Monday, August 31, 2015

Case of the Week 362

A worm-like object was removed during routine colonoscopy from a 60-year old woman and was submitted to surgical pathology for sectioning and staining. Below are representative images from this case. Identification? (CLICK ON IMAGES TO ENLARGE)

H&E, 20x original magnification
H&E, 100x original magnification
 H&E, 400x original magnification
 H&E, 400x original magnification (with narrowed condenser)


Dan Milner said...

A beautiful (simple) case like this is why we have to crack the whip when teaching pathology! We can't just serve up all this knowledge on a tea tray and expect them to get it. If one can focus on the case and not let the overwhelming pressure of the image prolapse your brain, you'll eventually sort it out. Lovely!!!

Anonymous said...

Wow, sound very much like a teacher. Most students need only to learn the simple truth:"nothing ventured, nothing gained", and they should love to whip the worm till the foot balls are out, avoiding a prolapse at the rear.

Florida Fan

Eagleville said...

Embryonated Enterobius vermicularis eggs?

Sheldon Campbell said...

I believe these are Tricuris triciuria ova; I can see mucus-plugged opercula on some of them. Sections can be misleading for these types of identifications; some of those ova certainly look enterobioid, but I think they're obliquely cut.

If you're hoping to get an ID from ova a squash is better with iodine to see the whole eggs; but then you mess up the body and if it's a male you're SOL.

Anonymous said...

Trichuris trichiura ova

Wan Hafiz

Unknown said...

Yes I agree with Trichuris trichiura, the ova a consistent with the morphology of whipworm, with bipolar plugs and heavy walls. The fist picture is particularly nice, showing sections of the thin anterior end as well as the much thicker posterior.

Its interesting that this worm was sectioned and stained rather than submitted as a gross specimen, which would have been much quicker and easier to identify!

Anonymous said...

I always complain about how the pathologist never narrow their condensers, the samples show a lot more stuff that way. In the last photo you can clearly see the mucoid plug and heavy wall of the Trichuris eggs.
Nice case!

-HLCM fan.

Unknown said...

At first glance, it looked like Enterobius eggs, but on the final slide and with the clever clues from Dan Milner, one can clearly see Trichuris eggs - that's alotta eggs! Beautiful slides

Alan Higgins

Unknown said...
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Unknown said...

Dear Bobbi,
Very nice pics ! Really interesting. Looks like Trichuris trichiura worm sections with its typical lemon-shape eggs. Best regards. Florent Morio