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Monthy Case Studies - 2002
Case #95 - November, 2002
A 45-year-old woman from northern Alberta, who grew up on a sheep farm and enjoyed hunting deer and moose, was seen at a university hospital in Canada for a cyst discovered in the right upper lobe of her lung during a routine chest x-ray. Despite the presence of the cyst, the woman was asymptomatic. The cyst was aspirated, examined in the pathology department, and reported as nondiagnostic. Further diagnostic work-ups, which included a review of the original Quik Diff stained smears by a senior microbiologist, were initiated before consideration of surgery. The image below shows one of two objects found on the smears. What is your diagnosis? Based on what criteria? What, if any, follow-up course of action would you recommend?
Figure A
Acknowledgement: The case history and image were kindly provided by the University of Alberta Hospitals, University of Alberta, Canada.
Answer to Case #95
The object shown was the hooklet of a larval cestode, most likely Echinococcus. The size of the object relative to the red blood cells in the background, along with the general morphology of the hooklet (shape, color, and refractile appearance), rules out the presence of an artifact. The parasite can be identified from the hooklet shown, although one would hope to see a cyst wall, germinal membrane, and hooklets together in a cyst aspirate. Serologic testing for echinococcosis on both pre- and post-aspiration sera is recommended to confirm the diagnosis.
More on: Echinococcosis
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.
