Monday, March 10, 2014

Case of the week 295

The following were seen in a Papanicolaou-stained urine specimen from a 53 year old woman with chronic dysuria.  She has no recent travel history outside of the U.S., but had been to parts of sub-Saharan Africa over 10 years ago. Images are shown at 400x magnification.  Identification?




 
 

(with polarized light microscopy)

14 comments:

Anonymous said...

Sure looks like Schistosoma, no? And if it's in the bladder causing urinary symptoms, you'd think haemotobium... I'm not a pathologist, but I think the little "spike" thing is also in the right spot for haematobium as opposed to mansoni when it's more on the side. Plus, she has a history of travel to Africa, which would fit.

JayD said...

Sure they look like Shisto but in my opinion they are artifacts, mostly urine crystals; the "membrane" is so thick to be a real membrane. The 4th picture shows a broken crystal.

Jamal

Bruce said...

I'm also voting S. haematobium. Thanks.

Anonymous said...

I'll make it a tie again - looks like crystals and maybe urate although that is a guess.

Anonymous said...

Schistosoma intercalatum--more diamond-shaped eggs with terminal spine

Anonymous said...

Wonderful, now we have a healthy debate. In general morphology, the objects may insinuate Schistosoma ova particularly S. haematobium. Upon further observation, their sizes are not quite uniform, a character that real ova would show. another trait is their lack of internal organization. As a result, I would go with crystals.

Florida Fan

Anonymous said...

It is pointed at both ends rather than just one as seen with the ova of S. haematobium. I would say artifact. They look like uric acid crystals seen in urine.

Tomáš Macháček said...

IMHO we do not look at the Schistosoma sp. eggs (no typical inner structures, size does not fit), the objects are crystals present in urine.

Arthur Morris said...

uric acid crystals, the bodies are not consistant with S.haematobium (though this would be the differential) due to the lack of visible miricidium, apart from anything else.

Anonymous said...

They look like S. haematobium, but they are way to small, S. Haematobium eggs are 140 um x 60.
I go for crystals.

Hans

Anonymous said...

I'm voting artifact as well. I don't think schistosomes would be so refractile under polarized light.

mona said...

uric acid crystals ofcourse

Dr.Codrina Enache-Romania said...

I follow you,very interesting blog.

Bobbi Pritt said...

Thank you!