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?
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.
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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.
ReplyDeleteI 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.
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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
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