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Soon-Hyung Lee,Seung-Yull Cho,*Byong-Seol Seo,Kuck Jin Choe and Je Geun Chi
Department of Parasitology and Institute of Endemic Diseases, College of Medicine, Seoul National University, Korea.
Department of Surgery, College of Medicine, Seoul National University, Korea.
Department of Pathology, College of Medicine, Seoul National University, Korea.
**Present address: Department of Parasitology, College of Medicine, Chung-Ang University, Seoul, 151 Korea.
Abstract
A case of ectopic fascioliasis involving cecum and ascending colon was reported. This case was a 19-year old Korean female who had a history of postprandial aggravation of intermittent abdominal pain of 3 weeks duration. She was presented with an abdominal mass in the right upper quadrant, for which an operation(right hemicolectomy) was performed. Whole cecum and ascending colon showed multifocal tunnel-like necrotizing granulmas with central cavitations. Numerous Charcot-Leyden crystals were seen along tracts of the worm. The lesion was distributed throughout the entire thickness of the wall.
Parasitological examination confirmed the worm found in the intestinal wall to be juvenile form of Fasciola species. Possibilities were discussed on the localization of the fluke and the mode of infection of present case.
Figures
Figs. 1-4 Fig. 1. X-ray findings of the bowel after barium administration. Note irregular "finger print" mucosal pattern that shows compression by intramural masses.
Fig. 2. Grcss specimen of the ascending colon after removal. There are mucosal edema and focal ulcerations.
Fig. 3. Cut sections along the longitudinal axis, showing multiple areas of necrosis with cavitations (arrows), located in the submucosa, muscularis and serosa.
Fig. 4. Close up view of the bowel wall, showing an impacted worm (arrow) iun the muscularis externa.
Figs. 5-8 Fig. 5. Low power photomicrograph of the worm and surrounding heavy inflammatory reaction. Necrotic debris is seen in the cavity. H & E, ×30.
Fig. 6. Rhomboid crystals of Charcot-Leyden scattered among necrotic materials and cell debris. These debris are seen inside the cavity. H & E, ×400.
Fig. 7. Cross sectioned worm at the level of cirrus sac, showing cuts of branched ceca. H & E, ×40.
Fig. 8. Higher magnification of Fig.5, showing Mehlis gland and o?type complex. H & E, ×100.
Figs. 9-10 Fig. 9. High power magnification of the worm shows typical trematode tegumental structure carrying many spines. H & E, ×200.
Fig. 10. Small testicular follicles (arrows) lying ventral to the intestine were seen in some sections of the worm. H&E, ×200.
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