Q J Med 2014; 107:857–858 doi:10.1093/qjmed/hcu062 Advance Access Publication 19 March 2014
Clinical picture Sparganosis in follicular lymphoma patient A 55-year-old woman presented with a 6-month history of lymphadenopathy in the occipital, cervical and inguinal regions. She had experienced breast cancer 8 years earlier, but there had been no evidence of recurrence. Histopathology of the left inguinal node showed plerocercoid larva of spirometra, including calcareous corpuscles characteristic of a cestode (Figure 1a and b).1,2 Granulomatous inflammation with coagulative necrosis was scattered in the node, which may have resulted from the spirometra infection. Serological
screening of Japan’s 12 major parasites was positive only for spirometra mansoni (dot-ELISA). Histopathology additionally showed the presence of grade 2 follicular lymphoma in the background of the larval lesion (Figure 1a). The lymphoma cells expressed CD3 , CD5 , CD10+, CD19+, CD20+, CD23 , CD56 , smIg-k+ and BLC2+. Although several complex karyotypes were found, they all had t(14;18)(q32;q21.3). According to positron emission tomography combined with computed tomography, clinical stage was IVA. Thus, she was Downloaded from by guest on November 14, 2015
Figure 1. (a) Histology of the lymph node: plerocercoid larva of spirometra (upper left) and granulomatous inflammation with coagulative necrosis against the background of follicular lymphoma. (b) High power view of the larva.
! The Author 2014. Published by Oxford University Press on behalf of the Association of Physicians. All rights reserved. For Permissions, please email: [email protected]
858
Clinical picture
diagnosed with sparganosis mansoni of the lymph node affected with follicular lymphoma. She had no habit of eating raw meat, but she frequently drank non-boiled mountain spring water for her health, suggesting that she had been infected by the ingestion of copepods, the first intermediate hosts of spirometra.1,2 Photographs and text from: H. Tsuda, Division of Haematology/Oncology, Kumamoto City Hospital, Kumamoto, Japan; N. Arima, Division of Clinical Pathology, Kumamoto City Hospital, Kumamoto, Japan. email: [email protected]
Conflict of interest: None declared.
References 1. Garcia HH, Jimenez JA, Escalante H. Cestodes. In: Versalovics J, Carroll KC, Funke G, Jorgensen JH, Landry ML, Warnock DW, eds, Manual of Clinical Microbiology. 10th edn. Washington, DC: ASM Press, 2011:2222–9. 2. Procop GW, Neafie RC. Less common helminth. In: Versalovics J, Carroll KC, Funke G, Jorgensen JH, Landry ML, Warnock DW, eds, Manual of Clinical Microbiology. 10th edn. Washington, DC: ASM Press, 2011:2243–54.
Downloaded from by guest on November 14, 2015
Clinical picture Sparganosis in follicular lymphoma patient A 55-year-old woman presented with a 6-month history of lymphadenopathy in the occipital, cervical and inguinal regions. She had experienced breast cancer 8 years earlier, but there had been no evidence of recurrence. Histopathology of the left inguinal node showed plerocercoid larva of spirometra, including calcareous corpuscles characteristic of a cestode (Figure 1a and b).1,2 Granulomatous inflammation with coagulative necrosis was scattered in the node, which may have resulted from the spirometra infection. Serological
screening of Japan’s 12 major parasites was positive only for spirometra mansoni (dot-ELISA). Histopathology additionally showed the presence of grade 2 follicular lymphoma in the background of the larval lesion (Figure 1a). The lymphoma cells expressed CD3 , CD5 , CD10+, CD19+, CD20+, CD23 , CD56 , smIg-k+ and BLC2+. Although several complex karyotypes were found, they all had t(14;18)(q32;q21.3). According to positron emission tomography combined with computed tomography, clinical stage was IVA. Thus, she was Downloaded from by guest on November 14, 2015
Figure 1. (a) Histology of the lymph node: plerocercoid larva of spirometra (upper left) and granulomatous inflammation with coagulative necrosis against the background of follicular lymphoma. (b) High power view of the larva.
! The Author 2014. Published by Oxford University Press on behalf of the Association of Physicians. All rights reserved. For Permissions, please email: [email protected]
858
Clinical picture
diagnosed with sparganosis mansoni of the lymph node affected with follicular lymphoma. She had no habit of eating raw meat, but she frequently drank non-boiled mountain spring water for her health, suggesting that she had been infected by the ingestion of copepods, the first intermediate hosts of spirometra.1,2 Photographs and text from: H. Tsuda, Division of Haematology/Oncology, Kumamoto City Hospital, Kumamoto, Japan; N. Arima, Division of Clinical Pathology, Kumamoto City Hospital, Kumamoto, Japan. email: [email protected]
Conflict of interest: None declared.
References 1. Garcia HH, Jimenez JA, Escalante H. Cestodes. In: Versalovics J, Carroll KC, Funke G, Jorgensen JH, Landry ML, Warnock DW, eds, Manual of Clinical Microbiology. 10th edn. Washington, DC: ASM Press, 2011:2222–9. 2. Procop GW, Neafie RC. Less common helminth. In: Versalovics J, Carroll KC, Funke G, Jorgensen JH, Landry ML, Warnock DW, eds, Manual of Clinical Microbiology. 10th edn. Washington, DC: ASM Press, 2011:2243–54.
Downloaded from by guest on November 14, 2015
