Monday, May 7, 2012

Case of the Week 207

The following were an unexpected finding on anal Papanicolaou-stained pap smear from a male with papular anal lesions.  Identification? (CLICK ON IMAGES TO ENLARGE).



MicrobeMan said...

Giardia intestinalis cysts! Also, that squamous epithelial cell looks a little suspicious - maybe a koilocyte? Does this patient have condyloma acuminata? It also has an interesting inclusion...hmmm.

Kathy said...

I agree with the Giardia.

Anonymous said...

Giardia Lamblia cysts.


Anonymous said...

I see the small blue cysts of Giardia lamblia.
Can the big pink thing be a liver fluke ?

Anonymous said...

Cute bugs.

Squame is koilocytic with binucleate and perinuclear halo but would probably leave as ASCUS rather than LSIL unless more and better although is really a distinction without meaning but seems to stir less anxiety.

These anal Paps were a great idea 10 yrs ago but incidence of anal sq cancer in the MSM/HIV crowd seems to have gone way done so not sure is worthwhile now.

Anonymous said...

Very cool - some cytotech had his/her mind open to see this. Squame is koilocytic and if a few more probably would call LSIL; if just this leave as ASCUS not that there is much/any management difference. Anal Paps in the HIV population were a great idea 10-15 years ago but I'm not sure they're worthwhile now that the incidence of ca seems way down with HAART.