Colonic High-grade Tubular Adenoma Associated withSchistosoma sp.

Abstract

Abstract Introduction/Objective Although not endemic in the United States, Schistosoma infection can be encountered in clinical samples from patients that have been in endemic regions and can present a challenge to the pathologist. Usually, intestinal schistosomiasis present with a granulomatous inflammatory reaction surrounding the eggs. Schistosome eggs can be found throughout the lamina propria, mucosa, and or submucosa of the intestinal wall. Methods/Case Report We present a 79-year-old Asian male, with history of chronic constipation. He was previously diagnosed with schistosomiasis 11 years ago. He received antischistosomal treatment, however, no further tests were done to confirm parasite eradication. Initial endoscopic examination of the colorectum demonstrated two polyps: the first was 2 cm in diameter, located 10 cm proximal from the anal verge, while the second was 2cm in diameter, located 20cm proximal to the anal verge. A biopsy of the first polyp showed a tubular adenoma while the second polyp was hyperplastic showing few calcified schistosome eggs in the submuscosa. Eight days later, a second endoscopy was performed to resect the entirety of the first polyp. Microscopy examination showed sessile tubular adenoma with high grade dysplasia. In addition, there was abundant calcified 50-75 micrometer ova of Schistosoma sp., occupying the submucosa beneath the adenoma without associated inflammation. Results (if a Case Study enter NA) NA. Conclusion To our knowledge, there are a few case reports describing colonic Schistosoma eggs without inflammation in the presence of tubular adenoma. Our case report adds to the sparse literature that can aid in identifying associations in the future.