Quiz Case

[Doctor B.]

This is an interesting case I ran across on one of my surg path months. The history is a 44 year old female from Senegal with a history of abnormal uterine bleeding for 2 years. The following are pictures from her pipelle biopsy:

Anyone care to hazard a dx?

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[deschutes]

Well, since we have nearly 20 threadviews and no volunteers....

I got as far as eosinophilic infiltrate and parasites. I can even see the organism, or organisms (it fills half my screen ). I just don't know what it is. The closest thing I've seen to that is Amoebiasis.

A higher-level can take over now!

 

[yaah]

Yeah - I don't recall seeing a parasite that looks like that either. Very cool though. Reminds me of a case I saw in med school that the pathologist who signed it out called the "case of the decade." It was a needle biopsy of breast for microcalcifications, and the microcalcifications were calcified schistosomiasis eggs, mimicking a pattern of malignancy on mammogram.

 

[Brian Pavlovitz]

I concur: there is a large eosinophilic and lymphocytic infiltrate, and what appears to be some sort of parasite...Echinococcus?? It doesn't look like typical Hydatid sand though...

Are those nuclei replaced with small parasites? Gosh, it's been A LONG TIME since Micro!

 

[deschutes]

Thinking torture-tray style, I suspect something is also going on in the glandular epithelium.

 

[Doctor B.]

Sorry for the huge images! Yaah, your memory serves you well. It is indeed schistosomiasis! We didn't speciate it but it is most likely S. haematobium which is the most common of the schistosome species to infect the female GU tract.

 

[deschutes]

Awwright, I am going to play the role of the dumb medical student a while longer - it still doesn't look like worm OR egg to me. Care to point out the parts?

 

[b&ierstiefel]

don't feel dumb. you got farther than i did. i can't wait until residency cuz i really suck at this stuff.

 

[deschutes]

The previewing time. It makes or breaks!

I really should go preview that section entitled "Abnormal uterine bleeding" instead.

5 months, just five months more of this grunt...

 

[Brian Pavlovitz]

Sorry for the huge images! Yaah, your memory serves you well. It is indeed schistosomiasis! We didn't speciate it but it is most likely S. haematobium which is the most common of the schistosome species to infect the female GU tract.

Get outtta here! Schistosomiasis? Wow. Great case, Dr.B!