Monday, August 17, 2026

Case of the Week 816

This week's case was generously donated by Dr. Daniel Montelong from UT Southwestern Medical Center. The patient is an elderly gentleman who underwent screening colonoscopy. Normal mucosa was found in the entire colon. However, a worm was found embedded in the cecum, measuring approximately 10 mm x 1 mm:

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?


2 comments:

Anonymous said...

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

BobD said...

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.