J Liver Cancer.  2023 Sep;23(2):389-396. 10.17998/jlc.2023.06.07.

Hepatic basidiobolomycosis masquerading as cholangiocarcinoma: a case report and literature review

• Sehrawat R
• Bansal N
• Srivastava A
• Malik D
• Vij V

• KMID: 2546418
• DOI: http://doi.org/10.17998/jlc.2023.06.07

Abstract

Basidiobolus ranarum is known to cause subcutaneous mycoses; however, rare cases of hepatic and gastrointestinal involvement by basidiobolomycosis have been reported. Hepatic basidiobolomycosis may be confused with a carcinoma on imaging, and histological examination and fungal culture can help distinguish between these two. We report a rare case of basidiobolomycosis in a 16-year-old male with liver and gastrointestinal involvement.

Keyword

Basidiobolus; Gastrointestinal; Hepatic; Fungus; Case reports

Figure

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  Figure 1. (A) An ultrasonography image shows a large hypoechoic lesion measuring 6.7×6.1 cm in the region of portal confluence involving segments 5, 6, and 7 of the liver (red arrow). (B) Color doppler reveals mild color flow within the lesion. (C) Transverse relaxation time fatsaturation magnetic resonance imaging of the liver demonstrates heterogeneously hyperintense signal intensity lesion (red arrow). (D) Magnetic resonance cholangiopancreatography sequence shows the mass effect with markedly dilated intrahepatic biliary radicles. (E, F) Diffusion-weighted imaging and corresponding ADC images show areas of diffusion restriction with low ADC in and around the lesion involving the right lobe of the liver (red arrows). On (G) pre- and (H) post-contrast mDIXON (T1W) studies, heterogeneous enhancement with few central non-enhancing areas was seen within the lesion (red arrows). These findings were suggestive of hilar cholangiocarcinoma. (I) Coronal post-contrast mDIXON images show thickening with an enhancement of the cecum, ascending colon, and heterogeneously enhancing lesion in the liver. ADC, apparent diffusion coefficient.

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  Figure 2. (A-C) Whole-body FDG positron emission tomography-computed tomography scan demonstrates FDG avid mass like ulcerated irregular thickening involving the cecum, distal ileum, and proximal ascending colon (red and black arrows) along with FDG avid paracecal lymph nodes. (D, E) A large, FDG-avid hypodense lesion showing heterogeneous post-contrast enhancement in the right lobe of the liver involving segments 5, 6, and 7 (red and black arrows) measuring approximately 7.0×8.0×6.4 cm in size. FDG, fluorodeoxyglucose.

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  Figure 3. Liver biopsy shows mainly fibrocollagenous tissue with inflammatory infiltrate and granulomatous reaction. Fungal spores are noted within giant cells. (A) H&E (×4), (B) H&E (×10), and (C) H&E (×20). H&E, hematoxylin and eosin.

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  Figure 4. (A, B) Colonoscopy shows deformed, edematous ascending colon and cecum along with deep ulcers in the colon (measuring up to 1 cm in diameter).

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  Figure 5. Section from colonic tissue biopsy shows an area of ulceration and a dense infiltrate of eosinophils. Splendore-Hoeppli phenomenon noted around fungal spores. (A) H&E (×4), (B) H&E (×10). Periodic acid-Schiff (PAS) and Grocott methenamine silver (GMS) stains show fungal spores (black arrow) with Splendore-Hoeppli phenomenon. (C) PAS (×20), (D) GMS (×10). H&E, hematoxylin and eosin.

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  Figure 6. (A, B) The triphasic follow-up contrast-enhanced computed tomography scan demonstrates interval resolution of the irregular, ileocecal thickening and paracecal lymph nodes (porto-venous phase). (C) Arterial, (D) porto-venous phase. There was an interval reduction in the size of the liver lesions.

Reference

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