RESUMO
A 69-year-old man was referred to our hospital for epigastralgia. He was found to have elevation of serum amylase and CA19-9. Ultrasonography, abdominal CT, MRCP, ERCP and EUS showed the cystic lesion and a possibility of an other tumor. There was a stenosis of the main pancreatic duct (MPD) at the pancreas head and dilatation of the MPD from the body to the tail. Intraductal papillary mucinous neoplasm (IPMN) of the branch pancreatic duct was diagnosed, and there was a likelihood of ductal carcinoma of the pancreas. We therefore performed pancreatoduodenectomy. Pathological finding showed invasive carcinoma from an intraductal papillary mucinous neoplasm with invasive ductal carcinoma of the pancreas.
Assuntos
Carcinoma Ductal Pancreático/diagnóstico , Carcinoma Papilar/diagnóstico , Cistadenocarcinoma Mucinoso/diagnóstico , Neoplasias Primárias Múltiplas , Neoplasias Pancreáticas/diagnóstico , Idoso , Carcinoma Ductal Pancreático/patologia , Carcinoma Papilar/patologia , Colangiopancreatografia Retrógrada Endoscópica , Cistadenocarcinoma Mucinoso/patologia , Endossonografia , Humanos , Masculino , Neoplasias Pancreáticas/patologia , Radiografia Abdominal , Tomografia Computadorizada por Raios XAssuntos
Eosinofilia/parasitologia , Fasciolíase/complicações , Icterícia Obstrutiva/parasitologia , Idoso , Anti-Helmínticos/uso terapêutico , Benzimidazóis/uso terapêutico , Fasciolíase/diagnóstico , Fasciolíase/tratamento farmacológico , Febre/parasitologia , Humanos , Masculino , Esfinterotomia Endoscópica/métodos , Resultado do Tratamento , TriclabendazolRESUMO
In human fasciolosis, differential diagnosis of the causative flukes, Fasciola hepatica and Fasciola gigantica, is problematic. We report a rare case of human fasciolosis in which an adult worm was recovered from the bile duct of a Japanese man. Morphometric data of the worm were consistent with those of F. hepatica, whereas the size of eggs in the stool indicated infection with F. gigantica. Nucleotide sequences of ITS-1 and -2 and CO1 genes of the DNA extracted from the eggs revealed that the genotype was that of F. hepatica. These findings suggest that the size of eggs is not a suitable marker for species identification in human fasciolosis, especially in settings such as the East Asian region where different karyotypes and hybrid genotypes of F. hepatica and F. gigantica have been found.