Case #272 – March, 2010

A 35-year-old male from the United Arab Emirates was hospitalized with complaints of upper and lower abdominal pain. Sections of the greater omentum and appendix were biopsied and sent to a pathology laboratory for sectioning and staining. Figures A–D show what was observed by the attending pathologist in sections of the greater omentum, stained with hematoxylin and eosin (H&E). What is your diagnosis? Based on what criteria? What other testing, if any, would you recommend?

Figure A

Figure B

Figure C

Figure D

This was a case of schistosomiasis, caused by Schistosoma mansoni. Diagnostic morphologic features included:

cross-sections of adult worms (Figure A), with the female residing in the gynecophoral canal of the male.
cross-sections of eggs showing miracidia (Figure C).
transverse-sections of eggs (Figures B and D), one of which (Figure D) shows the lateral spine characteristic of S. mansoni.

Although a species-level identification could be made by the images in this case, serology is also recommended when schistosomiasis is suspected.