Biliary ascariasis associated with cholangiocarcinoma

Area of Science:

• Gastroenterology and Hepatology
• Parasitology
• Oncology

Background:

• Obstructive jaundice is a critical clinical presentation requiring prompt diagnosis.
• Biliary ascariasis, caused by the roundworm Ascaris lumbricoides, is a rare but significant cause of biliary tract disease, particularly in endemic areas.
• Cholangiocarcinoma, a malignancy of the bile ducts, presents a diagnostic challenge, especially when co-occurring with other biliary pathologies.

Observation:

• A 52-year-old male patient presented with symptoms of obstructive jaundice.
• Abdominal sonography revealed dilated intrahepatic bile ducts containing multiple elongated intraluminal lesions consistent with biliary ascariasis.
• A distinct mass was identified projecting into the common bile duct, causing significant obstruction.

Findings:

• The intraluminal lesions within the dilated bile ducts were confirmed to be due to biliary ascariasis.
• Histopathological examination of the obstructing mass revealed a coexistent cholangiocarcinoma.
• This case demonstrates a rare concurrent presentation of parasitic infestation and malignancy within the biliary system.

Implications:

• Highlights the importance of considering parasitic infections in the differential diagnosis of obstructive jaundice, even in the presence of a suspicious mass.
• Emphasizes the need for advanced imaging and potentially invasive procedures to differentiate between parasitic masses and malignancy in the bile ducts.
• Suggests that early detection and management of biliary ascariasis might be crucial, and its potential role in the pathogenesis or progression of cholangiocarcinoma warrants further investigation.