Incidental giardiasis diagnosed by fine-needle aspiration of a phantom cecal “mass”

Pu, Robert T.; Rosenthal, Dorothy L.

doi:10.1002/dc.20351

Cited by 3 publications

(3 citation statements)

References 8 publications

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“…Similarly, Pu and Rosenthal. 11 documented giardial enteritis in the aspiration material from a cecal mass detected by imaging studies in a 58-yr-old male. In the current case, the organisms may have been aspirated from the small intestine during attempts to sample the pancreatic mass.…”

Section: Discussionmentioning

confidence: 94%

Giardia lamblia infection diagnosed by endoscopic ultrasound‐guided fine‐needle aspiration

Carter

Nelson

Eves

et al. 2007

Diagnostic Cytopathology

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The protozoan Giardia lamblia is a major cause of gastrointestinal disease worldwide. We report the case of a 59-yr-old male who presented to his primary care physician with complaints of abdominal pain and weight loss. Imaging studies revealed a liver mass and a pancreatic head mass. Biopsy of the liver mass proved to be benign, and endoscopic ultrasound-guided fine-needle aspiration of the mass in the head of the pancreas showed no evidence of malignancy; however, numerous pear-shaped, binucleated, flagellated organisms morphologically consistent with trophozoites of Giardia lamblia were identified in the specimen. With the increasing use of endoscopic ultrasound-guided fine-needle aspiration for sampling of gastrointestinal, hepatobiliary, and pancreatic lesions, cytopathologists examining such specimens will need to be familiar with the diagnostic characteristics of this protozoal parasite.

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Section: Discussionmentioning

confidence: 94%

Giardia lamblia infection diagnosed by endoscopic ultrasound‐guided fine‐needle aspiration

Carter

Nelson

Eves

et al. 2007

Diagnostic Cytopathology

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“…Misra, et al looked at the association of gastric giardiasis and carcinoma stomach and found that eight of 54 biopsies of gastric carcinoma cases contained G. lamblia [7]. Pu, et al report G. lamblia enteritis in a cecal mass aspirate [8]. The authors also hypothesize that this patient may have had chronic G. lamblia infection as a potential cause for the T-cell-rich B-cell lymphoma manifestation.…”

Section: Discussionmentioning

confidence: 99%

Giardia-filled Pancreatic Mass in a Patient With Recently Treated T-cell-rich B-cell Lymphoma

Raj

Asif

Johnson

2017

Cureus

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Giardia lamblia (G. lamblia)-filled pancreatic masses are a rarely reported entity. Furthermore, there are only a few case reports in literature on the association of these masses with cancer. We present a case of a G. lamblia-filled pancreatic cystic mass in a patient with a history of T-cell-rich B-cell lymphoma. The authors performed a PubMed search using (Medical Subject Headings) MeSH terms of pancreas, mass, Giardia, and lymphoma. A 53-year-old male with past medical and surgical history of T-cell-rich B-cell lymphoma, status post R-CHOP (cyclophosphamide, doxorubicin, vincristine, and prednisone plus rituximab) therapy with positron emission tomography (PET) scan showing no residual disease, essential hypertension, and alcohol use disorder presented to the emergency department (ED) with epigastric pain and nausea for one week. Computed tomography (CT) scan of the abdomen showed a 2.3 cm hypodense pancreatic cystic mass. This was a new finding when compared to his prior abdominal imaging. Fine needle aspiration (FNA) biopsy of the mass showed lymphocytes, reactive atypical epithelial cells, and numerous organisms consistent with Giardia lamblia. He was treated with metronidazole 250 mg by mouth three times a day (TID) for five days. Follow-up magnetic resonance imaging (MRI) and magnetic resonance cholangiopancreatography (MRCP) showed complete resolution of the pancreatic mass.There are only a few case reports on G. lamblia in the pancreas. The pathologist indicated sheets of numerous Giardia in the sample, making small bowel contamination less likely and G. lamblia aspirate from the pancreas more probable as the source. The authors hypothesize that this patient may have had chronic G. lamblia infection as a potential cause for the T-cell-rich B-cell lymphoma manifestation. The patient reported travel to an area with possible exposure to G. lamblia one year prior to presentation with the lymphoma. During that time he had increasing abdominal pain, intermittent chronic diarrhea, and weight loss. G. lamblia’s mechanism of action has been theorized to involve induction of pro-apoptotic factors, intestinal barrier dysfunction, up-regulation of cell-cycle genes, and crypt hyperplasia. The mechanism of action of pancreatic masses filled with G. lamblia and the association of G. lamblia and cancer is not completely understood. Further research is required to better understand these possible phenomena as it can help us better comprehend G. lamblia, its associations, and new cancer etiologies.

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“…In hematoxylin and eosin (H&E)-stained duodenal biopsies, G lamblia trophozoites are not easily seen, especially under low-power examination, and can be either missed or interpreted as fragments of epithelial cells cytoplasm, mucus, or artifacts (such as dirt) [10,11]. When G lamblia is adherent to the mucosal surface or located within the cytoplasm of the epithelial cells, its appearance is even more subtle.…”

Section: Introductionmentioning

confidence: 99%

C-kit (CD117) immunostain is useful for the diagnosis of Giardia lamblia in duodenal biopsies

2009

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Incidental giardiasis diagnosed by fine-needle aspiration of a phantom cecal “mass”

Cited by 3 publications

References 8 publications

Giardia lamblia infection diagnosed by endoscopic ultrasound‐guided fine‐needle aspiration

Giardia lamblia infection diagnosed by endoscopic ultrasound‐guided fine‐needle aspiration

Giardia-filled Pancreatic Mass in a Patient With Recently Treated T-cell-rich B-cell Lymphoma

C-kit (CD117) immunostain is useful for the diagnosis of Giardia lamblia in duodenal biopsies

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