“Stranger things” in the gut: uncommon items in gastrointestinal specimens

Abstract

Organic (such as parasites or vegetable remnants) and inorganic substances may be encountered during routine pathology diagnostic work up of endoscopic gastrointestinal biopsy samples and major resections, causing possible diagnostic conundrums for the young and not so young pathologists. The main aim of this review is the description of the most frequent oddities one can encounter as foreign bodies, in gastrointestinal pathology, on the basis of the current literature and personal experience. The types of encountered substances are divided into four principal categories: parasites (helminths such as Enterobius vermicularis, Strongyloides, Schistosoma, and Anisakis, and protozoa such as Entamoeba, Giardia and some intestinal coccidia); drugs and pharmaceutical fillers (found as deposits and as bystanders, innocent or not); seeds (possibly confused with worms) and plant remnants; pollutants (secondary to post-resection or post-biopsy contamination of the sample). An ample library of images is provided in order to consent easy referencing for diagnostic routine.

Intestinal pseudo-obstruction caused byGiardia lambliainfection

“…The recognition of the parasite in the duodenal lumen of our patient occurred only after a second look, suggesting that diagnosis might be difficult for the pathologist 34. In line with this observation, 18% of false negatives were reported in a retrospective histological analysis of duodenal samples from 567 cases of giardiasis presenting with celiac-like duodenal histology 35.…”

“…33 The recognition of the parasite in the duodenal lumen of our patient occurred only after a second look, suggesting that diagnosis might be difficult for the pathologist. 34 In line with this observation, 18% of false negatives were reported in a retrospective histological analysis of duodenal samples from 567 cases of giardiasis presenting with celiac-like duodenal histology. 35 In this context, the microscopic analysis of duodenal aspirate might have represented another diagnostic option, although not superior to the analysis of duodenal biopsies when available.…”

Imported parasitosis as a diagnostic challenge in Primary Healthcare Clinic in the non-endemic region — a case study of schistosomiasis in English Division student

“…The most common findings of schistosomiasis on endoscopy include inflammatory pseudopolyps, sessile, pedunculated or cauliflower-like, ranging in size from 1 to even above ≥ 20 mm. The endoscopic presentation of the intestinal wall may be challenging to diagnose and in non-endemic regions may suggest ulcerative colitis, Crohn's disease, or ischaemic colitis [21,22]. According to more casuistic situations, schistosomiasis mimicking neuroendocrine tumours was reported [23].…”

Pathologie infectieuse du tube digestif : diagnostics à ne pas manquer

“…G . lamblia est trouvé le plus souvent dans le duodénum bien que des localisations iléale, gastrique ou colique aient également été rapportées [27] .…”