September, 2008

Case 235
A 25-year-old man returned from three months of studying abroad in southeast Asia.  Countries he visited during his studies included the Philippines, Indonesia and Thailand.  Shortly after returning to the United States, he presented to his health care provider with abdominal pain, cramps and diarrhea.  Due to the travel history, a routine ova and parasite (O&P) examination was performed on the patient’s stool.  Objects A-F show objects observed in the formalin-concentrated stool specimen.  All images were captured at 400x magnification.  The object in Figure A measured approximately 70 micrometers long by 47 micrometers wide and was seen in large numbers.  The objects in Figures B and E measured approximately 75 micrometers long by 60 micrometers wide and were seen in moderate numbers.  The object in Figure C measured approximately 67 micrometers long by 38 micrometers wide and was seen in moderate numbers.  The objects in Figures D and F measured approximately 25 micrometers long by 13 micrometers wide and were seen in rare numbers. What is your diagnosis? Based on what criteria?

A	B

 

C	D

 

E	F

Click here for the answer to Case 235.

Case 236
A 30-year-old who frequents sushi restaurants started experiencing severe gastritis, including epigastric pain, nausea and vomiting.  He had reported eating at a sushi restaurant the previous day.  After being admitted to the hospital for severe pain, a gastric biopsy was performed.  A tissue specimen was sectioned and stained with hematoxylin and eosin (H&E).  The attending pathologist observed unusual structures from the biopsied material and sent the slide to the CDC for diagnostic assistance.  Figures A-C show structures observed on the slide; images were captured at 100x, 200x and 400x, respectively.  What is your diagnosis?  Based on what criteria?

A	B

 

C

Click here for the answer to Case 236.

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.