The worm was removed with the biopsy forceps, and biopsies from the mucosal site of worm attachment were also taken with a cold forceps for histology. The histopathology report described the presence of colonic mucosa with focal eosinophilic crypt abscess and increased eosinophils in lamina propria, in addition to the identification of the worm. Based on the histopathologic appearance from the following images, what is your diagnosis?
12 comments:
Ah! The colonoscopy pictures demonstrate a helminth. I remember there was a case we had years ago and suspect that the same scenario happened again. The forcibly removal severed the handle of the whip from its filamentous anterior portion of its body. Another possible misleading or confusing aspect is that the culprit here is a HE and not a SHE and this explains the absence of football shape ova. My bet therefore is for Trichuris trichura. Forgive me for being unable to point out the anatomy of the sections, one I suspect to be longitudinal and the other transversal.
Florida Fan
I wonder if it might be a pinworm, based solely on the location and size of the suspect-they are occasionally implicated in appendicitis. I am sadly unable to decipher the histopathology from these images.
I consulted CDC reference on the cross sections of Trichuris trichura and believe seeing the thick cuticle, a thin nucleated hypodermis and the layer of polymarian cells. The second cross section shows the bacillary bands. What is missing are the two pointed projections of the lateral alae of Enterobius vermicularis.
Florida Fan
I don't have a clue about the cross sections but based on the location, size and morphological (round worm with pointed end, not tapered) I would lean into a juvenile Ascaris. Eric Lind UVMMC
I lean more for Trichuris than Enterobius, because it's missing the lateral alae in the cross section... but I wonder if the alae is present across all tha body.
Guess we have to wait for the answer!
-HLCM fan
HLCM fan, the answer to your question is in case 800. BTW are you in Chile?
Just curious.
Florida Fan
Also favor Trichuris given the degree of embedding into the intestine, absence of alae (Enterobius) and location where the worm was found (argues against hookworm).
Florida fan:
Thank you very much for the answer! I didn't remember that information.
I'm from Santiago, Chile! How did you know? Curious too.
-HLCM fan
Hospital Luis Calvo Mc Kenna. Encuentro la información de la red. Su comentarios son muy interesantes. Que tenga un buen día.
Florida Fan
Trichiuris endoscopically for size shape location of course I trust the parasitologists with the morphology
Anisakis? /Patrik
Florida fan:
Exactamente! Muchas gracias por su comentario, tu aportes siempre son un agrado de leer y me enseñan mucho.
Saludos desde el otro lado del mundo.
-HLCM fan
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