March, 2009

Case 247
A patient, originally from Ethiopia but living in the United States for the past five years, presented to her primary care provider with complaints of abdominal pain.  A computed tomography (CT) scan was performed, and cysts were observed in the liver.  Serologic testing for Hepatitis B Virus, amebiasis, and echinococcosis were all negative.  An aspirate from one of the cysts was drawn, and sent to a pathology laboratory for work-up.  Slides made from the specimen were eventually forwarded to the CDC-DPDx for diagnostic assistance.  The following images show was what observed on a Papanicolaou-stained (PAP) slide of the specimen.  Figures A, B, C and E were taken at 500x magnification; Figures D and F were taken at 1000x magnification.  What is your diagnosis?  Based on what criteria?  What other testing, if any, would you recommend?

A	B

 

C	D

 

E	F

Acknowledgements: This case was kindly provided by CellNetix Pathology in Seattle, WA.

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Case 248
A 36-year-old immigrant from Mozambique presented to his health care provider with heartburn and chronic right abdominal pain.  All previous ova and parasite (O&P) examinations were negative.  An endoscopy was performed, upon which a worm-like object was observed in the ascending colon near the ileocecum.  The suspicious object, measuring approximately 7 mm in length, was removed, collected in 10% formalin, and sent to Pathology for work-up.  The object was sectioned, stained with hematoxylin and eosin (H&E) and reviewed by the attending pathologist, who in turn captured the following images and sent them to DPDx for telediagnosis assistance.  What is your diagnosis?  Based on what criteria?

A	B

 

C	D

 

E

Acknowledgements: This case and images were kindly provided by the Department of Pathology, Cambridge Health Alliance in Cambridge, MA.