Monday, May 26, 2014

Case of the week 305

Multiple small worm-like objects were identified on endoscopic retrograde cholangiopancreatography (measuring approximately 5 mm - 8 mm in length) in a patient from Korea with recurrent right upper quadrant abdominal pain and a liver mass.  One worm was removed and sent to the laboratory for identification, where it was stained (carmine stain) and mounted on a slide.

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13 comments:

Anonymous said...

Clonorchis sinensis

Anonymous said...

Agree with the above. Asian origin of the patient and piriform eggs support Clonorchis sinensis.

Jamal

Tomáš Macháček said...
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Tomáš Macháček said...

It's Clonorchis sinensis, typical testes and eggs shape underpin the determination. Clonorchiasis is a fish-born disease which may be associated with cholangiocarcinoma (http://www.ncbi.nlm.nih.gov/pubmed/16480786).

Anonymous said...

Clonorchis sinensis eggs and adult worm.

Lee

Anonymous said...

Clonorchis

Anonymous said...

Clonorchis sinensis

Arthur Morris said...

lovely Clonorchis sinensis

Anonymous said...

What a beautiful stain of Clonorchis sinensis. We can see the oral sucker, the esophagus, the twin ceca, the ova filled uterus, lateral vitellaria, the vitelline ducts, the seminole receptacle and the ootype.

Florida Fan

Lukus Roberts said...

adult and egg morphology as well as reported symptoms and geogrpahical location all consistant with trematode Clonorchis sinensis

Anonymous said...

C. sinensis because of the location. What would rule it out being Opisthorchis? Nice prominent operculums on the shoulders of the eggs.

Mommy123 said...

I live in Texas and believe I've acquired liver flukes from some unknown origin. I have passes these whitish-grey flatworms and they were all dead and rolled over. It began with facial hives and swelling around my eyes which then moved on to lower leg/ankle swelling, extreme constipation, my stomach constantly making noises, thumping feelings coming from liver and under right rib/stomach. I am also getting red streaks that appear on my skin and disappear. I am passing what looks like rolled up tomato skins, these yellowish pods in my stool, along with black and metallic green specs/kiwi seed looking things. I can email you or send you a picture of what has been going on with me..... and I think my children are going through the same thing as I'm finding pods in their stool and rolled up tomato skins as well. and I don't know if this is related or not but throughout my school there are these black hair looking things taken out by the bunches and sometimes when I wipe they are climbed up and Leonard throughout the stool on top of the toilet paper. I don't know what this means but my stool also smells like muddy water. I have pictures of the things I've passed and the anything that I found online closely resembles liver flukes.

Mommy123 said...

Eta: the sentence before the last should've read, " and I do not know is related or not but throughout my stool are these objects that I can only describe as "coiled, black, thin, hair-like strands" upon defecation they are taken out by the bunch and when I wipe they are littered in the feces on the toilet paper. I've seen these organisms in both of my children's stool, too (girl 19mo, boy 5mo). One more thing: I have something odd going on within my oral cavity too...don't know what an earth it could be and have never experienced anything like it...clear, tiny things that come out of my mouth when I eat, I assume they are coming from within my gums/between my teeth. They can be spat out, flossed out from between teeth and sometimes resemble a rose petal with a teeny tail -but are white, clear or transparent. When they are left out on a napkin they harden and if placed on my finger they adhere to my skin then harden. I first noticed something going on with my mouth when I was eating and I was using a fork and every time I took the utensil out of my mouth and got another bite there was this white film that was left on the food or plate. I have pictures of everything mentioned. Please get back with me. I will contact you through email if you like or I can message you and give you my personal telephone number. -Meghan