Case #373 – June 2014

A worm-like object was observed during a routine colonoscopy screening of an adult living in Hawaii. The specimen was collected, sectioned, and stained with hematoxylin-and-eosin (H&E). Figures A-C show what was observed by the attending pathologist. Figure A was taken at 20x magnification; Figures B and C at 100x. What is your diagnosis? Based on what criteria?

Figure A

Figure B

Figure C

This was a case of hookworm infection. Diagnostic features shown in the images included:

a strong muscled esophagus (Figures A and C).
presence of a buccal capsule (Figure A) characteristic of adult hookworms.
the presence of a bursa (Figure B), which indicated that the worm was a male.

An adequate presentation of the buccal capsule was not available to determine if the worm was Necator or Ancylostoma.