Monday, July 30, 2018

Case of the Week 504

For this week's case, I'm going to take advantage of whole slide imaging technology via the cloud. The specimen is a section of large bowel obtained at autopsy. The prosectors were surprised to see several small worm-like objects attached to the bowel mucosa and therefore submitted representative sections for processing and microscopic examination. Here is a representative view of what they found:
To see the entire slide and zoom in on the diagnostic areas, click HERE.
Note that you don't need to download any special software to view this slide. You can use the "+" sign to zoom in, or simply use the track wheel on your mouse. It's pretty slick! Special thanks to Dr. Andy Norgan who made "Helminths in the Cloud" possible.

12 comments:

Blaine A. Mathison said...

Trichuris trichiura. If the eggs in utero were not enough, there is also stichocytes and bacillary bands (best seen in the anterior end of the worm within the tissue), polymyarian/coelomyarian musculature, and a strongly nucleated hypodermis. The size and egg morphology rules-out Capillaria philippinensis, which would also be in the intestinal tract and have trichuroid features of stichocytes and bacillary bands.

Anonymous said...

Really COOL!!! Thanks Parasite Gal.
I'm going with whip worm (but questioning why the diligent resident didn't note them macroscopically) . . .

Joe Camp said...

A very complete summary by Blaine. Nicely done!

Anonymous said...

The degree of preservation of the tissue is quite remarkable for an autopsy. It looks more like a colectomy specimen. I would love to know the postmortem interval and when during the autopsy procedure the prosectors examined and fixed the colon.
BW in Vt

Idzi P. said...

What more could I add?
Trichuris indeed!
Very nice!

William Sears said...

beautiful technology.

I think it is trichuris trichuria based on the knobs on the eggs visible in some of the slices. Also, it is telling that the thinner head part is imbedded in the tissue and the larger tail is not imbedded consistent with whipworm.

mcoleman1517 said...
This comment has been removed by the author.
mcoleman1517 said...

I saw an egg that looked liked Trichuris trichiura too

Sean Smith said...

Any Links to the original Home Page / Website? having trouble backtracking from the image link...and google search isn't helping... many thanks for an awesome blog...as always.... cheers! ~ smith

Anonymous said...

Great comments! Since "cut worm" is not my cup of tea, I have to say that this is a great learning experience for me.
Thank you all for your informative comments.
Florida Fan

Unknown said...

It is a whipworm based on the correct comments of Blaine. An the location of the anterior end of the worm.

Bobbi Pritt said...

Great observation by BW in VT. The history I received was autopsy, but agree that the mucosa is VERY well preserved for this specimen type. If this specimen was indeed collected at autopsy, then it must have been a very short interval between death and fixation in formalin as suggested.