A Case of Intraabdominal Paragonimiasis Mimicking Metastasis of Lung Cancer Diagnosed by Endoscopic Ultrasound-guided Fine Needle Aspiration

Cho Rong Oh; Mi-Jin Kim; Kwang Hyuck Lee

doi:10.4166/kjg.2015.66.1.41

Journal List > Korean J Gastroenterol > v.66(1) > 1007460

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Oh, Kim, and Lee: A Case of Intraabdominal Paragonimiasis Mimicking Metastasis of Lung Cancer Diagnosed by Endoscopic Ultrasound-guided Fine Needle Aspiration

Case Report

Korean J Gastroenterol 2015;66(1):41-45.

Published online: 4 October 2015

DOI: https://doi.org/10.4166/kjg.2015.66.1.41

A Case of Intraabdominal Paragonimiasis Mimicking Metastasis of Lung Cancer Diagnosed by Endoscopic Ultrasound-guided Fine Needle Aspiration

Cho Rong Oh, Mi-Jin Kim, Kwang Hyuck Lee

Division of Gastroenterology, Department of Internal Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea

Correspondence to: Kwang Hyuck Lee, Division of Gastroenterology, Department of Internal Medicine, Samsung Medical Center, 81 Irwon-ro, Gangnam-gu, Seoul 135-710, Korea. Tel: +82-2-3410-3409, Fax: +82-2-3410-6983, E-mail: lkhyuck@gmail.com

Received 3 November 2014 Revised 26 December 2014 Accepted 6 January 2015

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Paragonimiasis has been continuously decreasing in Korea. However, it still occurs by ingesting raw or incompletely cooked fresh water crab or crayfish. The diagnosis of paragonimiasis is challenging because of its rarity. It may be confused with other inflammatory disease or carcinomatosis. Endoscopic ultrasound-guided fine needle aspiration (EUS-FNA) has lower risk of complications such as bleeding, perforation than percutaneous fine needle aspiration. EUS-FNA is more accurate and popular method to find mucosal or submucosal tumors and the lesions of several organs. Benign and malignant tumors, infectious diseases have been diagnosed by EUS-FNA, but there was no report describing the use of EUS-FNA for diagnosing paragonimiasis. Herein, we present a 47-year-old male patient with paragonimiasis diagnosed by EUS-FNA. Imaging studies revealed mass lesions in the lung and peritoneal cavity, which was eventually confirmed as paragonimiasis using EUS-FNA.

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Keywords: Paragonimiasis, Endoscopic ultrasound-guided fine needle aspiration

References

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Fig. 1.

CT scans of chest and abdomen at admission. (A) At medial basal segment of right lower lobe, there is a 4.0 cm sized soft tissue density mass (arrow) harboring multifocal low attenuation areas. (B, C) On upper abdomen, there are three soft tissue density masses containing multiple necrotic low attenuation areas of bunch-of-grapes shape. A 3.5 cm sized mass (black arrow) is observed at right peri-renal space, a 4.5 cm sized mass (white arrowhead) at greater curvature side of stomach lower body along gastroepipoloic vessel, and a 4.6 cm sized mass (white arrow) at portocaval space.

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Fig. 2.

PET scan images. (A) PET scan reveals an ovoid nodular opacity (arrow) with mild F-18 fluorodeoxyglucose (FDG) uptake in the right lower lobe of lung (maximal standardized uptake value [SUV] 3.2). (B-D) PET scan reveals three low attenuation lesions (arrows) with increased FDG uptakes in the portocaval space, gastroepiploic area and right peri-renal space (maximal SUV 5.1).

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Fig. 3.

Endoscopic ultrasonography-guided fine needle aspiration findings. (A) On portocaval space, there was a heterogeneous hypoechoic 3 cm sized cystic mass with much debris. (B) After fine needle aspiration, muddy colored pus was obtained.

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Fig. 4.

Eggs of Paragonimus wester-mani obtained by endoscopic ultra-sonography-guided fine needle aspiration from tissue (A) and pus (B). The eggs are ovoid, with a thick shell and often asymmetrical with one end slightly flattened (H&E stain, ×400).

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Fig. 5.

Follow-up CT scans of chest and abdomen. (A-D) Fifteen months later after chemotherapy, chest and abdomen CT scans reveal much decreased mass lesions (black and white arrows and arrowhead).

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