Monday, May 19, 2014

Case of the Week 304

This week's case was generously donated by Ahrong Kim in South Korea.  The specimen is from a Papanicolaou-stained urine cytology specimen from a 60-year-old male with history of bladder papilloma.  Dr. Kim was particularly hoping that someone could give him an exact diagnosis so that he can figure out where the organism came from.  Your suggestions are greatly appreciated!

Images are at 1000x (Pap stain)




12 comments:

Anonymous said...

Looks like some kind of crayfish ?
how is the sample taken ?
What are the dimensions ?

Tom Luke said...

It looks like a copodod that has had its appendeges shorn off. Did the individual have a urinary catheter inserted previously? It is not uncommon for people to reuse the catheter after cleaning with water.

Tomáš Macháček said...

What a nice case this week! For me it looks like some rotifer since in the second picture, there is even the mastax visible. General morphology resembles the genus Lepadella. It's very probably a sample contamination.

http://www.ncbi.nlm.nih.gov/pubmed/12713478

Bobbi Pritt said...

Great comments so far - thank you! I can't tell you the exact size, but based on the magnification (1000x), I am thinking it is ~200 microns in length.

Anonymous said...

I also thought rotifer as soon as I opened the page. --bks

김아롱 said...

Hello. This is Ahrong Kim. Thank you so much for all your comments. The patient has a history of urothelial papilloma (about 1.2cm), so he had trans-urethral resection in 2011. Since then, cystoscopy was regularly performed for a follow-up evaluation. And also, the urine was obtained during cystoscopy this time. We never reuse the urinary catheter. And the organisms were about 150-200 micrometer in length.

Hans Naus said...

Are you sure the container you used to catch the urine was sterile ?

Aussie fan said...

It looks like a copepod. I did a quick search and found an artical about a copepod found in fish bladders but nothing in a human bladder.

Christen Rune Stensvold said...

Is DNA extraction possible? You could do an 18S PCR maybe.

Anonymous said...

Based on size I say rotifer 0.1mm-2 mm long as opposed to a copepod, which are 1-2mm long.

Just my 2cts worth...Lee

Arthur Morris said...

I'd agree with rotifer, in which case I can only imagine it is a contaminant

Anonymous said...

Once again, we have a case of the unthinkable. The morphology is very compatible with copecods. I would be much obliged for an answer.

Florida Fan