October, 2007

Case 213:
A 49-year-old man, with no known travel history, had a colonoscopy.  His physician observed small worms during the procedure that were 3 to 4 mm in length.  The worms were submitted to a pathology laboratory for sectioning and staining.  Figures A-C were captured from hematoxylin and eosin (H & E) stained sections; A was taken at 100× magnification and B and C were taken at 200× magnification.  Images were sent to DPDx for diagnostic assistance along with a presumed diagnosis based on the size and morphologic features.  The DPDx Team requested more information on the size of the oval structures (Figure C, blue arrows) and were told that they were approximately 50-55 micrometers in length.  What is your diagnosis?  Based on what criteria?

A	B

C

Acknowledgement: This case was kindly contributed by Dr. R Worthington at Sheboygan Memorial Hospital.

Click here for the answer to Case 213.

Case 214:
An 18-year-old woman sought medical attention due to a painful lesion between her toes.  She reported travel to Africa.  The lesion was excised and sent to CDC for closer examination and identification.  The tissue was noted to be fibrous and was carefully dissected to examine what was inside.  Figure A shows what was revealed within the tissue; the image was taken with a hand-held digital camera mounted to a dissecting microscope.  What is your diagnosis?  Based on what criteria?

A

Click here for the answer to Case 214.

Images presented in the monthly case studies are from specimens submitted for diagnosis or archiving.  On rare occasions, clinical histories given may be partly fictitious.