Clonorchis sinensis: a mimic of hepatic mucinous cystic neoplasm or just a fluke?

Authors

  • Tushar L. Agrawal Department of General Surgery, Gold Coast University Hospital, Southport, Queensland, Australia
  • Brielle E. Williams Department of General Surgery, Gold Coast University Hospital, Southport, Queensland, Australia
  • Bryan M. Tran Department of General Surgery, Gold Coast University Hospital, Southport, Queensland, Australia
  • Ramesh Damodaran Prabha Department of General Surgery, Gold Coast University Hospital, Southport, Queensland, Australia
  • Sooraj Pillai Department of Anatomical Pathology, Gold Coast University Hospital, Southport, Queensland, Australia
  • Craig Sommerville Department of General Surgery, Gold Coast University Hospital, Southport, Queensland, Australia

DOI:

https://doi.org/10.18203/2349-2902.isj20240574

Keywords:

Clonorchis sinensis, Liver flukes, Endemic

Abstract

Liver flukes, endemic in East Asia, are parasites that can infect humans and cause liver and bile duct disease. While most infected individuals are asymptomatic, chronic infection can lead to structural hepatobiliary manifestations including hepatomegaly, intrahepatic bile duct dilatation, epithelial hyperplasia, periductal fibrosis, and potentially cholangiocarcinoma. There are no reports of human cases of liver fluke infection presenting as a hepatic cystic lesion. We present the case of a 52-year-old asymptomatic Chinese immigrant presenting with a suspected mucinous cystic neoplasm of the liver. CT and Ultrasound examinations demonstrated an enlarging complex cyst involving segments II and III. Liver function tests, hydatid serology and tumour markers were normal. He underwent elective laparoscopic left hemi-hepatectomy with liver fluke discovered on histology. Subsequent genetic testing confirmed Clonorchis sinensis infection. The patient made an uneventful recovery from surgery and was treated with anthelminthic therapy. This case highlights the importance of considering liver fluke as a differential diagnosis for hepatic cystic lesions in patients from endemic regions. Appropriate diagnosis could avoid surgery, whilst targeted anthelminthic therapy minimises the risk of chronic infection and associated complications, including cholangiocarcinoma.

References

Keiser J, Utzinger J. Food-borne trematodiases. Clin Microbiol Rev. 2009;22(3):466-83.

Chai JY, Jung BK. Epidemiology of Trematode Infections: An Update. Adv Exp Med Biol. 2019;1154:359-409.

Qian MB, Li HM, Jiang ZH, Yang YC, Lu MF, Wei K, et al. Severe hepatobiliary morbidity is associated with Clonorchis sinensis infection: The evidence from a cross-sectional community study. PLoS Negl Trop Dis. 2021;15(1):e0009116.

Marcos LA, Terashima A, Gotuzzo E. Update on hepatobiliary flukes: fascioliasis, opisthorchiasis and clonorchiasis. Current Opinion in Infectious Diseases. 2008;21(5):523-30.

Kim TS, Pak JH, Kim JB, Bahk YY. Clonorchis sinensis, an oriental liver fluke, as a human biological agent of cholangiocarcinoma: a brief review. BMB Rep. 2016;49(11):590-7.

Liu JX, Liu M, Yu GZ, Zhao QQ, Wang JL, Sun YH, et al. Clonorchis sinensis infection induces hepatobiliary injury via disturbing sphingolipid metabolism and activating sphingosine 1-phosphate receptor 2. Front Cell Infect Microbiol. 2022;12:1011378.

Oh JT, Kang DB, Jo HJ. Acute cholecystitis associated with Clonorchis sinensis infection. Ann Surg Treat Res. 2014;87(2):104-7.

Won J, Cho Y, Lee D, Jeon BY, Ju JW, Chung S, Pak JH. Clonorchis sinensis excretory-secretory products increase malignant characteristics of cholangiocarcinoma cells in three-dimensional co-culture with biliary ductal plates. PLoS Pathog. 2019;15(5):e1007818.

Fürst T, Keiser J, Utzinger J. Global burden of human food-borne trematodiasis: a systematic review and meta-analysis. Lancet Infect Dis. 2012;12(3):210-21.

Lim JH, Kim SY, Park CM. Parasitic diseases of the biliary tract. AJR Am J Roentgenol. 2007;188(6):1596-603.

Malekzadeh S, Widmer L, Salahshour F, Egger B, Ronot M, Thoeny HC. Typical imaging finding of hepatic infections: a pictorial essay. Abdom Radiol (NY). 2021;46(2):544-61

Xavier FG, Morato GS, Righi DA, Maiorka PC, Spinosa HS. Cystic liver disease related to high Platynosomum fastosum infection in a domestic cat. J Feline Med Surg. 2007;9(1):51-5.

Assawarachan SN, Yodsheewan R, Maneesaay P, Rattanapinyopituk K, Chuchalermporn P, Kongchun A, et al. Feline Cyst-like Lymphocytic Cholangiohepatitis in a Cat: First Case Report. Animals (Basel). 2022;12(23):3278.

Worasith C, Wangboon C, Duenngai K, Kiatsopit N, Kopolrat K, Techasen A, et al. Comparing the performance of urine and copro-antigen detection in evaluating Opisthorchis viverrini infection in communities with different transmission levels in Northeast Thailand. PLoS Negl Trop Dis. 2019;13(2):e0007186.

Kim EM, Verweij JJ, Jalili A, Van Lieshout L, Choi MH, Bae YM, et al. Detection of Clonorchis sinensis in stool samples using real-time PCR. Ann Trop Med Parasitol. 2009;103(6):513-8.

Keiser J, Utzinger J. The drugs we have and the drugs we need against major helminth infections. Adv Parasitol. 2010;73:197-230.

Downloads

Published

2024-02-29

Issue

Section

Case Reports