Published online Aug 27, 2019. doi: 10.4254/wjh.v11.i8.656
Peer-review started: April 29, 2019
First decision: June 3, 2019
Revised: June 14, 2019
Accepted: August 20, 2019
Article in press: August 20, 2019
Published online: August 27, 2019
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.
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.
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.
Core tip: Human fascioliasis is caused by drinking water or freshwater plants (watercress, etc.) contaminated with metacercariae. Fascioliasis may remain asymptomatic for many years and is usually detected incidentally during radiological examinations for other reasons. Radiologically, fascioliasis can be confused with many other benign and malignant hepatobiliary diseases. One of the most common malignant liver diseases mimicking fascioliasis includes colon cancer liver metastasis. We aimed to present the diagnosis and treatment process in a patient with fascioliasis radiologically mimicking colon cancer liver metastasis.