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Case Reports
. 2019 Aug 27;11(8):656-662.
doi: 10.4254/wjh.v11.i8.656.

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

Sami Akbulut  1 , Egemen Ozdemir  2 , Emine Samdanci  3 , Selver Unsal  4 , Murat Harputluoglu  5 , Sezai Yilmaz  6
Affiliations
Case Reports

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

Sami Akbulut et al. World J Hepatol. .

Abstract

Background: Fascioliasis is caused by watercress and similar freshwater plants or drinking water or beverages contaminated with metacercariae. Fascioliasis can radiologically mimic many primary or metastatic liver tumors. Herein, we aimed to present the treatment process of a patient with fascioliasis mimicking colon cancer liver metastasis.

Case summary: A 35-year-old woman who underwent right hemicolectomy due to cecum cancer was referred to our clinic for management of colon cancer liver metastasis. Both computed tomography and 18F-fluorodeoxyglucose positron emission tomography revealed several tumoral lesions localized in the right lobe of the liver. After a 6-course FOLFOX (folinic acid, fluorouracil, oxaliplatin) and bevacizumab regimen, the hypermetabolic state on both liver and abdominal lymph nodes continued, and chemotherapy was extended to a 12-course regimen. The patient was referred to our institute when the liver lesions were detected to be larger on dynamic liver magnetic resonance imaging 6 weeks after completion of chemotherapy. Right hepatectomy was performed, and histopathological examination was compatible with fascioliasis. Fasciola hepatica IgG enzyme-linked immunosorbent assay was positive. The patient was administered two doses of triclabendazole (10 mg/kg/dose) 24 h apart. During the follow-up period, dilatation was detected in the common bile duct, and Fasciola parasites were extracted from the common bile duct by endoscopic retrograde cholangiopancreatography (ERCP). Triclabendazole was administered to the patient after ERCP.

Conclusion: Parasitic diseases, such as those caused by Fasciola hepatica, should be kept in mind in the differential diagnosis of primary or metastatic liver tumors, such as colorectal cancer liver metastasis, in patients living in endemic areas.

Keywords: Case report; Colon cancer liver metastasis; Fasciola hepatica; Misdiagnosis; Positron emission tomography.

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Conflict of interest statement

Conflict-of-interest statement: The authors declare no conflicts of interest.

Figures

Figure 1
Figure 1
Computed tomography image after contrast medium injection. Axial computed tomography image revealed that hypodense and heterogenous lesions with soft tissue density of maximally 40 mm × 33 mm in diameter in the right lobe of the liver.
Figure 2
Figure 2
18F-fluorodeoxyglucose positron emission tomography/Computed tomography was performed using 5.5 mCi of 18F-fluorodeoxyglucose injection. Maximum intensity projection of images shows that high fluorodeoxyglucose uptakes in different segments of the liver.
Figure 3
Figure 3
Granuloma with central necrosis (HE ×100).
Figure 4
Figure 4
Charcot–Leyden crystals near granuloma (arrows) (HE ×100).
Figure 5
Figure 5
Endoscopic view of endoscopic retrograde cholangiopancreatography procedure. Extraction of Fasciola hepatica in the common bile duct using a basket catheter.
Figure 6
Figure 6
Course of blood CA19-9 levels. Black arrows indicate the days of endoscopic retrograde cholangiopancreatography.
See this image and copyright information in PMC

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