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Download Images in Clinical Tropical Medicine Chronic Schistosomiasis in a
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Am. J. Trop. Med. Hyg., 80(1), 2009, pp. 1–2 Copyright © 2009 by The American Society of Tropical Medicine and Hygiene Images in Clinical Tropical Medicine Chronic Schistosomiasis in a Patient with Rectal Cancer Ajay R. Bharti,* Noel Weidner, and Sonia Ramamoorthy Departments of Medicine, Pathology, and Surgery, University of California San Diego, La Jolla, California A previously healthy 66-year-old Filipino woman presented with a 2-month history of intermittent rectal bleeding, pain with defecation and a 9-lb weight loss. A 5-cm anal tumor, found on colonoscopy and confirmed by magnetic resonance imaging scan (Figure 1) was surgically removed. Histopathologic examination of the specimen showed a moderately differentiated adenocarcinoma and heavily calcified, nonviable Schistosoma japonicum ova in the rectum, vessels, and lymph nodes (eggs roughly 60 µm in diameter, oval to round in shape with no spine or a small barely detectable subterminal spine). The eggs were predominantly submucosal (Figure 2), with no predilection for carcinomatous versus non-carcinomatous bowel (Figure 3). The patient immigrated to the United States when she was 8 years old (she grew up in rural Philippines, a known endemic region) and had never been to a Schistosomiasisendemic region since that time. She had, therefore, acquired the infection almost 60 years ago in the Philippines. We speculate that the inflammation caused by chronic S. japonicum infection contributed to the development of rectal cancer. An association between urinary bladder cancer and S. hematobium has been well established1; a similar association FIGURE 2. Normal mucosa overlying submucosal layer containing numerous Schistosoma eggs. The latter are heavily calcified but are ovoid with a thin shell without or with an inconspicuous, small, lateral, hook-like structure. This morphology is consistent with S. japonicum infestation. This figure appears in color at www.ajtmh.org. between S. japonicum and colon cancer is emerging.2 Early detection and treatment of S. japonicum infection may prevent future development of colorectal cancer. * Address correspondence to Ajay R. Bharti, University of California San Diego, School of Medicine, Division of Infectious Diseases, Department of Medicine, 9500 Gilman Drive, MC 0847, La Jolla, CA 92093-0847. E-mail: [email protected] Received September 15, 2008. Accepted for publication September 22, 2008. Authors’ addresses: Ajay R. Bharti, Division of Infectious Diseases, Department of Medicine, University of California San Diego, FIGURE 3. Invasive adenocarcinoma of the classic enteric type invading submucosal layer. Also present are a few calcified S. japonicum eggs. The latter were found in both normal and carcinomatous bowel wall. This figure appears in color at www.ajtmh.org. FIGURE 1. Pelvic magnetic resonance imaging scan showing a mass in the mid-rectum. 1 2 IMAGES IN CLINICAL TROPICAL MEDICINE 9500 Gilman Dr., 0847, La Jolla, CA 92093-0847, Tel: 619-5435669, Fax: 619-543-1235, E-mail: [email protected]. Noel Weidner, Department of Pathology, University of California San Diego, 200 W. Arbor Dr., 8720, San Diego, CA 92103-8720, Tel: 619543-5402, Fax: 619-543-5249, E-mail: [email protected]. Sonia Ramamoorthy, Department of Surgery, University of California San Diego, 3855 Health Sciences Dr., 0987, La Jolla, CA 92093-0987, Tel: 858-822-6277, Fax: 858-822-6263, E-mail: [email protected]. REFERENCES 1. Mostafa MH, Sheweita SA, O’Connor PJ, 1999. Relationship between Schistosomiasis and bladder cancer. Clin Microbiol Rev 12: 97–111. 2. Qiu DC, Hubbard AE, Zhong B, Zhang Y, Spear RC, 2005. A matched, case-control study of the association between Schistosoma japonicum and liver and colon cancers, in rural China. Ann Trop Med Parasitol 99: 47–52.
