Monday, May 9, 2011

Case of the Week 160

The following were seen in a Papanicoloau stained urine preparation. They vary in size from 40 to 60 microns in length. Identification?







11 comments:

Luke Roberts said...

Im a little stumped to be honest. The blue cells are normal epithelium, the black dots are the eosin stained nuclei, but the lemon shapeed objects are causing me problems! They look a lot like they should be helminth eggs of some kind, but not any that I can think of look like this. The objects have bi-polar spines and seem to be held within a sheath. They crack in the middle sometimes which makes me think they have some sort of shell. The shape reminds me of Trichuris eggs but they don't have the bi-polar plugs or apparently any larvae inside (though is that a worm in the object 2nd picture down 1st on the right? ). Obviously spined objects in the urine would make you immediately think 'Schistosoma' but these objects are double spined which non of the 3 human species (haematobium, mansoni, japonicum) are to my knowledge...plus, they dont have the internal structure of digenean eggs. They also look nothing like the giant kidney worm's eggs (Dioctophyme renale)...

so I don't know. Are the red stained circular objects any clue?

Anonymous said...

Some weirdo artifact. I thought it might be a uric acid crystal, but it's too rounded; and too small to be S. hematobium.

Kathy said...

They look like dematiaceous macroconidia with maybe a few microconidia thrown into the mix.

neuro_nurse said...

Artifact. It might be a fungus, but I don't recognize it.

Tom said...

Pollen? (though I thought pollen was a little more rounded than this....)

Anonymous said...

Not Schistosoma and no fungus I can recognize. Artifact? Instilled medication?

Dana said...

not an organism because of the varying degrees of sizes. It is uric acid crystals.

Luke Roberts said...

hmmm...im not so sure abouyt uric acid crystals - they seem a little too rounded - not square edged enough -happy to be shown wrong though. I am however on board with the artifact shide of things though.

Lady Bug said...

Too curved for crystals found in urine . Some kind of unfertilized parasite egg??

Parasite Gal said...

Uric acid crystals often have a curved "lemon" shape in urine. Here are some other images:

http://www.ndt-educational.org/fogazzislidepart3.asp

http://www.nejm.org/doi/full/10.1056/NEJM199403173301106

http://www.netterimages.com/image/19896.htm

Note that, while some are angular in these images, many are very rounded.

David Shapwe said...

Definately macroconidia, of what species, I am not familiar. The visible segmention in one, is the pinning evidence.