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Presented by Ralph Hruban, M.D. and prepared by Andrea Subhawong, M.D.
Case 1: This adult patient with a history of travel overseas presented with the complaint of blood in his stool.
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1. Question
Week 399: Case 1
This adult patient with a history of travel overseas presented with the complaint of blood in his stool. Abdominal imaging revealed multiple liver nodules. A biopsy of the GI tract was performed.images/7.13.09.01a.jpg
images/7.13.09.01b.jpg
images/7.13.09.01c.jpgCorrect
Answer: Entamoeba histolytica
Histology: This biopsy reveals numerous protozoa in the submucosa. The parasites have a small nucleus and some appear to have ingested red blood cells.
Discussion: The protozoan Entamoeba histolytica is spread by the fecal-oral route and can cause dysentery and liver abscesses. It has been estimated that as many as 500 million people are infected.
Ingested cysts colonize the colonic mucosa where they release trophozoites, the ameboid form of the organism. When the amebae attach to the epithelium they can induce apoptosis, and invade into the lamina propria. These tend to create the flask-shaped ulcers we all learned about in medical school.
The infection typically involves the cecum and ascending colon. The organisms look a lot like macrophages, except they have smaller nuclei which contain a large karyosome. The parasite can embolize to the liver and produce liver abscesses.
Incorrect
Answer: Entamoeba histolytica
Histology: This biopsy reveals numerous protozoa in the submucosa. The parasites have a small nucleus and some appear to have ingested red blood cells.
Discussion: The protozoan Entamoeba histolytica is spread by the fecal-oral route and can cause dysentery and liver abscesses. It has been estimated that as many as 500 million people are infected.
Ingested cysts colonize the colonic mucosa where they release trophozoites, the ameboid form of the organism. When the amebae attach to the epithelium they can induce apoptosis, and invade into the lamina propria. These tend to create the flask-shaped ulcers we all learned about in medical school.
The infection typically involves the cecum and ascending colon. The organisms look a lot like macrophages, except they have smaller nuclei which contain a large karyosome. The parasite can embolize to the liver and produce liver abscesses.
