Journal of Parasitic Diseases

, Volume 40, Issue 3, pp 976–980 | Cite as

Human Schistosomiasis mansoni associated with hepatocellular carcinoma in Egypt: current perspective

  • Manar Mahmoud El-Tonsy
  • Hesham Mohammed Hussein
  • Thanaa El-Sayed Helal
  • Rania Ayman TawfikEmail author
  • Khalid Mohamed Koriem
  • Hend Mohamed Hussein
Original Article


Hepatocellular carcinoma (HCC) is one of the most common cancers worldwide. It was reported to account for about 4.7 % of chronic liver disease in Egyptian patients. The present study aimed at studying the different factors that may be implicated in the relationship of schistosomiasis mansoni with HCC in Egypt. A total of 75 Egyptian patients with primary liver tumours (HCC) were enrolled in this study. They were subjected to full history taking and indirect hemagglutination assay (IHA) for the diagnosis of schistosomiasis. According to the results, the patients were categorized into two groups: Group I: 29 patients with negative IHA for schistosomiasis and hepatitis C virus (HCV) positive with no history or laboratory evidence of previous or current Schistosoma mansoni infection. Group II: 46 patients with positive IHA for schistosomiasis and HCV positive. The significant higher proportion of HCC patients in the present study had concomitant HCV and schistosomiasis (61.3 %) compared to HCC patients with HCV alone (38.7 %) suggesting that the co-infection had increased the incidence of HCC among these patients. Analysis of the age distribution among HCC patients revealed that patients in Group II were younger in age at time of diagnosis of HCC with mean age 57.1 years, as compared to patients in Group I with mean age 64.3 years with a highly significant statistical difference between the 2 groups. HCC in Group II was more common in rural residents while it was more common in urban areas in Group I with a significant statistical difference between the 2 groups. Analysis of the sex distribution among the studied groups showed that HCC was more common in males than females in both groups. As regards the aggression of HCC, it was more commonly multifocal and larger in size in patients with concomitant infection than in patients with HCV alone.


Schistosoma mansoni Hepatocellular carcinoma Risk factors Egyptian patients 


  1. Abdel-Wahab M, El-Ghawalby N, Mostafa M, Sultan A, El-Sadany M, Fathy O, Salah T, Ezzat F (2007)  Epidemiology of hepatocellular carcinoma in lower Egypt, Mansoura Gastroenterology Center. Hepatogastroenterology 54(73):157–62Google Scholar
  2. Abdel-Rahman M, El-Sayed M, El Raziky M, Elsharkawy A, El-Akel W, Ghoneim H, Khattab H, Esmat G (2013) Coinfection with hepatitis C virus and schistosomiasis: fibrosis and treatment response. World J Gastroenterol: WJG 19(17):2691CrossRefPubMedGoogle Scholar
  3. Angelico M, Renganathan E, Gandin C, Fathy M, Profili MC (1997) Chronic liver disease in the Alexandria governorate, Egypt: contribution of schistosomiasis and hepatitis virus. J Hepatol 26:236–243CrossRefPubMedGoogle Scholar
  4. Badawi AF, Michael MS (1999) Risk factors for hepatocellular carcinoma in Egypt: the role of hepatitis-B viral infection and schistosomiasis. Anticancer Res 19:4565–4569PubMedGoogle Scholar
  5. El-Nady GM, Ling R, Harrison TJ (2003) Gene expression in HCV associated hepatocellular carcinoma-upregulation of a gene encoding a protein related to the ubiquitin-conjugating enzyme. Liver Int 23:329–337CrossRefPubMedGoogle Scholar
  6. El-Serag HB (2002) Hepatocellular carcinoma: an epidemiologic view. J Clin Gastroenterol 35(Suppl. 2):S72–S78CrossRefPubMedGoogle Scholar
  7. El-Tonsy MM, Hussein HM, Helal TES, Tawfik RA, Koriem KM, Hussein HM (2013) Schistosoma mansoni infection: is it a risk factor for development of hepatocellular carcinoma? Acta Trop 128(3):542–547CrossRefPubMedGoogle Scholar
  8. El-Zayadi AR, Abaza H, Shawky S, Mohamed MK, Selim OE, Badran HM (2001) Prevalence and epidemiological features of hepatocellular carcinoma in Egypt—a single center experience. Hepatol Res 19:170–179CrossRefGoogle Scholar
  9. El-Zayadi AR, Badran HM, Barakat EM, Attia ME, Shawky S, Mohamed MK, Selim O, Saeid A (2005) Hepatocellular carcinoma in Egypt: a single center study over a decade. World J Gastroenterol 11(33):5193–5198PubMedCentralPubMedGoogle Scholar
  10. Hassan MM, Zaghloul AS, El-Serag HB (2001) The role of hepatitis C in HCC: a case control study among Egyptian patients. J Clin Gastroenterol 33:123–126CrossRefPubMedGoogle Scholar
  11. Hussein HM, El-Gindy IM, Abdel-Hamid DM, El-Wakil HS, Maher KM (2004) Characterization of three types of Schistosoma mansoni soluble egg antigen and determination of their immunodiagnostic potential by western blot immunoassay. Egypt J Immunol 11(1):65–73PubMedGoogle Scholar
  12. Iida F, Lida R, Kamijo H, Takaso K, Miyazaki Y, Funabashi W et al (1999) Chronic Japanese schistosomiasis and hepatocellular carcinoma; ten years of follow-up in Yamanashi Prefecture, Japan. Bull World Health Organ 77:573–581PubMedCentralPubMedGoogle Scholar
  13. Kamal S, Madwar M, Bianchi L, Tawil AE, Fawzy R, Peters T, Rasen JW (2000) Clinical, virological and histopathological features: long-term follow-up in patients with chronic hepatitis C co-infected with S. mansoni. Liver 20:281–289CrossRefPubMedGoogle Scholar
  14. Kamal SM, Turner B, He Q, Rasenack J, Bianchi L, Al Tawil A, Nooman A, Massoud M, Koziel MJ, Afdhal NH (2006) Progression of fibrosis in hepatitis C with and without schistosomiasis: correlation with serum markers of fibrosis. Hepatology 43:771–779CrossRefPubMedGoogle Scholar
  15. Ohata K, Hamasaki K, Toriyama K, Ishikawa H, Nakao K, Eguchi K (2004) High viral load is a risk factor for hepatocellular carcinoma in patients with chronic hepatitis B virus infection. J Gastroenterol Hepatol 19:670–675CrossRefPubMedGoogle Scholar
  16. Pleguezuelo M, Lopez LM, Rodrigues A, Montero JL et al (2010) Proteomic analysis for developing new biomarkers of hepatocellular carcinoma. World J Hepatol 2(3):127–135CrossRefPubMedCentralPubMedGoogle Scholar
  17. Santamaria E, Munoz J, Fernandez J, Prieto J, Corrales J (2007) Towards the discovery of new biomarkers of HCC by proteomics. Liver Int 27(2):163–173. ISSN 1478–3223CrossRefPubMedGoogle Scholar
  18. Strickland TG (2006) Liver disease in Egypt: hepatitis C superseded schistosomiasis as a result of iatrogenic and biological factors. Perspect Clin Hepatol 43(5):915–922Google Scholar
  19. Xiong J, Yao YC, Zi XY, Li JX, Wang XM, Ye XT, Zhao SM (2003) Expression of hepatitis B virus X protein in transgenic mice. World J Gastroenterol 9:112–116CrossRefPubMedCentralPubMedGoogle Scholar
  20. Yu MC, Tong MJ, Govindarajan S, Henderson BE (1991) Nonviral risk factors for hepatocellular carcinoma in a low-risk population, the non-Asians of Los Angeles County, California. J Natl Cancer Inst 83:1820–1826CrossRefPubMedGoogle Scholar

Copyright information

© Indian Society for Parasitology 2014

Authors and Affiliations

  • Manar Mahmoud El-Tonsy
    • 1
  • Hesham Mohammed Hussein
    • 1
  • Thanaa El-Sayed Helal
    • 2
  • Rania Ayman Tawfik
    • 1
    Email author
  • Khalid Mohamed Koriem
    • 3
  • Hend Mohamed Hussein
    • 1
  1. 1.Department of Parasitology, Faculty of MedicineAin Shams UniversityCairoEgypt
  2. 2.Department of Pathology, Faculty of MedicineAin Shams UniversityCairoEgypt
  3. 3.Medical Research Division, Department of Medical PhysiologyNational Research CenterCairoEgypt

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