Monday, October 8, 2018

Case of the Week 514

This week's case is a classic case from Heather Rose Arguello, my fabulous parasitology specialist. This is a wet preparation of liver cyst fluid (40x objective):
Identification?

14 comments:

Dwight Ferris said...

Hooklets from Echinococcus sp sand aspirated from a Hydatid cyst

Lyne C├ędilotte said...

Echinococcus sp from Hydatid cyst. Many hooklets.

Luis Fernando Solorzano said...

Echinococcus
Arena hidatidica

Sir Galahad said...

Uncini di Echinococcus granulosus

Carlo Alberto Varlani

Sam said...

Rostellar hooklets of Echinococcus granulosus. Species E.granulosus is likely due to detection of hooklets in a liver cyst.

Anonymous said...

Hooklets most likely of E. granulosis giving the fact that it was aspirated from a liver cysts.
Florida Fan

Hunlang said...

Hydatid sand showing numerous hookless of echinococcus species

Old One said...

The larval cestodes having rostella with two rows of hooks (one row large hooks, one row small hooks} making this cestode "armed". An armed rostellum puts this worm into the family taeniidae.

The specimen appears to to contain a number of protoscolices in a liquid media from a single cyst. This would be consistent with the hydatid sand from an Echinococcus granulosis cyst.

A close relative which can also be found infecting the human liver, E. multilocularis contains far less liquid and much more debris from locular membranes. I have seen only one case of E. multilocularis and it was sterile (containing no protoscolices). I was told that most human cases are sterile. Please let me know if there is any truth to that statement.

There are other species of Echinococcus but I'm not familiar with their larval stages.

Therefore, my diagnosis is definitely Echinococcus, most likely E. granulosis

P.S. a size bar would be nice

P.P.S. I believe I once saw a movie made at the MAYO whose subject was the diagnosis and removal of E. cyst. Am I hallucinating ?

the old one



Idzi P. said...

Yep, definitely hooklets of Echinococcus species! Most likely granulosus, as multilocularis usually produces sterile cysts. Some other species (like E. oligarthrus , E. vogeli, etc) can also sometimes infect humans.

Blaine A. Mathison said...

I agree with Idzi and the Old One. Echinococcus, in the 'granulosus-complex' (I am sure Bobbi will address recent taxonomic issues with this complex in her answer). As previously mentioned, E. multilocularis usually manifests as a proliferating tumor in the liver that is 'sterile' (i.e., protoscoleces are not seen in the human host; they are seen in the liver of the natural rodent intermediate host however).

This form in aspirates where you have disintegrating protoscoleces with free hooklets and calcareous corpuscles is often referred to as 'hydatid sand'.

Agnes Kurniawan said...

I agree, there are many hooklets, most likely from hydatid cyst Echinococcus granulosus as it was from liver cyst fluid

Old One said...

Hollywood trivia:

TV Dr. Marcus Welby diagnosed a case of hydatid disease in his son-in-law, an engineer who built dams in Latin American. The good Dr. performed surgery but lost his patient to anaphylactic shock.

Bobbi Pritt said...

To Old One - there were actually several videos of echinococcosis that came out of Mayo Clinic, including work by my predecessors, Dr. John Thompson and Dr. Thomas Magath, who both did research in this area (1940s-50s). They collaborated with Disney to produce a film on E. multilocularis, and later went on to do studies where dogs were orally-inoculated with hydatid cyst material (yuck!). It was quite the advance back in the days...

Old One said...

to Dr. Pritt,
Perhaps Dr. Welby (as well as his son-in-law)would've benefited greatly from a consult with Mayo Clinic.

I believe I've met Dr. Thompson, if I remember correctly his sense of humor had no equal. I heard jokes that I still cherish today.