Hepatic Schistosomiasis Presenting as a Hepatic Mass

CASE REPORT A 78-year-old man from China was referred to an outpatient gastroenterologist for evaluation of a hepatic mass. Computed tomography revealed a 2.5 by 2.4 cm hepatic mass with calcification and right lobe atrophy (Figure 1). Subsequent liver biopsy revealed multiple portal tracts with Schistosoma ova with partial calcification, but no evidence of malignancy (Figure 2). He was treated with praziquantel for hepatic schistosomiasis presumably from Schistosoma japonicum, which is endemic to China. An ova and parasite stool test after treatment was recommended, which the patient declined.Figure 1.: (A) A precontrast CT with calcifications seen in the right liver (big arrow). (B) A CT with contrast showing diffuse calcifications (small arrows) and a hyperenhanced mass (circled). CT, computed tomography.Figure 2.: Pathology shows a portal tract with calcified schistosome eggs (circled) and surrounding granulomatous reaction (arrows). Magnification: 100×.Hepatic schistosomiasis is one of the most prevalent chronic liver diseases worldwide.1 Although cases in the United States are uncommon, low suspicion and inadequate screening of travelers to and from endemic areas can result in chronic infections.2,3 A characteristic finding in hepatic schistosomiasis is periportal fibrosis.2 Presentation as a hepatic mass is highly unusual, which initially raised concerns for malignancy in our patient. Malignancy cannot be excluded from imaging alone as radiographic findings of atrophy, calcification, and fibrosis can be seen in both conditions. We conclude hepatic schistosomiasis, in the appropriate context, should be considered in the differential of a hepatic mass. DISCLOSURES Author contributions: J. Yun drafted the manuscript. J. Shen performed histopathological examination and interpretation. U. Dahal reviewed and revised the first and final draft. K. Flora provided conceptualization and supervision as the senior author. All authors provided critical review and approval of the final version of the manuscript. J. Yun is the article guarantor. Financial disclosure: None to report. Previous presentation: This case was presented as a poster abstract by J. Yun at the American College of Gastroenterology Annual Scientific Meeting on October 28, 2024 in Philadelphia, PA. Informed consent was obtained for this case report.