Opisthorchiasis: A clinicopathologic study of 154 autopsy cases

Abstract

A study of 15,641 autopsies performed during the years 1954 to 1974 revealed 154 cases of Opisthorchis viverrini infection of the liver, a prevalence of nearly one per cent at the Siriraj Hospital, of these, 85 cases (55%) had carcinoma of the liver. The 154 patients ranges in age from 9 to 80 years with a median of 43 years. Men were affected more often than women in the ratio of 7 : 2. The highest incidence occurred in the 40-49 age-groups in both males and females. The most common complaints were pain and mass in the right upper quadrant of the abdomen, anorexia and weight loss, and icterus. Hepatic failure was the most common cause of death. Jaundice, ascites and hepatosplenomegaly were commonly found. The average weights of the liver and spleen in adults were 1,958 gm and 186 gm respectively. Inflammatory infiltration of bile duct walls, dilatation and proliferation of bile ducts were found in most cases. Periductal fibrosis were seen in 52%. Gallstones in the gallbladders were found in 4 patients, but no calculi in the intrahepatic bile ducts were observed. Flukes were seen in the pancreatic ducts in 2 cases. Squamous metaplasia of pancreatic ducts was not observed. Among the 85 patients with carcinoma of the liver, 67 (79%) were classified histologically as adenocarcinoma of intrahepatic bile ducts (cholangiocarcinoma). This unusually high incidence of cholangiocarcinoma in association with opisthorchiasis is more than coincidental.