Pseudo-Tumor of the Epididymis, a Rare Clinical Presentation of Human Dirofilaria repens Infection: a Report of Autochthonous Case of Dirofilariasis in Southwestern Slovakia.

PURPOSE: Dirofilariasis caused by the filarial nematode Dirofilaria repens is mainly a disease of dogs and other carnivores. Also, humans can be accidentally infected with this parasite. The infective third-stage filariform larvae are transmitted by various species of mosquitoes. Until this day, a total of 17 human cases caused by D. repens have been diagnosed in Slovakia, 11 subcutaneous, 4 ocular, 1 pulmonary and 1 in the epididymis. The aim of this report was to describe an unusual clinical case of dirofilariasis of the scrotum. METHODS: Extirpated worm was subjected to the molecular and histological identification. PCR for the amplification of cytochrome oxidase subunit 1 (CO1) was performed using specific D. repens primer pair. RESULTS: Here we document the 13th case of human dirofilariasis in a 46-year-old man from southwestern Slovakia. Very rare in humans, genital involvement manifests itself as pseudotumor nodule affecting the epididymis. The patient consulted a general practitioner due to a palpable subcutaneous lump in the scrotum. Routine laboratory analysis revealed blood eosinophilia (16.6%). The ultrasound examination was indicated, and subsequently, surgical excision of the right epididymal nodule was performed. On the basis of histological microscopic examination and PCR-based detection, the helminth was identified as Dirofilaria repens. This represents the ninth case of autochthonous dirofilariasis in Slovakia. CONCLUSIONS: The majority of D. repens infections were recorded in southwestern regions of Slovak Republic, which are considered to be endemic areas for canine dirofilariasis. Our described patient also comes from southwestern part of Slovakia (Topolníky, Dunajská Streda region).

Pseudotumor inflamatorio por Fasciola hepática: a propósito de un caso / Inflammatory pseudotumor by Fasciola hepática: a case report

Introduction: Fasciola hepatica is a parasite of the class Trematoda. It commonly has been found in developing countries. When it infects humans is characterized by a triad of fever, pain in right upper quadrant and peripheral eosinophilia. We present a 67-year-old female from a rural town of the north of Lima, Peru, it was found abdominal pain, eosinophilia and focal hepatic lesions. For this reason, a hepatic mass was the initial suspicion. The hepatic biopsy was performed and one of the findings was eosinophilia. Fasciola hepatica infection should be considered as part of differential diagnosis in hepatic tumors with eosinophilia when the origin of the patient is from endemic areas of F. hepatica.

Fasciola hepática es un parásito de la clase Trematoda común en países en desarrollo. La infección en el ser humano se caracteriza por la triada de fiebre, dolor abdominal en el cuadrante superior derecho y eosinofilia. Se presenta el caso de una mujer de 67 años procedente de una zona rural al norte de Lima, con historia de dolor abdominal de seis meses de evolución, con una imagen hipodensa hepática en el TAC abdominal y eosinofilia. La biopsia hepática mostró un infiltrado inflamatorio con eosinofilia. En el diagnóstico diferencial en pacientes con un tumor hepático y eosinofilia, se deben incluir infecciones parasitarias como F. hepatica; sobre todo en pacientes que proceden de áreas endémicas.

[Inflammatory pseudotumor by Fasciola hepática: a case report]. / Pseudotumor inflamatorio por Fasciola hepática: a propósito de un caso.

INTRODUCTION: Fasciola hepatica is a parasite of the class Trematoda. It commonly has been found in developing countries. When it infects humans is characterized by a triad of fever, pain in right upper quadrant and peripheral eosinophilia. We present a 67-year-old female from a rural town of the north of Lima, Peru, it was found abdominal pain, eosinophilia and focal hepatic lesions. For this reason, a hepatic mass was the initial suspicion. The hepatic biopsy was performed and one of the findings was eosinophilia. Fasciola hepatica infection should be considered as part of differential diagnosis in hepatic tumors with eosinophilia when the origin of the patient is from endemic areas of F. hepatica.

A rare case of hematemesis following gastro-duodenal strongyloides infection.

We report the case of a 30-year old Black African man with a two-year history of nausea, abdominal discomfort and pruritus due to infection with Strongyloides stercoralis, which was successfully treated, but then complicated by the development of a bleeding pseudo-tumor in the duodenum. A review of the literature was performed.

[Pancreatic ascariasis mimicking a pancreatic tumor]. / Ascariasis pancreática que simula un tumor pancreático.

BACKGROUND AND AIM: Ascaris lumbricoides infection in Spain is anecdotal and is usually associated with travel to areas with high endemicity such as India and South America. Biliopancreatic disease caused by this parasite is both rare and one of the most feared complications. There are few publications in the literature about pancreatic involvement in ascariasis. We describe a case of pancreatic ascariasis diagnosed after a pancreaticoduodenectomy was performed for a suspected pancreatic adenocarcinoma. PATIENT: A 58-year-old man consulted for longstanding abdominal pain and diarrhea. Computed tomography and magnetic resonance scans, endoscopy, and endoscopic ultrasound-guided fine-needle cytology were performed. The pathological diagnosis was moderately differentiated adenocarcinoma of the pancreatic head. RESULTS: Cephalic pancreaticoduodenectomy was performed. The postoperative course was favorable. A pancreatic fistula type B (ISGPF classification) developed and was resolved with conservative treatment. Analysis of the surgical specimen revealed the presence of a pancreatic pseudotumor due to Ascaris lumbricoides. After these findings, treatment was completed with oral albendazole. CONCLUSIONS: Pancreatic ascariasis in our environment is unusual, but should be included in the differential diagnosis of tumors and inflammatory processes of the pancreas.

A case of pseudotumorous form of ascaris.

A 35-year-old woman presented with lower abdominal pain and amenorrhoea. CT showed a thick walled lobulated mass with Ascaris adjacent to caecum along with the presence of a left ovarian mass. The peroperative findings were a tubular mass with central tunneling containing an Ascaris lumbricoides. Left ovary showed a haemorrhagic cyst. Biopsy of the mass showed acute on chronic granulomatous inflammation and the worm was found to be female. This was a rare case of Ascaris lumbricoides presenting as a pseudotumorous mass.

X-cells in pseudotumors of yellowfin goby Acanthogobius flavimanus: a protistan organism distinct from that in flathead flounder Hippoglossoides dubius.

Yellowfin goby Acanthogobius flavimanus affected with X-cell pseudotumors were sampled from a river estuary in Tokyo Bay, Japan. We amplified the gene for small subunit ribosomal RNA (18S rRNA) of X-cells of the goby with PCR using universal primers. The gene that we obtained (DDBJ Accession no. AB451874) showed 91% sequence identity to that of the X-cells of the flathead flounder Hippoglossoides dubius. With in situ hybridization, the probes specific for the gene that we obtained hybridized with the goby X-cells but not with the flounder X-cells, whereas probes for the 18S rRNA gene of flounder X-cells hybridized with the flounder X-cells but not with goby X-cells. These findings indicate that, although the X-cells found in the goby are closely related to the protist found in flounder, the two are clearly distinct organisms.

Hepatogastric inflammatory pseudotumor presumably deriving from prior amebic infection.

INTRODUCTION: Inflammatory pseudotumor is a rare entity with a clinical and radiographic presentation that is difficult to differentiate from malignancy. This is a case report of a large hepatogastric inflammatory pseudotumor that presumably developed from a prior amebic pseudocyst. CASE REPORT: A 14-year-old boy presented with increasing vomiting, epigastric pain, dysphagia, asthenia and weight loss. The clinical history included an amebic infection at the age of 2 months. Instrumental investigations revealed an 8 x 6 cm left subdiaphragmatic mass inseparable from the gastric fundus, which appeared to infiltrate the left hepatic lobe. Surgery disclosed a bulky mass adhering to the gastric fundus and left hepatic lobe that prompted total gastrectomy, resection of the second and third hepatic segments, and Roux-en-Y esophagojejunal loop anastomosis. Histology subsequently confirmed that this was a pseudocyst with a large calcified nucleus surrounded by myofibroblastic proliferation associated with a diffuse lymphoplasmacytic infiltrate affecting the gastric wall and hepatic parenchyma, hence the final diagnosis of inflammatory pseudotumor, presumably in response to a prior amebic pseudocyst. CONCLUSIONS: Inflammatory pseudotumor is a rare entity that is seldom found in the stomach. The particular interest of the present case lies in the fact that it developed in the stomach and liver, presumably deriving from a previous amebic pseudocyst.

[Inflammatory pseudo-tumor of the liver in a child: case report]. / Pseudo-tumeur inflammatoire du foie chez l'enfant: à propos d'un cas.

Inflammatory pseudotumor of the liver is uncommon in children. Only 14 cases have been reported in the literature. The underlying etiology is unclear but traumatic and infectious factors may be implicated. This report describes an inflammatory pseudotumor that was observed in a 9-year-old child from the Ivory Coast one year after traumatic injury of the right hypochondrium. Clinical findings were limited to non-febrile but painful hepatomegaly with weight loss. Laboratory tests were consistent with an inflammatory process. Ultrasonography revealed a poorly delimited, heterogeneous area approximately 5 cm in diameter at the level of the VI segment which had been resected. Histology documented the presence of fibro-inflammatory tissue with granulomatous inclusions. At the center of the lesion was a foreign body corresponding to a Schistosoma mansoni egg. In this case the mechanism underlying inflammatory pseudotumor could have involved either bilharziasis or trauma. A review of the literature allows the authors to enumerate the main features of this uncommon benign tumor of the liver in children.

Visceral larva migrans induced eosinophilic cardiac pseudotumor: a cause of sudden death in a child.

A case of fatal cardiac larva migrans in a 10-year-old boy is described. The autopsy findings were quite dramatic, with a bosselated, sessile polypoid mass involving the left ventricular myocardium and protruding into the ventricular lumen. The precise morphologic characterization of the zoonotic ascarid larva was impaired by advanced resorption of the larva by an inflammatory infiltrate. Nonetheless, morphometry of the larval remnants strongly suggested the raccoon ascarid, Baylisascaris procyonis, as the causative agent.