This week's case was generously donated by Dr. Michal Kamionek. The following worms were identified on routine screening colonoscopy in the small and large intestine. A portion of one worm was submitted to anatomic pathology for examination, and the section is shown below. What is your identification?
12 comments:
I'm going to guess strongyloides given number, apparent size and distribution. Not sure how I'd prove it but would immediately chat with GI and ID as to what they think and clinical setting respectively in terms of acuteness and need to start treatment.
They're too big to be strongyloides. The histology reveals is is a cestode
trichuris trichiura potentially
Hymenolepis nana
Tough case indeed. The most often encountered in a routine colonoscopy is Trichuris trichura. These worms usually don’t cause any symptoms. The nasty case of “coconut rectum” can be only found in the most severe infection. The first picture gives images suggesting whip worm morphology. I believe that Dr. Pritt made it more intriguing by giving us the section of a male since the female will be too easy to guess spilling all the footballs. From past cases, I learned that cestodes sections will have calcareous clear objects in their HE sections. I don’t see these in this section.
Just curious about the colonoscopy. I thought the small intestine could not be reached in a colonoscopy.
Hi Anonymous, you have a good question about the colonoscopy. The terminal ileum is usually reached, but otherwise, the small intestine is not included.
I’d go for Rodentolepis nana (formerly known as Hymenolepis nana). I have the impression that we see two of the suction discs located on its head. Size would be consistent with what I see on colonoscopy (some centimeters). It’s brother/sister (Hymenolepis diminuta) is more uncommon and would be longer (about 10 cm or a bit more).
Btw: that’s a VERY cool histological picture Dr. Pritt! It would look incredibly good on a calendar! 😉
Histo picture in fact looks like a VERY angry parasite… frightening… 😅
Idzi, Comment well received.
Oh, good point Idzi!
Tapeworm with what looks like a rostellum. My initial guess would be T. solium or H. nana. The proglottids are wider than long so I'll go with H. nana
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