Comorbid Gastric Adenocarcinoma and Gastric and Duodenal <I>Strongyloides stercoralis</I> Infection: A Case Report

Abstract

Strongyloides stercoralis can cause systemic infection, termed strongyloidiasis, and gastrointestinal ulcer disease in immunocompromised patients. However, to our knowledge, there are no reported cases of comorbid gastric adenocarcinoma and S. stercoralis infection. Here, we report a case of an 81-year-old Korean man who presented with S. stercoralis infection coexisting with early gastric adenocarcinoma (T1aN0M0). S. stercoralis eggs, rhabditiform larvae, and adult females were observed in normal gastric and duodenal crypts. They were also observed in atypical glands representative of adenocarcinoma and adenoma. Preliminary laboratory tests revealed mild neutrophilic and eosinophilic leukocytosis. A routine stool test failed to detect rhabditiform larvae in the patient’s fecal sample; however, S. stercoralis was identified by PCR amplification and 18S rRNA sequencing using genomic DNA extracted from formalin-fixed paraffin-embedded tissues. Postoperatively, the patient had a persistent fever and was treated with albendazole for 7 days, which alleviated the fever. The patient was followed-up by monitoring and laboratory testing for 4 months postoperatively, and no abnormalities were observed thus far. The fact that S. stercoralis infection may be fatal in immunocompromised patients should be kept in mind when assessing high-risk patients.

Carcinogenesis associated with parasites other than Schistosoma, Opisthorchis and Clonorchis: A systematic review

“…The mechanisms of action to promote malignancy from a parasitic infection reported here include chronic inflammation, genomic instability, activation of invasion, angiogenesis and metastasis, dysregulation of tumor suppressor genes, alteration of Wnt pathway, sustained cell proliferation, inhibition of apoptosis, modulation of energetic metabolism and evasion of immune response . Based on our results, it seems that carcinogenesis associated with parasite infections can be triggered by various mechanisms different from that the so‐called “chronic inflammatory infection process” (Table ).…”

“…Inflammation drives reactive oxygen species (ROS) generation that promotes the acquisition of mutations. This has been described in chronic infections by T. muris, P. fastosum, C. parvum, T. gondii, T. vaginalis, F. gigantica and S stercoralis . In vitro, chronic T. muris infection initiated the tumor development and increased the number of tumors in two cancer‐model mice suggesting that T. muris is associated with exacerbated intestinal tumors .…”

“…The trematode P. fastosum was found in cholangiocarcinoma in liver from cats, the development of such tumor was presumed to be associated with the chronic infection by this parasite . S. stercoralis eggs and adult worms were found into the moderately differentiated gastric adenocarcinoma and colon adenocarcinoma of two human cases, but causality cannot be determined . A significant correlation was found between the number of endogenous developmental stages of C. parvum and the development of high‐grade intestinal dysplasia, thus demonstrating the impact of parasite load on neoplastic transformation .…”

“…This has been described in chronic infections by T. muris, P. fastosum, C. parvum, T. gondii, T. vaginalis, F. gigantica and S stercoralis. [9][10][11][12][13][14][15][16][17] In vitro, chronic T. muris infection initiated the tumor development and increased the number of tumors in two cancer-model mice suggesting that T. muris is associated What's new? Certain parasites may do more than cause chronic health problems.…”

Parasite Infection, Carcinogenesis and Human Malignancy

“…Further analysis revealed that the gastric adenocarcinoma and adenoma tissues were positive for S. stercoralis suggesting a causative effect of S. stercoralis (Seo et al, 2015). An association of colorectal cancer with chronic S. stercoralis infection has also been reported in a Columbian patient (Tomaino et al, 2015).…”