Monday, August 31, 2020

Case of the Week 604

 This week's case was generously donated by Dr. Peter Gilligan, and features a histopathology section of an appendix from a patient with Crohn's disease. The pathologist was concerned when they saw the following object in the lumen of the appendix. Identification?

11 comments:

nema said...

Ascaris lumbricoïdes

Unknown said...

I'm certainly no histologist but the clear thick wall around the stained object appears to be of host origin (granulomatous?). While It seems to have cells, I don't see discernable worm organs. I'll guess: not a worm

Anonymous said...

Long time no see, yet cases from Dr. Pete are always intriguing. From the photograph, There is a lack of a cuticle typical of an intestinal parasite. There does not seem to be a layer of polymarian cells as well as the other anatomical components such as a digestive tube or reproductive organs and no excretory organs either.
As such, I do not believe that this is a worm. My guess is that the object may be of vegetal origin, possibly an undigested bean or pea which happens to be lodged in the lumen of the appendix.
Florida Fan

AZ Parasite said...

Cool object but I’m guessing not clinically significant. The “inside of the egg” doesn’t appear to have any defined features one would expect to fine in an egg from a parasite.

Idzi P. said...

Nice case!
Looking at the size, it seems too big to be an egg, and I’m missing typical structures of adult or larval parasites.
My guess: not a parasite!
Possibly a grain of corn...?

Dr Sharmina said...

Looks like plant matter with inflammatory cells
No parasite noted

Anonymous said...

On second look, when magnified enough we can see polygonal cells often observed on vegetal matters. The other observation is that there is a fine brown line inside which I believe to contain melanin pigment, a character we do not find on helminths.
Florida Fan

Jose said...

Cool picture but it lacks characteristic features of a worm. I think it is a it could be an artifact ( a cotton fiber?)

Anonymous said...

Too funny that pathologists still don't know how to sort the various veggies and stuff we see all the time -- I remember someone doing a veggie talk for a cytology group and at the end we all threw up our hands and can't tell beans from corn etc. -- maybe there's a food scientist out there?

It's a lot of fun to put sections through of stuff we touch: Nieman Ranch sausage is almost all meat and no I can't tell chicken vs beef. Spam is totally amorphous. The grayish small nodules in bacon are benign lymph nodes.

Harry Porterfield said...

Not a parasite (looks like a seed to me)

PCoyne said...

Dr. Gilligan up to his old tricks again...
The area which at first glance looks like it might be cuticle clearly is NOT. No internal structure to comment on.
Differential: sesame seed vs bean (NOS)