Case #324 – May, 2012

A 58-year-old female who had emigrated from Africa was seen by her health care provider for complications with squamous cell carcinoma of the cervix. CT scans of the pelvis revealed a small mass in the bladder. Biopsy specimens of the bladder and subsequent bladder washings were sent to Pathology for histological work-up. Microscopic examination of the specimens by the attending pathologist revealed structures suggestive of a parasite. Digital images were sent to the DPDx Team for diagnostic assistance. Figures A–D show what was observed in the biopsy specimens, stained with hematoxylin and eosin (H&E). Figures E and F show what was observed in the bladder washings, stained with Papanicolaou stain. The object in Figure E measured 150 micrometers in length. What is your diagnosis? Based on what criteria?

Figure A

Figure B

Figure C

Figure D

Figure E

Figure F

This was a case of schistosomiasis caused by Schistosoma haematobium. Morphologic diagnostic features included:

presence of eggs in bladder tissue (Figures A–D).
elongated, non-operculated eggs bearing a terminal spine and within the size range for S. haematobium (Figure E).
eggs containing defined miracidia (best seen in the biopsy sections in Figures B–D).
free ciliated miracidium (Figure F).