A Case Report of Fascioliasis in the Pancreas Preoperatively Diagnosed as Cystadenocarcinoma by Endoscopic Retrograde Pancreatography

Shoichi Fujita, Makoto Beppu, Kousei Haku, Kenichi Fujimoto, Tsugukiyo Hirai, Nobuhiro Murai, Sekizou Taniguchi, Takeo Matsumura*

Department of Surgery, Nishinomiya Prefectural Hospital
*Department of Medical Zoology, School of Medicine, Kobe University

This is a case report of fascioliasis in the pancreas definitively diagnosed by a resected specimen. Preoperatively the fascioliasis had been diagnosed by endoscopic retrograde pancreatography (ERP) as cystadenocarcinoma of the pancreas. A 72-year-old man was admitted with persistent upper abdominal pain. Abdominal ultrasonography and computed tomography (CT) scan showed a space-occupying lesion in the pancreatic body. ERP disclosed a cystic mass in the pancreatic body, which was tentatively diagnosed as cystadenocarcinoma of the pancreas. Resection of the pancreatic body and tail, and total gastrectomy were performed. The lesion was found by microscopic examination of the resected specimen to be inflammatory granuloma with many parasite eggs and infiltrated eosinophils and lymphocytes. The size and shape of parasite eggs identified them as those of Fasciola hepatica. Identified the eggs and a skin test with F. hepatica antigen positively, specific positive reaction of an Ouchterlony test and immunoelectrophoresis indicated the infection was F. hepaica. From these 5 findings, this case was definitely diagnosed as F. hepatica ectopic parasitism in the pancreas.

Key words
fascioliasis, ectopic parasitism in the pancreas, Fasciola hepatica egg, cystadenocarcinoma of the pancreas

Reprint requests
Shoichi Fujita Nishinomiya Prefectural Hospital
13-9 Rokutanji-cho, Nishinomiya, 662 JAPAN

Accepted
January 16, 1991

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