Sympathetic and Vagal Distribution in Hepatic Alveolar Echinococcosis and Its Clinical Correlation.

INTRODUCTION: To explore the distribution characteristics of sympathetic and vagal nerves in hepatic alveolar echinococcosis (AE). By analyzing pathological specimens from patients, we focused on the differential distribution of nerves in lesions, perilesional zones, and normal liver tissues and revealed their correlation with clinical local staging, hepatic fibrosis and regenerative processes. METHODS: Pathological specimens from 74 patients diagnosed with hepatic AE were analyzed. The differential distribution of sympathetic and vagal nerves was examined in three distinct tissue regions: the central lesion, the perilesional zone, and distal normal liver tissue. The correlation between the percentage of sympathetic nerve positivity and clinical local stage, fibrosis, and cell proliferation was statistically analyzed. RESULTS: The analysis revealed a marked hyperplasia of sympathetic nerves specifically within the lesion and the perilesional zone, whereas no significant changes were observed in the normal liver tissues. The distribution of vagal nerves showed no significant variation across all regions. The density of sympathetic nerves demonstrated a positive correlation with the clinical local staging of the disease. Histopathological examination confirmed multiple round lesions with fibrous encapsulation and prominent inflammatory cell infiltration in the perilesional zone. Furthermore, sympathetic nerve hyperplasia was significantly correlated with the degree of fibrosis in both the lesion and perilesional zone. The density of sympathetic nerves in the perilesional zone was also positively associated with local inflammatory cell proliferation. CONCLUSION: Sympathetic nerves, but not vagal nerves, exhibit significant hyperplasia within and around hepatic AE lesions. The density of these sympathetic nerves is strongly correlated with disease progression, the extent of fibrosis, and local cellular proliferation. These findings suggest that sympathetic nerves may play a key role in the pathological remodeling and progression of hepatic AE.