Indian Journal of Pathology and Microbiology

: 2015  |  Volume : 58  |  Issue : 4  |  Page : 566--567

Cases of bowel schistosomiasis presenting as carcinoma colon

Biswajit Biswas1, Deepak Vedant1, Vijay Kaushal1, Pooja Chauhan1, Tanish Mandal1, Nidhi Raina1, Brij Sharma2,  
1 Department of Pathology, Indira Gandhi Medical College, Shimla, Himachal Pradesh, India
2 Department of Gastroenterology, Indira Gandhi Medical College, Shimla, Himachal Pradesh, India

Correspondence Address:
Dr. Biswajit Biswas
Department of Pathology, Indira Gandhi Medical College, Shimla, Himachal Pradesh - 171 001

How to cite this article:
Biswas B, Vedant D, Kaushal V, Chauhan P, Mandal T, Raina N, Sharma B. Cases of bowel schistosomiasis presenting as carcinoma colon.Indian J Pathol Microbiol 2015;58:566-567

How to cite this URL:
Biswas B, Vedant D, Kaushal V, Chauhan P, Mandal T, Raina N, Sharma B. Cases of bowel schistosomiasis presenting as carcinoma colon. Indian J Pathol Microbiol [serial online] 2015 [cited 2020 Jul 8 ];58:566-567
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A 29-year-old male patient was admitted to our hospital in January 2014, with a 1-year-old history of pain in right lumbar region and history of significant weight loss and malaise. There was no significant past history. Due to the inconclusive investigations, patient was given presumptive alternating triple therapy, despite treatment for 4 months, the patient had no relief. Hematologic laboratory tests revealed no abnormalities. An abdominal ultrasonography was done which showed omental thickening and omental lymphadenopathy with matted gut loops and thickened hepatic flexure, ascending colon, and possibility of abdominal tuberculosis was suggested.

On computed tomography scan, asymmetric circumferential heterogenously enhancing wall thickening involving ascending colon and hepatic flexure, with strictures and dilated small gut loops with marked abdominal lymphadenopathy, with the possibility of intestinal tuberculosis or neoplastic etiology were suggested. Colonoscopy showed a polypoidal ulcerated friable growth at hepatic flexure suggesting carcinoma hepatic flexure; however, colonic biopsy was nondiagnostic revealing features of chronic nonspecific colitis. S. carcinoembryonic antigen and tissue transglutaminase were within normal limits (4 ng/ml, 4.7 U/ml, respectively), stool was negative for occult blood so after clinical, radiological, and laboratory investigations, diagnosis of carcinoma ascending colon was made, and patient underwent right extended hemicolectomy. The operative finding was growth in the hepatic flexure adherent to gall bladder and gerota's fascia, along with multiple mesenteric lymph nodes. Small gut was dilated with no evidence of ascites.

The surgical specimen received, revealed an ulceroproliferative growth with areas of the stricture. Histopathological examination of the sections from growth and stricture showed ulceration of lining epithelium, lamina propria showed hypertrophy and irregularly dilated glands, submucosa showed extensive areas of fibrosis and occasional granuloma formation, muscle layer was thickened and showed parasites having brownish thick wall with clear space at center along with chronic inflammatory cell infiltrate, granuloma, and giant cell formation. Serosa and adjoining fat showed dense fibrosis and chronic inflammatory cell infiltrate. Sections from lymph node showed eosinophilic proteinaceous deposits. Sections from the appendix and both resection lines were within normal limits [Figure 1].{Figure 1}

Histological features were of intestinal schistosomiasis with stricture and granulomatous reaction.

Schistosomiasis remains one of the most prevalent parasitic infections in the world. It is endemic in 76 countries and territories and continues to be a global public health concern in the developing world. Because it is a chronic insidious disease, it is poorly recognized at early stages and becomes a threat to development by disabling men and women during their most productive years. It is particularly linked to agricultural and water development schemes and is typically a disease of the poor who live in conditions that favor transmission and have no access to proper care or effective prevention measures. Although the distribution of schistosomiasis has changed over the past 50 years, and there have been successful control programs, the number of people estimated to be infected or at risk of infection remains unchanged.[1]

Despite major advances in control and substantial decrease in morbidity and mortality, schistosomiasis continues to spread to new geographic areas. Environmental changes that result from the development of water resources and the growth and migration of population can facilitate the spread of schistosomiasis.[2] According to WHO, 200 million people are infected worldwide, leading to loss of 1.53 million disability-adjusted life years.[3] Depending on the parasitic species liver, colon, urinary bladder, and ureter are the main organs affected, however, any organ can be affected even such as lungs, skin, kidney, and central nervous system.

Here, we reported a case of intestinal schistosomiasis presenting as carcinoma colon.

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1Crompton DW, Montresor A, Nesheim MC, Savioli L, editors. Controlling Disease Due to Helminth Infections. Geneva: World Health Organization; 2003.
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3Gryseels B, Polman K, Clerinx J, Kestens L. Human schistosomiasis. Lancet 2006;368:1106-18.