Earlier this week, we gave you a hypothetical patient with the following case:
This week's hypothetical patient is a Vietnam War veteran who was admitted to the hospital after experiencing abdominal pain, fever, nausea, and episodes of vomiting. His urine is a dark color and his stools are light, almost white, in color. He reports that he has been losing weight unintentionally lately and that he has been experiencing itching sensations. He appears to be jaundiced upon admittance. His physician had seen a similar case with a Vietnam veteran a few years ago when she worked in a different hospital. She asked her patient if he had ever eaten raw or under-cooked fish from rivers in Vietnam while he had served during the war. He stated that he had. She then ordered a few blood tests to check liver function and for antibodies to a suspected type of pathogen. She also ordered a CT scan, an MRI, and a MRCP. After getting the results back, the physician talked with her patient about options for treating a cholangiocarcinoma that had formed.
This week's hypothetical patient is a Vietnam War veteran who was admitted to the hospital after experiencing abdominal pain, fever, nausea, and episodes of vomiting. His urine is a dark color and his stools are light, almost white, in color. He reports that he has been losing weight unintentionally lately and that he has been experiencing itching sensations. He appears to be jaundiced upon admittance. His physician had seen a similar case with a Vietnam veteran a few years ago when she worked in a different hospital. She asked her patient if he had ever eaten raw or under-cooked fish from rivers in Vietnam while he had served during the war. He stated that he had. She then ordered a few blood tests to check liver function and for antibodies to a suspected type of pathogen. She also ordered a CT scan, an MRI, and a MRCP. After getting the results back, the physician talked with her patient about options for treating a cholangiocarcinoma that had formed.Today, we reveal that our hypothetical patient was diagnosed as having:
Bile Duct Cancer Caused by a
Previous Liver Fluke Infection
In our hypothetical situation, the patient contracted an infection with a liver fluke after eating raw or under-cooked fish while serving in Vietnam during the Vietnam War. The parasite infection was likely asymptomatic, but over time the infection caused the development of a cholangiocarcinoma (CCA), which is a rare tumor that forms in the bile ducts. These may manifest long after initial parasite infections and we are seeing a rise in cases among US Vietnam Veterans five decades after the end of the war. The physician ordered blood tests to check liver function and to look for immunological markers that could indicate previous infection with a liver fluke (typically either Opisthorchis viverrini or Clonorchis sinensis). She ordered the CT, MRI, and MRCP to look for evidence of a cholangiocarcinoma. Endoscopic retrograde cholangiopancreatography (ERCP) has been used to examine bile ducts in the past, but more health care professionals are moving to magnetic resonance cholangiopancreatography (MRCP) to look at this area because it is less invasive and offers 3-D images without needing dyes to enhance the images. There are many different approaches to treating bile duct tumors. The treatment plan is guided by the results of imaging tests and may include surgery, liver transplantation, chemotherapy, radiation therapy, photodynamic therapy, and/or biliary drainage.
Thanks for joining us for this week's Mystery Case and we hope to see you next week!
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