Indian Journal of Pathology and Microbiology
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Year : 2012  |  Volume : 55  |  Issue : 3  |  Page : 377-378
Bilharzial endocervical polyp

Department of Pathology, Faculty of Medicine, Mansoura University, Mansoura, Egypt

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Date of Web Publication29-Sep-2012


Schistosomiasis still represents a major threat to women's health in many developing countries. The frequency in developed countries is increasing among immigrants and tourists who have a history of freshwater exposure in endemic areas. This is a case of 43-year-old immunocompetent Egyptian woman presented by abnormal vaginal bleeding. The gynecological examination revealed an endocervical polyp measuring 3 x 2 x 1 cm. Polypectomy was done. Histopathological examination revealed several granulomas containing viable eggs of Schistosoma hematobium. Schistosomiasis is rarely presented with endocervical polyp. In developing countries, schistosomiasis may be considered in differential diagnosis of patient with endocervical polyp.

Keywords: Bilharziasis, endocervical polyp, polyp

How to cite this article:
Eladl AE, Shebl AM, ElKashef WF, Zalata KR. Bilharzial endocervical polyp. Indian J Pathol Microbiol 2012;55:377-8

How to cite this URL:
Eladl AE, Shebl AM, ElKashef WF, Zalata KR. Bilharzial endocervical polyp. Indian J Pathol Microbiol [serial online] 2012 [cited 2020 Jul 5];55:377-8. Available from: http://www.ijpmonline.org/text.asp?2012/55/3/377/101750

   Introduction Top

Schistosomiasis is the second most common human parasitic infection following malaria. It is estimated that more than 200 million people worldwide have schistosomiasis. [1],[2] Schistosoma haematobium infection involves mainly the urinary system. However, egg deposition can occur in any pelvic organ leading to the so-called ectopic localizations. Female genital schistosomiasis is defined as the presence of ova and/or a characteristic pathology in reproductive organs. [3] This can be explained on the basis of porto-systemic venous anastomosis at the level of ano-rectalis plexus and perivesical plexus from where they can enter the uterine and vaginal veins. [4] Genital schistosomiasis may affect up to 50% of women in highly endemic areas. [2] The first reported case of FGS, described by Madden [5] in Egypt (1899), was in the vagina.

   Case Reports Top

A 43-year-old Egyptian female presented with abnormal vaginal bleeding. The patient was immunocompetent. On colposcopic examination, cervical polyp measuring 3 x 2 x 1 cm was noted, for which polypectomy was done. Grossly, the polyp was soft. Histological examination revealed intact endocervical epithelium with underlying multiple granulomas [Figure 1]. These are composed of epithelioid histiocytes, lymphocytes, numerous eosinophils, and multinucleated giant cells. The center of each granuloma showed ova containing miracidium. The ova had terminal spines, characteristic of Schistosoma haematobium [Figure 2]. The diagnosis proposed was Bilharzial endocervical polyp.
Figure 1: Bilharzial endocervical polyp: Endocervical epithelium with underlying multiple Bilharzial granulomas (Hematoxylin-eosin, ×100)

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Figure 2: Bilharzial granuloma: Epithelioid histiocytes, eosinophils, and multinucleated giant cells engulfing Bilharzial ova (Hematoxylineosin, ×400)

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   Discussion Top

Schistosomiasis still represents a major threat to women's health in many developing countries. The frequency in developed countries is increasing among immigrants and tourists who have a history of freshwater exposure in endemic areas. [6]

Clinically, the most common sites of female genital schistosomiasis are the cervix, the  Fallopian tube More Detailss, and the vagina. However, in autopsy specimens, Bilharzial eggs are found commonly in the ovaries, uterus, and vulva. [1],[4]

Cervical schistosomiasis is associated with a wide range of clinical symptoms as well as wide spectrum of colposcoipc appearance. The patient may present by pain (dysmenorrhoea, lower abdominal pain, and dyspareunia), bleeding (men-orrhagia, post-coital bleeding, and inter-menstrual bleeding), or leucorrhoea.­[3] On colposcopic examination, cervical schistosomiasis may show cauliflower-like growths, nodular hypertrophy, ulcerative, and polypoid lesions, and so-called sandy patches. [7]

Microscopically, cervical schistosomiasis has two patterns. Type A pattern occurs around sites of viable egg deposition and is formed of intense inflammatory reaction of plasma cells, lymphocytes, eosinophils, and macrophages. This pattern is noted in our case. Type B pattern occurs mainly around non-viable eggs or calcified shell fragments. It is formed of a fibrous connective tissue reaction with a minimal cellular infiltrate. In both types, ova are predominantly located at the ecto-endocervical junction. [7],[8]

Cervical schistosomiasis is considered a risk factor for infection by the sexually transmitted diseases. Recent studies suggest a significant role in modifying the natural history and immunological response to those infections, especially human immunodeficiency virus (HIV), and human papilloma virus (HPV). [7],[9]

   References Top

1.Kjetland EF, Leutscher PDC, Ndhlovu PD. A review of female genital schistosomiasis. Trends Parasitol 2012;28:58-65.  Back to cited text no. 1
2.Kjetland EF, Mduluza T, Patricia D. Ndhlovu PD, Gomo E, Gwanzura L, et al. Genital schistosomiasis in women: A clinical 12-month in vivo study following treatment with praziquantel. Trans R Soc Trop Med Hyg 2006;100:740-52.  Back to cited text no. 2
3.Poggensee G, Feldmeier H. Female genital schistosomiasis: Facts and hypotheses. Acta Trop 2001;79:193-210.  Back to cited text no. 3
4.Laven JSE, Vleugels MPH, Dofferhoff ASM, Bloembergen P. Schistosomiasis haematobium as a cause of vulvar hypertrophy. Eur J Obstet Gynecol Reprod Biol 1998;79:213-6.  Back to cited text no. 4
5.Madden F. A case of bilharzia of the vagina. Lancet 1899;153:1716.  Back to cited text no. 5
6.Chen W, Flynn EA, Shreefter MJ, Blagg NA. Schistosomiasis: An unusual finding of the cervix. Obstet Gynecol 2012;119:472-5.  Back to cited text no. 6
7.Mosunjac MB, Tadros T, Beach R, Majmudar B. Cervical schistosomiasis, human papilloma virus (HPV), and human immunodeficiency virus (HIV): A dangerous coexistence or coincidence? Gynecol Oncol 2003;90:211-4.  Back to cited text no. 7
8.Helling-Giese G, Sjaastad A, Poggensee G, Kjetland EF, Richter J, Chitsulo L, et al. Female genital schistosomiasis (FGS): Relationship between gynecological and histopathological findings. Acta Trop 1996;62:257-67.  Back to cited text no. 8
9.Van Bogaert LJ. Biopsy-diagnosed female genital schistosomiasis in rural Limpopo, South Africa. Int J Gynaecol Obstet 2011;115:75-6.  Back to cited text no. 9

Correspondence Address:
Abdelhadi M Shebl
Pathology Department, Faculty of Medicine, Mansoura University, 35516, Mansoura
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/0377-4929.101750

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  [Figure 1], [Figure 2]

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