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)




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12 comments:

  1. AnonymousMay 20, 2014 at 6:17 AM

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

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  2. Tom LukeMay 20, 2014 at 6:43 AM

    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.

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  3. UnknownMay 20, 2014 at 7:06 AM

    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

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  4. ParasiteGalMay 20, 2014 at 8:51 AM

    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.

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  5. AnonymousMay 20, 2014 at 1:10 PM

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

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  6. UnknownMay 20, 2014 at 7:36 PM

    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.

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  7. Hans NausMay 21, 2014 at 3:29 AM

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

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  8. Aussie fanMay 21, 2014 at 8:45 AM

    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.

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  9. Rune StensvoldMay 22, 2014 at 12:55 AM

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

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  10. AnonymousMay 22, 2014 at 1:25 PM

    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

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  11. UnknownMay 23, 2014 at 11:55 AM

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

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  12. AnonymousMay 24, 2014 at 5:50 PM

    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

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