver Disease
Research Institute during the period from November 2017 to May 2018, they were
subjected to full history taking, Kato Katz and indirect hemagglutination (IHA) techniques
for the diagnosis of S. mansoni. Accordingly, the participants were categorized into two
groups: group I: sixty two HCC patients with negative Kato Katz and negative IHA for
schistosomiasis, with no laboratory evidence or US and CT scan (i.e. no liver fibrosis) of
current S.mansoni infection. group II: twenty-eight HCC patients with negative Kato Katz,
positive IHA for schistosomiasis. The Child-Pugh scoring system and BCLC staging
system were used to classify the HCC pathological features in the studied patients.
Regarding the demographic data, the present study showed that, among the 90
examined patients, the greater proportion of patients who were positive for S. mansoni was
in the group 49-59 years. As for gender, HCC was higher among males compared to
females; 78.9% vs 21.1% respectively. HCC with and without schistosomiasis was more
common in rural than urban.
The clinical parameters revealed that upper gastrointestinal bleeding and blood
transfusion were statistically significantly higher among positive S. mansoni (group II)
compared to the negative one (group II) (P≥ 0.002). The overall prevalence of HCV Ab
and HBsAg was 87.1%, 8.1 % in group I and 96.4% and 7.1% in group II respectively. A
higher proportion of HCC patients showed concomitant HCV and S. mansoni compared to
those with HCC alone (96.4% vs 87.1%). There was no significant difference between the
two groups in any of the most of studied parameters; ALT, AST, total bilirubin, direct
bilirubin, and albumin. Normalizing ratio for prothrombin time (INR) was significantly
higher in HCC S. mansoni positive cases. There was no significant difference between the
two groups regarding AFP.
The Child-Pugh scoring system and BCLC staging system showed no statistical
difference between the two groups. However, the BCLC staging system showed ln class D
a significant statistical difference between the two groups( 14.5% in group I vs 35.7% in
group II).
The above results revealed indirect association between S. mansoni and HCC.
S. mansoni infection accelerates hepatic dysplastic changes in the presence of other risk
factors causing cancer to appear at an earlier age and with a more aggressive nature
compared to the same risk in absence of schistosomiasis. The present study and the
literature indicate that HCV and HBV infections, possibly act as a cofactor for hepatic
lesions and potentiate liver damage in schistosomiasis.
6.2 Conclusion
from the obtained results, it can be concluded that:
- HCC is a health problem in Egypt and it is higher in this study area in rural
community in Kafr El Sheikh governorate.
- The larger proportion of HCC patients who were positive for S. mansoni was in the
group 49-59 years indicating that chronic Schistosoma infection accelerated the
appearance of HCC at an earlier age.
- Despite the absence of significant, the combination of chronic schistosomiasis caused
by S. mansoni and HBV or HCV may cause a higher risk of HCC.
- AFP partially fulfills the requirements of an ideal tumor marker but showed no
significant difference between the two studied groups (HCC positive S. mansoni and
HCC negative S. mansoni).
- It remains unclear if S. mansoni infection alone has liver carcinogenic potential.
- BCLC staging system showed statistically significant difference in class D among
HCC positive S. mansoni group compared to the negative one.
- chronic Schistosomiasis mansoni, in the presence of HBV and HCV infections, may
act as a cofactor for the hepatic lesion, potentiates HCC appearance and accelerates
its progression.
- There are some limitations of the present study. It is a cross sectional study of
records which was performed in a single institution, which may not allow the
generalization of these data to the common population. Therefore, further studies are
needed in other localities of demographic and environmental variations.