Case #432 – November, 2016

A 61- year-old man presented in 2015 with abdominal pain and was found to have a perforated sigmoid colon. Initial course notable for intra-abdominal collection, associated with the perforation, which was drained. Surgical procedures included sigmoid resection and diverting colostomy. A biopsied specimen revealed cancer and appropriate chemotherapy was administered for 7 months. No reported travel to rural areas or exposure to farm animals and only travel history outside the U.S. was to Canada and the Bahamas on a cruise 25 years ago. The patient has not eaten beef or pork for about 7 years, aside from a 2 month period in 2015 (while undergoing the cancer treatment). As an outpatient he was having carcinoembryonic antigen (CEA) levels monitored, and a recent increase prompted a positron emission tomography (PET) scan that revealed a liver lesion. He was admitted for a right liver lobe resection and a small incidental capsule nodule was noticed, removed and sent to pathology. Previous laboratory results included no evidence of eosinophilia. Figures A–F show what was observed on a hematoxylin and eosin stained section. Figures B and C were captured at 200x magnification; Figures D–F at 400x. What is your diagnosis? Based on what criteria?

Figure A

Figure B

Figure C

Figure D

Figure E

Figure F

Although the object resembled a coiled nematode, it is an artifact and most likely some type of plant seed and its presence probably a result of the perforated colon. Morphologic features shown in the figures were lack of internal organs and muscle cells and presence of thick-walled cells consistent with plant cells.