pathology

1. DR. KALYANI MAHORE
HISTOPATHOLOGICAL STUDY OF
PROTOZOA AND NEMATODES

2. PROTOZOA:
 A) Amoeba :E. histolytica, E. coli, Naegleria
fowleri, Acanthoamoeba species
 B)Flagellates :
 1)Intestinal & Genital – Giardia lamblia,
Trochomonas vaginalis, etc
 2) Hemoflagellates – Leishmania donovani,
Trypanosoma cruzi
C) Sporozoa :Toxoplasma gondii, Malaria,
Cryptosporidium parvum, Isospora belli,
Sarcocystis species,

3. NEMATODES :
 A)Intestinal :
1)Small intestine – Ascaris lumbricoides
(Roundworm),
A. duodenale, N. americanus(Hookworm)
2)Large Intestine:Trichuris trichura (Whipworm). E.
vermicularis (Threadworm/Pinworm)
B) Somatic human nematodes:
W. bancrofti, Brugia malayi, B. timori
Trichinella spiralis, D. medinensis

4.  C) Larva migrans –
 1)Visceral –Toxocara, gnathostoma
 2) Cutaneous – A. brazillensis.A. canicum
D)Other animal nematode rarely infecting man –
1) Dirofilaria
2)Capillary hepatica
3) Strongyloides fulleborni, etc

5. Case 1
 20 year old woman from village area presented
with dyspepsia, nausea, watery diarrhoea and
malabsorption since 1 month.
 Endoscopy followed by jejunal biopsy was
done.

6. Patchy whitish reticular pattern of the mucosa

7. Low power view :

9.  Giardiasis

11. Case 2
 44 year patient with AIDS, complaints of
watery diarrhoea since 2 days.
 CD4 count less than 50/mm3.

12. Acid-fast cysts in diarrheal stool

13. Low
Low power view :

14. High power x400

15. cryptosporidiasis

16. CASE 3
 a 70-year old , Chronic diarrhea with a 35 kg
weight loss (75 kg to 40 kg) occurred during 2
years.
 History of chronic alcoholism for more than 30
years.
 IncreasedWBC count with high peripheral blood
eosinophilia (36.8-39.9%) .
 Lowered protein and albumin levels .
 fecal examination was repeated 3 times with
negative results.

17. (A)simpleabdominal(erect)radiographofthepatient(B)Endoscopicviewoftheupperjejunum(C)Another
endoscopicviewofthejejunumtakenatthetimeofendoscopicbiopsy

18. Sectionsoftheupperjejunumshowingvariousdevelopmental(asexualandsexual)stagesofIsosporabelli(×1,000,H-Estain).(
A)Trophozoites(arrows),sphericalinshape.
(B)Animmatureschizontundergonenucleardivision(arrow).Manyeosinophilsareinfiltratedinthelaminapropria.(
C)Amatureschizontwithabout6merozoites(leftarrow)andamerozoitewhichenteredanenterocyte(rightarrow).Eosinophil
infiltrationsarealsoseeninthisfigure.(
D)Twomerozoitesinanenterocyte(longarrow),2macrogamonts(shortarrows),andadevelopingtrophozoite(leftlower)areseenin
thejejunalepitheliallayer.

19. SectionsoftheupperjejunumshowingvarioussexualstagesofIsosporabelli(×1,000,H-Estain).
(A)Adeveloping microgamont(arrow)withmultiplenuclei attheperiphery
B)Amature microgamont withmultiplenuclei(arrow)inanenterocyteofthecryptlayer.
C)Aprobableearlymacrogamont (arrow)inanenterocyte.
D)Anoldmacrogamont ormacrogamete (arrow)inajejunalepithelialcell.

20.  ISOSPOROSIS

21. CASE 4
 34 year female presenting as appendicitis

25.  ENTEROBIASIS

26. Lowerleftwormfemaleshowingovariescontainingdeveloping eggs
Centralworm hasrupturedwall
Allfourwormshavecharacteristicprojectionscalled lateralcuticle 'alae'
Allfourwormshavedarkerpurplestructurewhichistheintestine.Thelumenoftheintestineappearssomewhatasan
X-shape.

27. CASE 5
 60 year male with prolonged fever , abdominal
discomfort and liver dysfunction, asthenia,
fatigue, pedal edema, difficulty in walking,
cough, hoarseness and considerable weight loss
since 2 years.
 Physical examination - his general condition was
very poor, with loose skin folds, muscle
flabbiness, dryness of the skin and mucosa,
mycosis of the tongue with areas of thickening.

28.  CBC – Pancytopenia
 USG : massive hepatospleenomegaly
 massive weight loss, severe hepato-
splenomegaly, pancytopenia and anti-HCV
positivity, a diagnosis of cirrhosis of liver was
made.

29. .
marrow biopsy, - amastigotes inside phagocytic cells
on bone marrow biopsy, in the form of round
cytoplasmic inclusions
amastigote stained well with giemsa, HE,

30. 
Liver biopsy showing Microgranulomas in the liver parenchyma with associated
Diffuse activation of Kupffer cells.

31.  Autopsied liver (HE, oil immersion) –
 occurrence of haloed small granules (protozoan bodies) in the cytoplasm of Kupffer
cells
 Histiocytes contain small oval organisms with bar shaped paranuclear kinetoplast

32.  VISCERAL LEISHMANIASIS (L. donovani)

33. Case 6
 A 54-year-old woman, with no past medical
history of lupus erythematosus or infectious
disease, presented with a 3-month history of
a slowly enlarging erythematous and
infiltrated plaque, extending over the nose,
the right cheek, and the internal aspect of the
right lower eyelid.

34. pseudolepromatous appearance

35. On high magnification the
amastigotes with their kinetoplasts
can be identified

37.  CUTANEOUS LEISHMANIASIS

38. TYPES
• Localized (acute) cutaneous leishmaniasis
• Diffuse (acute) cutaneous leishmaniasis
( disseminated anergic cutaneous leishmaniasis)
• Chronic cutaneous leishmaniasis (including
leishmaniasis recidivans or lupoid leishmaniasis)
• Post–kala-azar dermal leishmaniasis
• Mucocutaneous leishmaniasis
•Visceral leishmaniasis
•Viscerotropic leishmaniasis

39. CASE 7
 20-year-old boy from Patna (Bihar, India)
presented with a lump in the left arm for
about 2-3 months.
 The lump was, firm, mobile, slightly tender
but not painful,ill-defined lump measured up
to 4 cm in greatest dimension.
 The clinical impression was that of an old
rupture and healed muscle or tendon.
 No radiological study was performed and a
muscle biopsy was done.

40.  Encysted oval shaped parasite occupying full thickness of the muscle fiber
and showing internal septations

41. A cyst of This longitudinal section demonstrates the wall showing radial
processes on the outer surfaces (cytophaneres). The internal mass is separated into
many compartments.

42.  Encysted parasite in skeletal muscle showing internal bradyzoite nuclei
separated by clear internal septations

43.  Sarcocystosis

44. CASE 8
 A 56-year-old man was admitted
for abdominal pain, diarrhea.

45. Colonoscopic finding showing a movable whitish worm, in the ileocecal valve.

46. ,The parasite was carefully retrieved by forceps. showing the intestine and
uterine tubules (H-E stain, ×40). (C) Barrel-shaped eggs of and the body wall
consisting of the cuticle, epicuticle, and muscle layer (H-E stain, original
magnification, ×400). (D) Moderate eosinophilic infiltration in lamina propria of
case 4 (H-E stain, original magnification, ×400).

47.  TRICHURIASIS

48. CASE 9
 52 year female presented with complaints of
intensely itchy serpiginous lesion on hand.
 Hematological and biochemical investigations
were normal.

50. B: The organism is found underneath the stratum corneum in the
upper portion of the stratum malpighii.

52.  CUTANEOUS LARVA MIGRANS

53. CASE 10
45 Year male presented with acute abdomen,
diarrhoea, fever , vomiting , nausea simulating
peptic ulcer disease since 1 month.
AEC – 1224 cells/ cumm

54. Diffuse suppurative ulcerin stomach

55. C and D, Gastric biopsies revealed inflammatory infiltrates,
foveolar hyperplasia, and intestinal metaplasia associated with the
presence of developing eggs and larvae (hematoxylin-eosin, original
magnifications ×250).
E and F, duodenal biopsies showed inflammatory reaction in the
lamina propria

59. strongyloidiasis

60. CASE 11
 50 Year male was admitted for dysentery,
anemia and pain in right hypochondriac
region.

65. a) Intestinal flask-shaped
ulcers observed though
rectosigmoidoscopy
examination. Arrows
indicate the colonic ulcers.
b) Large bowel specimen
Arrows indicate
hemorrhagic ulcers and
important intestinal
mucosa necrosis d)
Intestinal biopsy obtained
from the edge of flask-
shaped ulcer where large
numbers of trophozoites
(HE and PAS stained, 60×).
Notice the presence of
trophozoites, hepatocytes,
and the large number of
inflammatory cells.

66.  AMOEBIASIS

67. CASE 12
 34Year male HIV patient admitted with
history of weakness of right side face and
difficulty in talking since 1 week.

72.  TOXOPLASMOSIS

73. CASE 13

74. One nodule had an opening to the surface of the skin that drained a purulent exudate; a large parasite was expressed from the nodule. The dog was
otherwise alert, active, and afebrile. Hematology and biochemical profiles were within normal limits and fecal flotation was negative. The dog was
routinely treated monthly with oral ivermectin heartworm preventative. The dog lived in southwestern Wisconsin, but vacationed regularly in central
Wisconsin near a spring-fed lake. The dog swam in that lake and periodically ate snails.
Gross Pathology: Subcutaneous nodules measuring 2-3 cm in diameter were palpable in the skin. The surrounding skin was erythematous. Nodules
developed an opening that drained a purulent exudate. The largest nodules were surgically removed.

75. A histologic section of a representative nodule reveals pyogranulomatous nodules localized in the deep dermis containing multiple cross sections of parasitic nematodes and
numerous embryos, both in a large uterus and free in the exudate. The adults have a thick cuticle and a prominent coelomyarian musculature. In some sections, there is a small
focus of epidermal ulceration with pyogranulomatous inflammation intermingled with embryos at the skin surface.

76.  DRACUNCULIASIS

77. CASE 14
 A four-year-old boy was admitted to the
hospital with high-grade fever, chills, and
weight loss (about 1.5 kg) of two months
duration.
 Hepatomegaly was noted in the physical
examination.
 A liver ultrasound showed a relatively well-
defined, but irregular isoechoic mass with a
hypoechoic periphery measuring 58 × 51 × 47
mm in the VII segment of right lobe.

78.  His complete blood count showed total white
cell count 8400/mm3 with 8% eosinophil and
mild anemia (Hb: 10.2 g/dL, normal 11-14
g/dL).
 Erythrocyte sedimentation rate was 97
mm/hour and C-reactive protein level was 31.
Liver enzymes were mildly elevated, AST:
220 IU/L; and ALT: 130 IU/L.

79. A Hypodense Lesion Measuring 65 × 33 cm With Irregular Edematous Border in The
LiverAbdominopelvic spiral computerized tomography (CT) scan without and with IV
and oral contrast media revealed ill-defined mass lesion 61 × 64 × 65 mm with thick
irregular peripheral enhancement and hypodense center in right lower liver lobe.

80. liver tissue was involved by extensive necrotizing granulomatous inflammation with severe eosinophilic infiltration . many multi-nucleated foreign body
type giant cells containing fragments of degenerating round worms as well as scattered degenerated worm body and unembryonated ova

81. The histopathological examination of liver biopsy revealed egg of nematode Capillaria hepatica. The eggs forms were pathog-
nomic with outer striated wall and polar plugs on both end of the spindle.

82.  CAPILLARY HEPATICA

83. Case 15
24 years months and had been healthy before
consuming a large portion of an uncooked pork
dish. His symptoms included watery, diarrhea,
fever, and asthenia.
 A few days before he died, he COMplained of
severe headache, generalized myalgia, confusion,
and respiratory difficulty. He was unconscious
when a relative were determined.
 LFT deranged . CBC -Eosinophilia
 he died shortly afterward autopsy has been done

84. Histologic sections of infected contained abundant eosinophils, neutrophils, plasma cells, and macrophages surrounding the muscle
tissue.
all of the muscle larvae examined were nonencapsulated by a collagenous material . Some of the muscle fibers contained several
hypertrophic nuclei and some revealed edematous and necrotic changes.
Trichinella larvae were found traversing the muscle fibers.

85.  TRICHINOSIS

86. Case 16
a 28-year-old male with a history of pain and swelling in his
left groin after his return from the trip of travel 6 months .
 Within one week of the swelling’s appearance, it became
very hard.There were no other systemic symptoms or signs
associated with the lesion.
 Physical examination revealed a 3 cm nodule, palpable in
the left inguinal canal, just lateral to the pubic tubercle and
inferior to the external inguinal ring.The mass was mildly
tender and could not be reduced.
 The pre-operative diagnosis was an incarcerated left
inguinal hernia or adenophathy or a soft tissue mass of
unknown origin.

87. with the coin-like
lesion

88.  At surgery, no hernia was present. Instead, a 3–4 cm soft
tissue tumor involving the spermatic cord, just inferior to
the external inguinal ring was found.The testicles appeared
normal.
 Two frozen sections of the mass showed necrotic cells
which could not otherwise be identified.The mass was
densely adherent to the vas deferens, testicular artery, and
veins, and could not be removed without a left
orchiectomy, which was done.
 Gross pathological examination of the surgical specimen
showed a fusiform, firm, pale tan swelling within the cord
beginning 2 cm from the surgical margin.The swelling
measured 5.2 x3.1 x2.9 cm.
 Cut sections of the mass revealed a granular, pale tan
surface that appeared necrotic.

89. Thick laminated cuticle, mucle cells broad lateral cords

91.  DIROFILARIASIS

92. CASE 17
 A 44-year-old male presented with a history of
progressively increasing swelling of the right side
of scrotum which he noticed following a fall.
 On examination, a tender, fluctuant, firm to hard
10 × 10 cm mass was noted on the right side of
the scrotum.
 Provisional diagnosis of hematoma was given.
 Scrotal exploration and evacuation - Fifty ml of
blood clot and 150 ml of thick pus was drained out.

93.  Thickened spermatic cord and necrotic testicular tissue were noted.
 High inguinal orchiectomy was performed to rule out malignancy.
 No microfilariae were detected on peripheral smear.
 A large ruptured cyst impregnated with necrotic debris was noted in
the paratesticular tissue

94. . (a) Fibrinopurulent response around dead microfilariae. (b) Multinucleated giant cells in lymph node parenchyma. (c)
Eosinophil rich granulation tissue. (d) Neutrophil collection and multinucleated giant cells (inset) (H and E, ×400)

95. Morphology of parasites. (a) Gravid worm in dilated lymphatics. (b) Dead microfilaria adherent to lymphatic wall. (c)
Cross-section of gravid worm showing internal organs. (d) Dead worm entrapped with fibrinous material attached to
lymphatic wall (H and E, ×100)

96. Lymphatic architecture. (a) Dilated perinodal lymphatics (H and E, ×100). (b) Dilated lymphatic distant to the site of worm
nest. (c) Lymphatics lined by endothelial cells having bulging nuclei (H and E, ×1000)

97.  FILARIASIS

98. References:

1.Rao RU, Klei TR. Cytokine profiles of filarial granulomas in jirds infected with Brugia pahangi. Filaria J
2006;5:3.
2.2Thakur BB, Sinha KC, Thakur S. Filariasis: An Appraisal. India: Medicine Update, API; 2005. p. 669-79.
 3.Boram, L. M. , K. F. Keller , D. E. Justus , and J. P. Collins . Strongyloidiasis in immunosuppressed patients. Am J
Clin Pathol 1981. 76:778–781
 4.Chitwood, M. B. and J. R. Lichtenfeld . Identification of parasitic metazoa in tissue sections. Exp Parasitol 1972.
32:407–519.[CrossRef] [Medline]
 5Hong ST, Chai JY, Choi MH, Huh S, Rim HJ, Lee SH. A successful experience of soil-transmitted helminth control
in the Republic of Korea. Korean J Parasitol 2006;44: 177-185. PMID: 16969055
 6.Joo JH, Ryu KH, Lee YH, Park CW, Cho JY, Kim YS, Lee JS, Lee MS, Hwang SG, Shim CS. Colonoscopic diagn
osis of whipworm infection. Hepatogastroenterology 1998;45: 2105-2109. PMID: 9951873.
 7.Mcadam AJ, Sharpe AH. Infectious diseases. In: Kumar V, Abbas AK, Fausto N, Aster JC, editors. Robbin and
Cotran Pathologic Basis of Disease. 8 th ed. Philadelphia: Elsevier; 2010. p. 380-1.
8. Cianferoni A, Schneider L, Schantz PM, Brown D, Fox LM. Visceral larva migrans associated with earthworm
ingestion: clinical evolution in an adolescent patient. Pediatrics. 2006;117:e336–e339. doi: 10.1542/peds.2005-
1596. [PubMed] [Cross Ref]
 9.Bhatia V, Sarin SK. Hepatic visceral larva migrans: evolution of the lesion, diagnosis, and role of high-dose
albendazole therapy. Am J Gastroenterol. 1994;89:624–627. [PubMed]

99.  Thank you