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Presented by Dr. Ashley Cimino-Mathews and prepared by Dr. J. Judd Fite.
Clinical History: 15 y/o M with symptoms of small bowel obstruction.
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Question 1 of 1
1. Question
Clinical History: 15 y/o M with symptoms of small bowel obstruction.
Correct
Answer: B. Cryptosporidiosis
Histology:
From low power, the section of small intestine looks essentially normal. There is no significant villous blunting, no ulceration, no neoplasm, and no granulomas. There are scattered lymphoid aggregates in the mucosa. Higher power examination shows eosinophils in the lamina propria, however the numbers are not markedly increased. Close examination reveals small round basophilic structures within the microvilli of the enterocyotes, distributed in a patchy distribution through the specimen. A diff quick special stain highlights the organisms, consistent with Cryptosporidia.Discussion:
Cryptosporidia is an intracellular Protozoa that infects cells of the digestive tract and respiratory tract. Infection causes a mild, self-limited diarrhea in immunocompetent individuals, but it can be severe in immunocompromised patients. It’s unclear if the infection in this patient is responsible for the patient’s symptoms. Cryptosporidia are intracellular and can be observed on H&E stains as small basophilic, round structures attached to/located within the microvilli; there may be increased numbers of eosinophils in the lamina propria, but there are no diagnostic histologic findings. Cryptosporidia and Giardia are the most common parasitic enteric pathogen in humans. In contrast to Cryptosporidia, the classic histologic features of giardia are the presence of teardrop/pear – shaped organism located in the lumen between villi. The clinical differential for this patient is Crohn’s disease, but there is no evidence of that here.Reference:
1. Chen XM, Keithly JS, Paya CV, LaRusso NF. Cryptosporidiosis. N Engl J Med. 2002 May 30;346(22):1723-31.Incorrect
Answer: B. Cryptosporidiosis
Histology:
From low power, the section of small intestine looks essentially normal. There is no significant villous blunting, no ulceration, no neoplasm, and no granulomas. There are scattered lymphoid aggregates in the mucosa. Higher power examination shows eosinophils in the lamina propria, however the numbers are not markedly increased. Close examination reveals small round basophilic structures within the microvilli of the enterocyotes, distributed in a patchy distribution through the specimen. A diff quick special stain highlights the organisms, consistent with Cryptosporidia.Discussion:
Cryptosporidia is an intracellular Protozoa that infects cells of the digestive tract and respiratory tract. Infection causes a mild, self-limited diarrhea in immunocompetent individuals, but it can be severe in immunocompromised patients. It’s unclear if the infection in this patient is responsible for the patient’s symptoms. Cryptosporidia are intracellular and can be observed on H&E stains as small basophilic, round structures attached to/located within the microvilli; there may be increased numbers of eosinophils in the lamina propria, but there are no diagnostic histologic findings. Cryptosporidia and Giardia are the most common parasitic enteric pathogen in humans. In contrast to Cryptosporidia, the classic histologic features of giardia are the presence of teardrop/pear – shaped organism located in the lumen between villi. The clinical differential for this patient is Crohn’s disease, but there is no evidence of that here.Reference:
1. Chen XM, Keithly JS, Paya CV, LaRusso NF. Cryptosporidiosis. N Engl J Med. 2002 May 30;346(22):1723-31.
