Schistosoma mansoni granuloma in late evolutive phase, in a case of tumoral form in man

Abstract

Introduction: Authors describe human schistosomal granuloma in late chronic phase, from the morphological and evolutionary viewpoints. Methods: The study was based on a histological analysis of two fragments obtained from a surgical biopsy of peritoneum and large intestine of a 42-year-old patient, with a pseudotumoral form mimicking a peritoneal carcinomatosis associated to the schistosomiasis hepatointestinal form. Results: Two hundred and three granulomas were identified in the pseudotumor and 27 in the intestinal biopsy, with similar morphological features, most in the late chronic phase, in fibrotic healing. A new structural classification was suggested for granulomas: zone 1 (internal), 2 (intermediate) and 3 (external). Conclusions: Regarding granuloma as a whole, we may conclude that fibrosis is likely to be controlled by different and independent mechanisms in the three zones of the granuloma. Lamellar fibrosis in zone 3 seems to be controlled by matrix mesenchymal cells (fibroblasts and myoepithelial cells) and by inflammatory exudate cells (lymphocytes, plasmocytes, neutrophils, eosinophils). Annular fibrosis in zone 2, comprising a dense fibrous connective tissue, with few cells in the advanced phase, would be controlled by epithelioid cells involving zone 1 in recent granulomas. In zone 1, replacing periovular necrosis, an initialy loose and tracery connective neoformation, housing stellate cells or with fusiform nuclei, a dense paucicellular nodular connctive tissue emerges, probably induced by fibroblasts. In several granulomas, one of the zones is missing and granuloma is represented by two of them: Z3 and Z2, Z3 and Z1 or Z2 and Z1 and, ultimately, by a scar.

Anal polyp caused by Schistosoma mansoni

“…Granulomatous reaction observed in this case is similar to that described in a pseudotumoral form of schistosomiasis mansoni 13 . Granulomas in several stages of evolution indicate oviposition in successive stages and that there was a modulation of the granulomatous reaction described in laboratory animals 14 and in human beings 15 .…”

Histological assessment of granulomas in natural and experimental Schistosoma mansoni infections using whole slide imaging

“…In pathological studies of schistosomiasis mansoni, assessment of granulomas by histological methods allows not only diagnosing the disease but also provides the basis for understanding the immunopathology of this infection [ 3 , 11 , 27 – 29 ]. Here, we applied WSI to study in detail the granulomatous response elicited in target organs (liver, small and large intestines) of two models of schistosomiasis mansoni.…”

“…Schistosomiasis-elicited granulomas have variable size and cell composition, depending on the evolutionary phases in which they are. The structural organization of the granulomas' stages, which is based on histological analyses, is thus complex and various classifications have been proposed and used to study both human and experimental infections [ 2 , 7 – 11 ].…”

“…Visual analysis of histological slides on the microscope, associated or not with morphometric methods, has been classically used to study the granulomatous injury triggered during schistosomiasis mansoni [ 8 , 9 , 11 ]. These procedures are time-consuming and limited, especially in large-scale studies, in which analyses of numerous slides and organs are required [ 12 ].…”

The first three years of Autopsy and Case Reports: an interesting journey

“…During the past two years, the first citations began to emerge 27 - 31. If we exclude self-citations and consider only citations in indexed journals, the citation per article index in two years (calculated just as the Impact Factor) for 2013 (concerning the 2011-2012 biennium) is 0.0469.…”