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  Table of Contents    
LETTER TO EDITOR  
Year : 2021  |  Volume : 64  |  Issue : 5  |  Page : 100-101
Sarcinia ventriculi, an incidental bacteria in gastric obstruction? Can it be a clue to underlying malignancy in endoscopic biopsy


1 Specialist, Department of pathology, Tata Main Hospitals, Jamshedpur, Jharkhand, India
2 Consultant Pathologist and Lab Head, Diagno Lab, India
3 Consultant Gastroenterologist, TMH, Jamshedpur, Jharkhand, India
4 Consultant Gastroenterologist, Healthworld Hospital, Durgapur, West Bengal, India
5 Consultant Pathologist and HOD, Department of Pathology, Tata Main hospitals, Jamshedpur, Jharkhand, India

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Date of Submission23-Dec-2019
Date of Decision25-Feb-2020
Date of Acceptance14-Aug-2020
Date of Web Publication7-Jun-2021
 

How to cite this article:
Saha K, Saha A, Kumar K, Majumder D, Mishra M. Sarcinia ventriculi, an incidental bacteria in gastric obstruction? Can it be a clue to underlying malignancy in endoscopic biopsy. Indian J Pathol Microbiol 2021;64, Suppl S1:100-1

How to cite this URL:
Saha K, Saha A, Kumar K, Majumder D, Mishra M. Sarcinia ventriculi, an incidental bacteria in gastric obstruction? Can it be a clue to underlying malignancy in endoscopic biopsy. Indian J Pathol Microbiol [serial online] 2021 [cited 2021 Jun 23];64, Suppl S1:100-1. Available from: https://www.ijpmonline.org/text.asp?2021/64/5/100/317937




Dear Editor,

Sarcinia ventriculi is a gram-positive bacteria and rare finding in upper gastroesophageal endoscopic biopsy. It's generally associated with gastroparesis. We report two cases of Sarcina ventriculi infestation in patients with gastric outlet obstruction due to adenocarcinoma. To the best of our knowledge, two cases Sarcina ventriculi have been reported till date in association with gastric adenocarcinoma ours being the third and fourth cases.[1],[2] A brief related review of literature is being done.


   Case 1 Top


A 67-year-old male presented with vomiting and pain in the abdomen since last 4 months. Upper gastrointestinal endoscopy revealed a hard ulceroproliferative mass completely obliterating the antral opening [Figure 1]a. Multiple endoscopic biopsies were taken. Microscopy showed ulceration of the lining epithelium with surface exudation, and presence of atypical cells in the lamina propria disposed in trabeculae, sheets and ill formed glands [Figure 1]b. Tumor cells showed marked pleomorphism with hyperchromatic nuclei and moderate amount of cytoplasm. The biopsy also demonstrated organisms present in tetrads and octads conforming to the morphology of Sarcinia, primarily on the luminal ulcerated mucosal surface epithelium [Figure 1]c and [Figure 1]d.
Figure 1: Esophagogastroscopy demonstrating a ulceroproliferative mass at pyloric antrum causing gastric outlet obstruction (a); Photomicrograph showing a poorly differentiated adenocarcinoma in stomach with overlying mucosal ulceration and organisms within the surface exudation. (b) (H&E stain, 100x); High power view demonstrating organisms present in tetrads and octads, morphologically resembling Sarcinia Ventriculi present within surface exudation on ulcerated luminal surface epithelium of stomach. (c and d) (H&E stain, 400x)

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   Case 2 Top


A 55-year-old female, known hypertensive on treatment for last 10 years, presented with recent onset of dyspepsia and vague abdominal pain in the epigastric region. She had prior history of percutaneous nephrolithotripsy for right renal stone, 6 years back and was also operated for neurofibroma of right arm. Presently routine examinations were within normal range and she was advised ultrasonographic evaluation of the whole abdomen. On radiology, an irregular concentric thickening was seen involving antropyloric region, measuring 1.8 cm in greatest dimension. She was further evaluated with endoscopy which revealed pyloric wall thickening with ulceration, a provisional diagnosis of infiltrative lesion was made with tissue biopsy taken for histopathological examination [Figure 2]a. On microscopy three mucosal bits were showing largely unremarkable mucosal changes. Only one fragment was showing superficial ulceration with few organism in tetrads with underlying scattered markedly pleomorphic cells in sclerotic stroma [Figure 2]b and [Figure 2]c. Tumor cells were disposed in acinar pattern focally. Gram staining demonstrated the gram positive nature of the organism [Figure 2]d. Final diagnosis of poorly differentiated adenocarcinoma with Sarcinia ventriculi infestation was rendered.
Figure 2: Esophagogastroscopy showing ulcerative stenosis at pyloric antrum causing gastric outlet obstruction (A); Micrograph showing a poorly differentiated adenocarcinoma in stomach with overlying organisms (arrowheads, H&E stain, 100x) (B); High magnification demonstrating organisms morphologically resembling Sarcinia Ventriculi (arrow head) admixed with poorly differentiated carcinoma (arrow, H&E stain, 400x) (C); Gram staining showing gram positive Sarcinia Ventriculi in tetrads and octads (Gram stain, 400X) (D)

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   Discussion Top


Sarcina ventriculi is a gram-positive, nonmotile anerobic coccus having exclusively fermentative metabolism that can grow in acidic environments.[2] It was first isolated from gastric content by Goodsir in 1842.[4] This organism is small measuring 1.8–3.0 μm in diameter, spheroid and typically occurs in tetrads or octads. The configurational peculiarity is result of cell division in at least two planes of growth.[2] Since discovery there have been 22 cases reported in electronic database, almost all cases being associated with delayed gastric emptying including cases of gastric ulcer, emphysematous gastritis, and peritonitis due to gastric perforation.[3] Of these cases only two cases were associated with Gastric adenocarcinoma and one case was associated with pancreatic adenocarcinoma.[1],[2],[5] Differential diagnosis includes is Micrococcus species. Both Sarcinia and Micrococcus are gram positive and occur in tetrads or packets. Micrococcus is smaller in size measuring 0.5 μm and Micrococcus tends to form clusters.[2] Although Sarcina has been associated with cases of gastric outlet obstruction, it has been suggested that Sarcina infection may not be directly pathogenic and rather it may be an incidental association. Fatalities are exceedingly rare in documented cases, only one case reported lately.[6]


   Conclusion Top


It is suggested that the presence of these organisms, especially in small endoscopic biopsy, may be considered as a marker of delayed gastric emptying and its presence should prompt the pathologist to diligently search for an underlying etiology including malignancy, as were present in both of our cases.

Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
   References Top

1.
Rasheed MRHA, Senseng CG. Sarcina ventriculi: Review of the literature. Arch Pathol Lab Med 2016;140:1441-5.  Back to cited text no. 1
    
2.
Bhagat P, Gupta N, Kumar M, Radotra BD, Sinha SK. A rare association of Sarcina with gastric adenocarcinoma diagnosed on fine-needle aspiration. J Cytol 2015;32:50-2.  Back to cited text no. 2
[PUBMED]  [Full text]  
3.
Laass MW, Pargac N, Fischer R, Bernhardt H, Knoke M, Henker J. Emphysematous gastritis caused by Sarcina ventriculi. Gastrointest Endosc 2010;72:1101-3.  Back to cited text no. 3
    
4.
Ratuapli SK, Lam-Himlin DM, Heigh RI. Sarcina ventriculi of the stomach: A case report. World J Gastroenterol 2013;19:2282-5.  Back to cited text no. 4
    
5.
Lam-Himlin D, Tsiatis AC, Montgomery E, Pai RK, Brown JA, Razavi M, et al. Sarcina organisms in the gastrointestinal tract: A clinicopathologic and molecular study. Am J Surg Pathol 2011;35:1700-5.  Back to cited text no. 5
    
6.
Dumitru A, Aliuş C, Nica AE, Antoniac I, Gheorghiţă D, Grădinaru S. Fatal outcome of gastric perforation due to infection with Sarcina spp. A case report. IDCases 2020;19:e00711.  Back to cited text no. 6
    

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Correspondence Address:
Arpita Saha
507/53 Jessore Road, Debendranagar, P.O.: Motijheel, Kolkata, West Bengal - 700 074
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/IJPM.IJPM_992_19

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