A case of adenocarcinoma developed in the small intestine with chronic strongyloidiasis

Abstract

We experienced a case of intestinal strongyloidiasis complicated by jejunal carcinoma. A Japanese male in his 50s, who has a 7-year medical history of duodenal ulcers, complained of loss of appetite, nausea, vomiting and diarrhea. Computed tomography and gastroduodenal endoscopic examination revealed a stenosis of the duodenum. To remove the stenosis, gastric bypass surgery was performed. The pathological diagnosis of the resected jejunum was strongyloidiasis and well-differentiated adenocarcinoma with subserosal invasion and vascular infiltration. After administration of Ivermectin, Strongyloides stercoralis was not found in any biopsies or in the specimens of the intestine, which were resected due to cancer recurrence 2 years later. There are three possibilities for the reason of coexistence of S. stercoralis and adenocarcinoma: S. stercoralis caused the adenocarcinoma, S. stercoralis moved to the carcinoma, or just coincidence. Although it is difficult to prove a causal relationship between S. stercoralis and adenocarcinoma, this is the first report of adenocarcinoma developed in the jejunum with chronic strongyloidiasis. The number of nematode infections, including strongyloidiasis, is decreasing in Japan, although not worldwide. Therefore, it should be considered in patients with prolonged intestinal ulcers.

Bacterial and Parasitic Pathogens as Risk Factors for Cancers in the Gastrointestinal Tract: A Review of Current Epidemiological Knowledge

“…However, risk of GI cancers other than liver cancer were not elevated amongst HTLV-infected individuals ( Tanaka et al, 2016 ). Epidemiological data addressing the association between S. stercoralis infection and GI cancers is limited to few case-control studies ( Supplementary Table 16 ; Hirata et al, 2007 ; Tanaka et al, 2016 ) and a number of case reports addressing strongyloidiasis and GC ( Seo et al, 2015 ) and intestinal cancer ( Tomaino et al, 2015 ; Catalano et al, 2017 ; Ishikawa et al, 2017 ; Sava et al, 2020 ). An almost threefold higher risk of developing cancer in the biliary tract was observed amongst patients with a S. stercoralis infection in a Japanese cohort (OR 2.7; 95% CI 1.1–6.3) ( Hirata et al, 2007 ).…”

The current status of neglected tropical diseases in Japan: A scoping review

“…Strongyloidiasis has been reported particularly among patients with other diseases and conditions, including adult human T-cell lymphotropic virus type 1 infection, meningitis, solid organ malignancy, rheumatic diseases, type 2 diabetes mellitus, steroid use, and organ or bone marrow transplant [279][280][281][282][283][284][285]. These cases suggest that the use of immunosuppressive drugs in asymptomatic carriers of S. stercoralis may be associated with hyperinfection syndrome and disseminated strongyloidiasis.…”

Spotlights on helminth pathogens’ innovative pathways of tumorigenesis

“…Since chronic colitis due to IBD is associated with an increased risk of colorectal cancer, it is conceivable that chronic colitis due to S. stercoralis infection may carry a similar risk. Epidemiological data reporting an association between S. stercoralis infection and gastrointestinal cancers is restricted to few reports of case-control studies and few case reports [97][98][99][100][101][102][103] . A case report of associated S. stercoralis infection and early gastric carcinoma was described in a Korean patient, revealing gastric adenocarcinoma and adenomatous tissue positive for S. stercoralis; implicating the causative effect of S. stercoralis [98] .…”