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)
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14 comments:

  1. AnonymousMarch 10, 2014 at 10:19 AM

    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.

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  2. JayDMarch 10, 2014 at 1:23 PM

    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

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  3. BruceMarch 10, 2014 at 2:58 PM

    I'm also voting S. haematobium. Thanks.

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  4. AnonymousMarch 10, 2014 at 3:38 PM

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

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  5. AnonymousMarch 10, 2014 at 3:56 PM

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

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  6. AnonymousMarch 10, 2014 at 4:10 PM

    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

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  7. AnonymousMarch 11, 2014 at 3:24 AM

    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.

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  8. UnknownMarch 11, 2014 at 6:57 AM

    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.

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  9. UnknownMarch 11, 2014 at 3:16 PM

    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.

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  10. AnonymousMarch 12, 2014 at 3:58 PM

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

    Hans

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  11. AnonymousMarch 12, 2014 at 4:30 PM

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

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  12. monaMarch 15, 2014 at 11:02 AM

    uric acid crystals ofcourse

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  13. Dr.Codrina Enache-RomaniaMarch 16, 2014 at 1:44 PM

    I follow you,very interesting blog.

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  14. ParasiteGalMarch 16, 2014 at 2:40 PM

    Thank you!

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