Indian Journal of Pathology and Microbiology

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


Kaushik Saha1, Arpita Saha2, Kundan Kumar3, Dipendu Majumder4, Minakshi Mishra5,  
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

Correspondence Address:
Arpita Saha
507/53 Jessore Road, Debendranagar, P.O.: Motijheel, Kolkata, West Bengal - 700 074
India




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;64:100-101


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 2022 Jan 23 ];64:100-101
Available from: https://www.ijpmonline.org/text.asp?2021/64/5/100/317937


Full Text



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



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}

 Case 2



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}

 Discussion



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



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

1Rasheed MRHA, Senseng CG. Sarcina ventriculi: Review of the literature. Arch Pathol Lab Med 2016;140:1441-5.
2Bhagat 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.
3Laass MW, Pargac N, Fischer R, Bernhardt H, Knoke M, Henker J. Emphysematous gastritis caused by Sarcina ventriculi. Gastrointest Endosc 2010;72:1101-3.
4Ratuapli SK, Lam-Himlin DM, Heigh RI. Sarcina ventriculi of the stomach: A case report. World J Gastroenterol 2013;19:2282-5.
5Lam-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.
6Dumitru 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.