Case Report: Two Cases of Cholangiocarcinoma in Patients with Opisthorchis felineus Infection in Western Siberia, Russian Federation

Abstract

Cholangiocarcinoma (CCA) is a cancer with high mortality owing to its aggressiveness and resistance to therapy. The liver flukes of the Opisthorchiidae family have been recognized as risk factors of CCA. Opisthorchis felineus infection occurs in Western Siberia, the biggest endemic area in the Russian Federation, and is associated with chronic inflammation of the bile ducts, which may be linked to severe hepatobiliary morbidity. We report two cases of confirmed CCA who had a chronic O. felineus infection. Both cases presented unspecific symptoms at the onset of the disease, a stage when severe pathological changes already had occurred. Both patients were living in endemic areas but did not receive any antihelminthic treatment. This report underlines the need for assessment of O. felineus infection as a causative factor of CCA. The results will provide further arguments for control of O. felineus in the Russian Federation.

Figure 1.

Case 1. Magnetic resonance imaging: signs of cholangiocarcinoma (axial view). (A) Enlarged intrahepatic bile ducts; (B) the common bile duct is not distinctly differentiated within 1.0 cm; its diameter is enlarged up to 1.0 cm in the proximal and middle part.

Figure 2.

Case 1. Histology of liver parenchyma: a moderately differentiated tubular adenocarcinoma with desmoplastic reaction is found. A small ductular carcinoma grows in desmoplastic stroma. Hematoxylin and eosin stain (original magnification, ×40). This figure appears in color at www.ajtmh.org.

Figure 3.

Case 2. Magnetic resonance imaging: signs of cholangiocarcinoma (sagittal view). Tumor in the right lobe of liver with bile hypertension, involving biliary cyst and defeat of regional lymphatic nodes. (A) Mass-like enlargement with unclear contours; (B) enlarged intrahepatic bile ducts.

Figure 4.

Case 2. Histology of liver parenchyma: bile ductular type of intrahepatic cholangiocarcinoma. Epithelial cells are cuboidal with eosinophilic cytoplasm and round central nuclei; tumor cells are heterogeneous and resemble bile duct cells. Poorly differentiated carcinoma grows in fibrous stroma and has cord-like growth. Hematoxylin and eosin stain (original magnification, ×20). This figure appears in color at www.ajtmh.org.

Figure 5.

Case 2. Histology of liver parenchyma: Opisthorchis felineus adult worms in intrahepatic bile duct. Hematoxylin and eosin stain (original magnification, Plan ×5). This figure appears in color at www.ajtmh.org.