Monday, April 5, 2021

Case of the Week 633

 This week's case was generously donated by Dr. Neil Anderson. The following structure was retrieved from the common bile duct during endoscopic retrograde cholangiopancreatography (ERCP). The patient is a refugee from Tanzania who presented with intermittent abdominal pain, distended gallbladder and hepatosplenomegaly. This was one of many "worm like" structures noted on ERCP.  Unfortunately this object appeared to tear during removal. The portion submitted measures several centimeters in length. No identifying external structures were identified.

Dr. Anderson's team tried to express eggs from this structure but was unsuccessful. In an effort to learn more about the nature of this object, a portion of it was submitted for histopathologic processing. Representative sections revealed the following: 

What is the most likely identification?


Dr Sarhan said...

Fasciola hepatica infection

Unknown said...

Fasciola hepatica maybe fasciola indica

Anonymous said...

The size is very large, the section of the cuticle appears to have villi. The polymorphic large structures underneath could be part of the vitellaria? I’m ready for a lesson in Pathology.
Florida Fan

Anonymous said...

Oops, forgot my guess: Fasciola gigantica.
Florida Fan

PCoyne said...

Agree that the histopath appears to show vitellaria. A trematode in the CBD of a Tanzanian... would seem to point to Fasciola, either gigantica or hepatica. Either way, triclabendazole is in this patient's future.