Genital schistosomiasis mansoni concomitant to genital tumor in areas of low endemicity: challenging diagnosis

Abstract

Genital infection by Schistosoma mansoni is usually misdiagnosed in individuals who reside in, or travel to endemic areas. We describe two cases of genital tumor associated with S. mansoni infection manifested by methrorragy. Surgical specimens revealed leiomyomas in both cases associated with S. mansoni. In one of them, granulomas were found in the ovary and in the other they were found in the uterine tube. Although none presented intestinal/hepatic disease, fecal egg excretion was detected in one. Both had elevated pretreatment antibody reactivity to S. mansoni antigen, but follow-up showed different outcomes. Schistosomiasis should be considered as a diagnosis in individuals with methrorragy residing in or having traveled to endemic areas. Since diagnosis follows genital amputation, and cure control is troublesome, improvement of diagnostic tools and follow-up markers are important priorities to decrease schistosomiasis morbidity.

Ovarian Manson's Schistosomiasis: Rare Diagnosis or Underestimated Prevalence?

“…Although ovarian schistosomiasis is not a common clinical finding for infections caused by S. mansoni , several cases have been described in the Brazilian literature. 20 23 24 25 30 However, it is noteworthy that in most of these cases, neoplasia was not a diagnostic hypothesis at any moment of the clinical investigation. 20 23 24 25 30 In most cases of ectopic forms of Manson's schistosomiasis, a single parasitological examination may have the capacity to prove the presence of parasitosis and open the way to better directed history-taking and investigation, thus enabling faster diagnoses with less harm to the patients' health.…”

“… 8 21 22 These findings have already been described in many other cases of ovarian schistosomiasis. 20 23 24 25 This is an immune-cellular response to the presence of a foreign body in the tissue stroma. Schistosomal granulomas can be characterized as compact and organized collections of migrant cells that, together with cells of the affected organ, become arranged as components of a heterogeneous extracellular matrix that forms a spherical structure surrounding each egg individually.…”

“…In fact, in most cases, the diagnosis was only made after an exploratory surgical intervention, by means of a histopathological examination of the material extracted. 17 19 20 24 25 28 31 Furthermore, some patients were discharged without the adequate treatment of the parasitosis, 8 and had to seek specialized hospital outpatient services to obtain a simple drug treatment consisting of the administration of praziquantel in a single or fractioned dose. 32 It is important to mention that the use of three doses of praziquantel to treat ectopic forms of the disease is a clinical practice among specialists to ensure parasitological cure.…”

Ovarian schistosomiasis: challenges of a neglected ectopic involvement of blood flukes. Case report and review of literature

“…Surgery was performed in our case in the suspect of malignancy, as also occurred in other reports in which schistosomiasis mimicked an oncological lesion 19 , 21 . The majority of the few available follow-up were clinically successful, except for one case that required a cycle of praziquantel after a first treatment with oxamniquine, to clear infection with rectal biopsy positivity at 20 months follow-ups from first diagnosis 14 .…”