Abstract and Introduction
Patient: 66-year-old ethnic Egyptian man.
Chief Complaint: Hematuria.
History of Present Illness: The patient had a history of multiple episodes of gross hematuria for the past 5 years. Because the hematuria usually resolved on its own, he did not seek medical attention during that time. Bladder cancer was suspected.
Past Medical History: The patient had a history of coronary artery disease, hypertension, nephrolithiasis, congestive heart failure, lifelong smoking, and ischemic cardiomyopathy. He has been taking the anticoagulants clopidogrel (Plavix) and warfarin (Coumadin).
Residency History: The patient is originally from Egypt and has been living in the United States for the past 10 years.
Principal Laboratory Findings: A complete blood count showed a hemoglobin of 13.0 g per dL (reference range, 14.0 to 18.0 g per dL), hematocrit 40% (40% to 54%), red blood cell count (RBC) 4.65 × 109 per L (4.60 to 6.00), and platelet count 179 × 109 per L (150 to 450). The urinalysis results showed 3+ protein, 4+ blood, and urine RBC of greater than 100 per high power field (hpf). The urinalysis results did not indicate the presence of parasitic ova or adult parasites. Based on these results, the physician ordered cystoscopic testing, suspecting bladder cancer. Analysis of the bladder tissue showed inflammation (Image 1) and several ova that were consistent with developing Schistosoma (Image 2). Many of the ova were calcified and surrounded by severely inflamed tissue (Image 3).
Inflammation (arrows) and ulceration seen in the bladder mucosa from patient during cystoscopic testing (hematoxylin-eosin staining, ×100).
Area of biopsied bladder tissue showing a developing miracidium (hematoxylin-eosin staining, ×400).
Area of biopsied bladder tissue showing a calcified ovum with a characteristic terminal spine (hematoxylin-eosin staining, ×400).
Lab Med. 2015;46(4):338-342. © 2015 American Society for Clinical Pathology