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

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 18 F-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.

Hepatic and Extrahepatic Fascioliasis Mimicking Colon Cancer with Hepatic Metastasis

“…T2 bright high-signal intensity microabscesses in the liver parenchyma, 'Tunnels and caves' sign in the subcapsular and peribiliary areas, T2 hyperintense wall thickening with a uniform layered pattern of the colon, severe edematous changes, and hemorrhage of the omentum and transverse mesocolon helped diagnose hepatic and extrahepatic fascioliasis. In the previous case reports, there were cases in which colon cancer was mimicked, and surgical excision was performed (5,6). The combination of multimodality imaging helped diagnose the disease, and unnecessary surgical intervention was prevented in this case.…”

“…There have been reports of extrahepatic fascioliasis in the GI tract, including the colon, cecum, and transverse mesocolon (2,5,6,11,12). Colon involvement is thought to be caused by the migration of penetrating larvae through the duodenal wall to a location other than the liver through the peritoneum or mesentery (1).…”

“…Extrahepatic manifestations are rare and have been reported in the subcutaneous tissue, brain, lungs, epididymis, and colon (3)(4)(5)(6). When extrahepatic fascioliasis appears as a tumor in the colon, malignancy can be mimicked, making it difficult to diagnose preoperatively (5,6). Herein, we report a case of hepatic and extrahepatic fascioliasis mimicking colon cancer with hepatic metastasis, in the form of multiple masses in the transverse colon and liver.…”

“…Symptoms include abdominal pain in the right upper quadrant, obstructive jaundice, and cholangitis (1,2). Extrahepatic manifestations are rare and have been reported in the subcutaneous tissue, brain, lungs, epididymis, and colon (3)(4)(5)(6). When extrahepatic fascioliasis appears as a tumor in the colon, malignancy can be mimicked, making it difficult to diagnose preoperatively (5,6).…”