Cancer Res Treat.  2014 Oct;46(4):419-424. 10.4143/crt.2013.104.

Bladder and Liver Involvement of Visceral Larva Migrans May Mimic Malignancy

• Kang EJ
• Choi YJ
• Kim JS
• Lee BH
• Kang KW
• Kim HJ
• Yu ES
• Kim YH

• KMID: 2380381
• DOI: http://doi.org/10.4143/crt.2013.104

Abstract

Visceral larva migrans (VLM) syndrome is a clinical manifestation of systemic organ involvement by Toxocara species. VLM with involvement of the bladder and liver is a rare finding. A 62-year-old woman presented with diffuse bladder wall thickening and multiple liver masses with peripheral eosinophilia and urinary symptoms. We considered malignancy or eosinophilic cystitis through clinical manifestations and imaging findings. However, no suspicious malignant lesions were observed on cystoscopy and liver mass biopsy revealed the presence of eosinophilic necrotizing granuloma without malignant cells. Anti-Toxocara antibodies were detected by western blotting and the patient was diagnosed with VLM syndrome. After taking prednisolone, urinary symptoms disappeared. On abdominal CT scan taken after three months, the size of multiple liver masses and bladder wall thickening had decreased. VLM syndrome should be suspected in patients with an atypical imaging pattern and peripheral eosinophilia.

Keyword

Visceral larva migrans; Toxocariasis; Urinary bladder; Liver; Neoplasm

MeSH Terms

Antibodies
Biopsy
Blotting, Western
Cystitis
Cystoscopy
Eosinophilia
Eosinophils
Female
Granuloma
Humans
Larva Migrans, Visceral*
Liver*
Middle Aged
Prednisolone
Tomography, X-Ray Computed
Toxocara
Toxocariasis
Urinary Bladder*
Antibodies
Prednisolone

Figure

• 

  Fig. 1. Abdominal computed tomography (CT) scan of the case patient shows multiple ill-defined hepatic nodules and bladder wall thickening. (A, B) Contrast-enhanced CT scan shows multiple ill-defined hypodense lesions in both lobes of the liver as well as enlarged portocaval lymph nodes. (C, D) Nodular enhancing lesion in the right anterior wall of the bladder and diffuse thickening of the wall were found.

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  Fig. 2. Histology of the case patient's liver biopsy sample. (A) Liver biopsy shows several necrotizing granulomas with associated fibrosis and mixed cell infiltrate with prominent eosinophils and lymphoplasma cells (H&E staining, ×40). (B) On medium power, central eosinophilic necrosis, surrounded by epithelial histiocytes and multinucleated giant cells are found. In the necrotic area, there are many Charcot-Leyden crystals. At the periphery of granulomas, irregular amphophilic degenerated materials are phagocytized by multinucleated giant cells (H&E staining, ×100).

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  Fig. 3. Positive western blot result of the case patient. Western blot analysis showing the presence of specific antigenic bands in sera from the case patient (lane 19). Two or more low molecular weight bands and intermediate molecular weight band in the ranges of 24-50 kDa is indicative of the presence of specific anti-toxocara IgG in the sample. Lane 16: positive control, lane 17: negative control, lane 18: result of the other patient with positive finding, lane 19: result of the case patient.

Reference

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