BackgroundThailand has a high incidence of cholangiocarcinoma (CCA), particularly in the north and northeastern regions. Most CCA patients come at a late, unresectable stage and presently no optimal screening test for CCA has been established. We determined the prevalence of CCA in a remote northern village and explored if screening could lead to early detection and survival benefits.MethodsA 5-year population-based study was started in October, 2011 for consented Thai individuals, aged 30–60 years. The screening program comprised blood testing, stool examination and serial ultrasonography every 6 months.ResultsDuring the first 3 years, 4,225 eligible individuals were enrolled. CCA was detected in 32 patients, with a mean age of 51.9 years (41–62 years), and 21/32 cases were at a curative resectable stage. The prevalence rate of CCA was 165.7 per 100,000 and one- and two-year incidence rate was 236.7/100,000 and 520.7/100,000, respectively. One- and 2-year overall survival rates of CCA patients were 90.9 and 61.5 %, respectively. Prognosis was better in resectable cases with 100 % 1-year and 77.8 % 2-year survival rates. Interestingly, premalignant pathological lesions (stage 0) were identified in 11 cases with 100 % 3-year survival rate. Serum biomarkers and alkaline phosphatase were not sufficient to detect early-stage disease. In 22 patients, stool samples were positive for Opistorchis viverrini, based on polymerase chain reaction.ConclusionDetection of premalignant lesions and early-stage resectable CCA by ultrasonography resulted in improved clinical outcome. Ultrasonography should be offered as a first screening tool for CCA in an endemic area until other useful biological markers become available.

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We report a case of subcutaneous larva migrans caused by a tape worm (sparganum), a rare and under-recognized food-borne parasitic zoonosis, in Nan Province, Northern Thailand. An obese 56-year-old female presented a 3-month history of an intermittent migrating subcutaneous nodule in the abdomen associated with pain and itching. Physical examination showed a tubal resection scar on the lower abdomen with a swelling and movable irregular, and firm nodule with ill-defined border at the right lower quadrant of abdomen. Blood examination showed slight increase of eosinophil levels (6%). Excisional biopsy showed a viable non-segmented tape worm in the subcutaneous tissue identified by morphological examination and Western blot technique as a sparganum. Surgical removal is recommended for a worm in the subcutaneous connective tissues and superficial muscles.