Human fascioliasis is a rare parasitic disease outside of countries in which it is endemic. The diagnosis of hepatic-phase fascioliasis by diagnostic imaging alone is challenging. A 69-year-old female was referred to our hospital for the treatment of a solitary solid cystic mass lesion, 6 cm in diameter, accompanied with mild symptoms and minimal changes in laboratory parameters. Intrahepatic cholangiocarcinoma was suspected, and she underwent extended posterior sectionectomy. Four months later, she was re-admitted because of fatigue, high fever, and epigastric pain. Her eosinophil fraction and immunoglobulin E levels were extremely elevated (49.1% and 6833 IU/ml, respectively). She was found to have two new reticular cystic hepatic tumors. Serum dot enzyme-linked immunosorbent assay for parasites revealed strong positivity for Fasciola hepatica. Praziquantel was ineffective, and multi-cystic tumors rapidly developed in the left lateral section, requiring emergency left lateral sectionectomy. An F. hepatica helminth, approximately 3 cm in size, was observed on the cut liver surface during hepatic resection. Prophylactic triclabendazole (1,000 mg/day) was administered twice. She has been well for over 10 years without relapse of fascioliasis. In patients with hepatic tumors accompanied by inflammatory changes and eosinophilia, detailed medical history and serological testing by dot enzyme-linked immunosorbent assay for parasites are strongly recommended.

Inflammatory Liver Tumor Caused by Fasciola hepatica Mimicking Intrahepatic Cholangiocarcinoma.

Fascioliasis presenting as colon cancer liver metastasis on 18F-fluorodeoxyglucose positron emission tomography/computed tomography: A case report

Fascioliasis presenting as colon cancer liver metastasis on 18F-fluorodeoxyglucose positron emission tomography/computed tomography: A case report.

A 94-year-old lady along with her son, primary health care personnel, from a village in Songhor city in Kermanshah province, Iran referred to a physician in early 2016, with chief complaints of severe anorexia, weight loss, icterus, severe pruritus, and right upper quadrant pain. The symptoms and signs had been started a few months ago with insidious exacerbation. Drug history was unremarkable. Considering the patient’s old age, cancer workup was conducted. The complete blood count demonstrated prominent eosinophilia. Ultrasound examination reported bile duct dilatation and hepatomegaly. To rule out periampullary and pancreatic cancer, Computed Tomography (CT) scanning was requested, which demonstrated bile duct dilatation and a shadow in a choledochal canal with motility and echo in favor of parasite. The patient was referred to an infectious and tropical disease specialist. Fasciola hepatica egg was confirmed on the stool examination. In the past, she had a history of consumption of fresh plants growing near the river. The patient was prescribed Triclabendazole (6 tablets). She had been informed of obstructive symptoms of parasite if it could not be excreted. Fortunately, after drug ingestion, all the obstructive symptoms and signs were subsided. Pruritus continued for a few months. The patient had passed away in winter 2018, according to our last follow-up in July 2018. Fascioliasis is an infestation of the liver by a fluke named Fasciola hepatica, which is a health problem in Iran. The number of human cases in Iran is underestimated. [1] Freshwater plant species, including watercress, especially in Iran, green leafy Nasturtium spp., and Mentha spp. may be the contributing factors for infestation. [1, 2] This zoonotic infestation is found in some provinces of Iran, including Kurdistan, Zanjan, Kermanshah, Mazandaran, Tehran, Azerbaijan, Guilan, Fars, and Khuzestan. [2, 3] Turkish researchers reported cases of Fascioliasis mimicking malignancy. [4, 5] One case was a 48-year-old lady with abdominal pain, fatigue, vomiting, nausea, weight loss, and a tiny neuroendocrine tumor, which finally showed Fasciola hepatica infestation with clinical, laboratory, and imaging data. [4] Another study included two ladies (26and 52-year-old) with abdominal pain and unremarkable physical examination and lab data, except for peripheral eosinophilia and liver masses, which were finally diagnosed as Fasciola hepatica histopathologically. [5] The present

https://biomedicine.edp-open.org/articles/bmdcn/pdf/2019/02/bmdcn2019090207.pdf

Fascioliasis mimicking malignancy in an old patient.

Insan fasioliazisi, Fasciola hepatica ve Fasciola gigantica’nin neden oldugu,  dunya genelinde nadir gorulen zoonotik bir hastaliktir. Genellikle ciftlik  hayvanlarini etkileyen bir trematod olup insan rastlantisal ara konakcidir.  Spesifik olmayan semptom ve bulgularinin bircok hepatobiliyer hastalikta  izlenebilmesi nedeniyle fasioliazisin tani ve tedavisi gecikebilmektedir. Elli  uc yasinda kadin hasta 18-Florodeoksi-glukoz pozitron emisyon bilgisayarali  tomo-grafi incelemesinde ekstrahepatik safra yollarinda yuksek florodeoksi- glukoz tutulumu nedeniyle klinigimize basvurdu. Hastada son 3 aydir  suren karin agrisi, kasinti ve halsizlik yakinmalari mevcuttu. Kolanjiyoselluler  kanseri taklit eden ve serolojik olarak tanisi konan biliyer fasioliazisli bu  vakayi sunacagiz.

/pdf/f-18-fdg-pet-bt-de-kolanjioselluler-kanseri-taklit-eden-nuyo0dfq6w.pdf

F-18-FDG PET/BT’de kolanjiosellüler kanseri taklit eden Fasciola hepatica vakası

A 48-year-old female with complaints of gastrointestinal symptoms such as abdominal pain, fatigue, vomiting, nausea, and weight loss was diagnosed with neuroendocrine tumor after removal of a 2 mm lesion from the stomach with endoscopic biopsy. Her magnetic resonance imaging that was performed due to on-going symptoms showed multiple linear hypointense lesions in the liver. Positron emission tomography/computed tomography (PET/CT) scan was performed for differential diagnosis, which showed high fluorodeoxyglucose (FDG) uptake in these lesions. Clinical and laboratory findings revealed the final diagnosis as Fasciola hepatica. The imaging features of this case is presented to aid in differentiating this infectious disease from malignancy and avoid misdiagnosis on FDG-PET/CT.

/pdf/fasciola-hepatica-mimicking-malignancy-on-18f-1gxqla2vgs.pdf

Abdüssamed Batur

Papers

Fasciola Hepatica Mimicking Malignancy on 18F-Fluorodeoxyglucose-Positron Emission Tomography/Computed Tomography.