Please help me with the Utah case of the week

[Shimshimay]

http://medlib.med.utah.edu/WebPath/COW/COW.html

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[yaah]

It's from Iran, so who knows what kind of parasite that could be...

p.s. you're not allowed to get help on the case of the week!! That's why you wait another week to get the answer!

 

[cryptic]

http://medlib.med.utah.edu/WebPath/COW/COW.html

Liver abscess caused by Ascaris lumbricoides.
Longer is female,shorter is male.

The other parasite toxocara canis(dog roundworm) is also implicated in pyogenic liver abscess in the scenario of visceral larva migrans.You can see granulomata and larvae on histological sections.I do not know of a case where adult toxocara worm(looks quite similiar to ascaris lumbricoides worm on casual exam but smaller in size) has been seen in liver.If such a case has been described,I would entertain it as a diagnostic possibility.

I know,for sure ,adult ascaris lumbricoides has been described in a pyogenic liver abscess and viewed on imaging.

 

[DarksideAllstar]

Liver abscess caused by Ascaris lumbricoides

While not a pathologist. nor having set foot in an anatomy lab for over 2 years, I thought the liver was in the RUQ as opposed to the LUQ as is described in the case.

Edit: I guess he could have situs inversus?

 

[cryptic]

While not a pathologist. nor having set foot in an anatomy lab for over 2 years, I thought the liver was in the RUQ as opposed to the LUQ as is described in the case.

Edit: I guess he could have situs inversus?

If there is an abscess involving the left lobe of the liver causing hepatomegaly,I would think you would have a LUQ mass.

The other possibility is the organ being a spleen(though I cannot appreciate the malphigian corpuscles and am missing the somewhat reddish hue of the spleen but that could all be explained by poor picture quality).

Even if it is the spleen ,I still think it is an abscess due to a round worm with ascaris lumbricoides being my top choice.

 

[bananaface]

Don't you wish people would give you a damn scale to go with these things?

I'm confused as to why people are talking about what organ this is supposed to be. I presumed this was a section from just under a skin lesion. To me, it looks like a nematode of some sort, but not an adult. Dracunculus medinensis is native to Iran. I'll use that as my guess. It can't be any less likely than Ascaris.

I'm not a pathologist, so I don't qualify as "helping". But, if I get it right, I want TWO cookies!

 

[yaah]

If there is an abscess involving the left lobe of the liver causing hepatomegaly,I would think you would have a LUQ mass.

The other possibility is the organ being a spleen(though I cannot appreciate the malphigian corpuscles and am missing the somewhat reddish hue of the spleen but that could all be explained by poor picture quality).

Even if it is the spleen ,I still think it is an abscess due to a round worm with ascaris lumbricoides being my top choice.

The specimen could also be fixed in formalin, which tends to alter colors a bit. I think when one says LUQ lesion you assume spleen until there is evidence to the contrary.

 

[cryptic]

The specimen could also be fixed in formalin, which tends to alter colors a bit. I think when one says LUQ lesion you assume spleen until there is evidence to the contrary.

Assume is a dangerous word.

 

[cryptic]

Assume is a dangerous word.

I tend to avoid it.

 

[Shimshimay]

You've made a good argument in favor of Ascaris. Thanks for taking a look at it for me.....

 

[Etomidate]

as a MS3 with no interest in path, case #167 was ridiculously easy. Are these cases supposed to be difficult?

 

[b&ierstiefel]

as a MS3 with no interest in path, case #167 was ridiculously easy. Are these cases supposed to be difficult?

yeah, #167 was pretty much a gimme. i've only looked at a little more than 10 of these COWs on the utah site. for some of them, i could come up with a reasonable differential and guess. for others, i had no clue whatsoever. #167 really does look like grapes. and when one thinks of grapes, the diagnosis of a mole (as well as the moley moley moley from Austin Powers) jumps out at you.

 

[yaah]

A lot of the cases are pretty easy - but they are good examples of "classics" that you should see, but maybe don't see a lot of.

 

[Shimshimay]

as a MS3 with no interest in path, case #167 was ridiculously easy. Are these cases supposed to be difficult?

I mean, given that the specimen came from Iran, there may be parasites there that we in the USA do not see. Also, there was a question as to whether the organ is a spleen or a lung. The pastey nature of the abscess is a little unusual too.

Occasionally Utah throws a bone to the medical students. I agree that #167 was easy. But if you look at the archives of these cases, about a third of them are difficult even for pathologists.

 

[yaah]

A lot of times though, gross pathology is indeterminate. There is a specimen down here today of a sarcoma apparently arising from the achilles tendon or somewhere thereabouts. All you can really tell grossly is that it is probably a sarcoma.