Congratulations to everyone who wrote in - you all got the correct answer!
The main identifying features are the longitudinal axostyle, flagella, and undulating membrane:
Sunday, August 8, 2010
Answer to Case 126
Answer: Trophozoite of Trichomonas vaginalis.
Congratulations to everyone who wrote in - you all got the correct answer!
The main identifying features are the longitudinal axostyle, flagella, and undulating membrane:
Congratulations to everyone who wrote in - you all got the correct answer!
The main identifying features are the longitudinal axostyle, flagella, and undulating membrane:
Sunday, August 1, 2010
Case of the Week 125
Bladder biopsy from a 28 year old male who immigrated from Kenya 5 years prior and presented with gross hematuria, flank pain, and bladder calcifications on a CT scan.
(CLICK ON IMAGES TO ENLARGE)
(hematoxylin and eosin stain, 100x original magnification)
.JPG)
(hematoxylin and eosin stain, 20x original magnification)
(hematoxylin and eosin stain, 400x original magnification)
.JPG)
Diagnosis? What is this patient at risk for?
Special thanks to Dr. Bekker from Fletcher Allen Health Care, VT, who donated this case!
(CLICK ON IMAGES TO ENLARGE)
(hematoxylin and eosin stain, 100x original magnification)
.JPG)
(hematoxylin and eosin stain, 20x original magnification)
(hematoxylin and eosin stain, 400x original magnification)
.JPG)
Diagnosis? What is this patient at risk for?
Special thanks to Dr. Bekker from Fletcher Allen Health Care, VT, who donated this case!
Answer to Case 125
Urinary schistosomiasis due to Schistosoma hematobium. This patient is at risk for squamous cell carcinoma of the bladder, caused by ongoing squamous metaplasia and inflammation from the eggs present in the bladder wall.
In histologic sections, the eggs are typically seen in various stages of degeneration and calcification. Here, some degenerating nuclei are present within the egg (H&E, 1000x).
+answer2.jpg)
To make a diagnosis to the species level, you need to see a clearly identifiable terminal spine. The spines of these eggs are fairly clear (arrows):
+answer.jpg)
and are even more pronounced in this image from a separate case:
+answer3.jpg)
When urinary schistosomiasis is suspected, examination of urine for characteristic eggs is a non-invasive way to make the diagnosis.
In histologic sections, the eggs are typically seen in various stages of degeneration and calcification. Here, some degenerating nuclei are present within the egg (H&E, 1000x).
+answer2.jpg)
To make a diagnosis to the species level, you need to see a clearly identifiable terminal spine. The spines of these eggs are fairly clear (arrows):
+answer.jpg)
and are even more pronounced in this image from a separate case:
+answer3.jpg)
When urinary schistosomiasis is suspected, examination of urine for characteristic eggs is a non-invasive way to make the diagnosis.
Monday, July 26, 2010
Case of the Week 124
The following were seen on peripheral blood smears. No history is available. Identification? (CLICK ON IMAGES TO ENLARGE)
Thick blood films, 1000x original magnification, Giemsa
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Thin blood films, 1000x original magnification, Giemsa
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Thick blood films, 1000x original magnification, Giemsa
.jpg)
.jpg)
Thin blood films, 1000x original magnification, Giemsa
.jpg)
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.jpg)
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Sunday, July 25, 2010
Answer to Case 124
Answer: Howell-Jolly Bodies
Congratulations to everyone who wrote in - you all got this correct!
Howell-Jolly bodies are basophilic nuclear remnants from when RBCs extrude their nucleus. Typically these are removed by the spleen; therefore, patients that are asplenic often have Howell-Jolly bodies in their peripheral circulation.
They are an important mimic of ring forms (trophozoites) of Plasmodium and Babesia spp., especially on thick smears. However, only the 'dot' is present, and the cytoplasmic 'ring' portion is absent, allowing the diagnosis to be made in most cases.
Congratulations to everyone who wrote in - you all got this correct!
Howell-Jolly bodies are basophilic nuclear remnants from when RBCs extrude their nucleus. Typically these are removed by the spleen; therefore, patients that are asplenic often have Howell-Jolly bodies in their peripheral circulation.
They are an important mimic of ring forms (trophozoites) of Plasmodium and Babesia spp., especially on thick smears. However, only the 'dot' is present, and the cytoplasmic 'ring' portion is absent, allowing the diagnosis to be made in most cases.
Monday, July 19, 2010
Case of the Week 123
The following objects were found in a toilet bowel and sent for identification. No further history is available. Identification? (CLICK ON IMAGE TO ENLARGE)
Case compliments of Dr. Washington Winn, Jr.
Case compliments of Dr. Washington Winn, Jr.
Sunday, July 18, 2010
Answer to Case 123
Answer: mucus cast from stool. "Anonymous" describes it well with the following:
"Looks like a cast. The edges of the object are cracked. The best test would be apply force to see if it falls apart. Other things to look for would be mouth parts, internal structures etc."
This is correct. Even though this structure may mimic a worm, it is cracked and does not have definable head and tail structures. When force is applied using an applicator stick, it easily falls apart. Finally, the fluid surrounding the object can be examined microscopically for eggs after the object is manipulated with the applicator stick. In this case, no eggs were seen.
This type of specimen is commonly submitted to the parasitology laboratory for identification, since patients (and clinician) mistake this object for a worm. Therefore, it is important to use these simple criteria described above to differentiate a true worm from a mimic.
Thank you all for your comments!
"Looks like a cast. The edges of the object are cracked. The best test would be apply force to see if it falls apart. Other things to look for would be mouth parts, internal structures etc."
This is correct. Even though this structure may mimic a worm, it is cracked and does not have definable head and tail structures. When force is applied using an applicator stick, it easily falls apart. Finally, the fluid surrounding the object can be examined microscopically for eggs after the object is manipulated with the applicator stick. In this case, no eggs were seen.
This type of specimen is commonly submitted to the parasitology laboratory for identification, since patients (and clinician) mistake this object for a worm. Therefore, it is important to use these simple criteria described above to differentiate a true worm from a mimic.
Thank you all for your comments!
Sunday, July 11, 2010
Case of the Week 122
The following was 'passed' in the stool of an otherwise asymptomatic 50 year old woman. (images courtesy of Dr. Washington Winn, Fletcher Allen Health Care, VT)
Identification?
(CLICK ON IMAGES TO ENLARGE)
Identification?
(CLICK ON IMAGES TO ENLARGE)
Saturday, July 10, 2010
Answer to Case 122
Answer: proglottids of the broad fish tapeworm Diphyllobothrium latum.
Congratulations to everyone who got this right! Also in the differential would be proglottids of Taenia spp. and artifacts such as onion skin which may be passed relatively intact and mimic tapeworm segments. However, the diagnosis is easily made by examining the central proglottid structures which form a rosette-structure, or so-called "Chinese character" as shown here:
When stained, this structure is more apparent (as seen from a previous case of the week):
Congratulations to everyone who got this right! Also in the differential would be proglottids of Taenia spp. and artifacts such as onion skin which may be passed relatively intact and mimic tapeworm segments. However, the diagnosis is easily made by examining the central proglottid structures which form a rosette-structure, or so-called "Chinese character" as shown here:
When stained, this structure is more apparent (as seen from a previous case of the week):
Tuesday, July 6, 2010
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