Journal of Cytology
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IMAGES IN CYTOPATHOLOGY  
Year : 2013  |  Volume : 30  |  Issue : 4  |  Page : 270-271
Serendipitously identified Strongyloides stercoralis in a cervicovaginal smear


1 Department of Cytopathology, Tata Memorial Hospital, Parel, Mumbai, Maharashtra, India
2 Department of Cytopathology; Department of Pathology, Tata Memorial Hospital, Parel, Mumbai, Maharashtra, India

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Date of Web Publication6-Feb-2014
 

How to cite this article:
Mayekar V, Ruben I, Rekhi B. Serendipitously identified Strongyloides stercoralis in a cervicovaginal smear. J Cytol 2013;30:270-1

How to cite this URL:
Mayekar V, Ruben I, Rekhi B. Serendipitously identified Strongyloides stercoralis in a cervicovaginal smear. J Cytol [serial online] 2013 [cited 2020 May 28];30:270-1. Available from: http://www.jcytol.org/text.asp?2013/30/4/270/126662


A 47-year-old post-menopausal lady, diagnosed with cervical intraepithelial neoplasia grade II, on cervical biopsy, 4 years ago, came for a routine follow-up. She presented with the complaints of backache. Her yearly cervicovaginal Papanicolaou (Pap) smears in the last 3 consecutive years were negative for intraepithelial lesion or malignancy.

At present, human papilloma virus deoxyribonucleic acid was not detected. Per speculum finding revealed pinpoint cervical os. Her colposcopy findings were unremarkable. Visual examination findings, including visual inspection with acetic acid and visual inspection with Lugol's iodine were negative for any significant lesion.

 Pap smear More Details showed mostly superficial and intermediate squamous cells; occasional metaplastic cells, along with few neutrophils and histiocytes against a relatively clean background. Incidentally, a single larval form of Strongyloides stercoralis with a stout anterior end, reminiscent of buccal cavity and a pointed posterior end was identified. The body of the parasite revealed deep purple color [Figure 1].
Figure 1: Papanicolaou (Pap) smear showing superficial and intermediate cells against a relativey clean background. Interspersed is partially coiled larval form of Strongyloides stercoralis with a deep purple appearance, including broad anterior end and a pointed posterior end Pap ×200. Inset: Larval form at higher magnification Pap ×400

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S. stercoralis, an intestinal nematode, occurs in tropical and subtropical areas, especially in areas with poor sanitation. Adult female parasites are 2-3 mm long and live buried in the mucosa of the duodenum, where they reproduce parthenogenetically. The eggs are deposited in the proximal segments of small intestinal mucosa; where after these hatch into rhabditiform larvae that are passed out in feces (eggs are almost never found) and further, develop into the infective, filariform larvae. These larvae penetrate skin of the exposed individuals and migrate through circulatory system to the lungs. Besides, there is also an indirect life cycle of this parasite. Another variation involves autoinfection wherein maturation of the infective filariform larvae is completed within the intestines, with subsequent reinvasion of the bowel mucosa or perianal skin by the infective larvae. Several forms of life cycle associated with S. stercoralis probably explains the colonization of different body sites by the various stages of its larvae that result in disease manifestations ranging from irritation, pruritis, to Loffler's syndrome; life-threatening pneumonia; diarrhea to chronic malabsorption syndrome. [1] Severe infections occur in immunocompromised individuals. [2] S. stercoralis has been rarely detected in Pap smears of cervicovaginal specimens.

There are only four previously reported cases of S. stercoralis in cervicovaginal smears. [3],[4],[5],[6] In each of these case reports, a single rhabditiform larva was identified, against an inflammatory, or a relatively clean background, the latter observed in the present case. Avram et al. [3] identified a single case of S. stercoralis out of 22,700 examined Pap smears. The present case is the first one from our Institution and the second such case reported from our country, to the best of our knowledge.

Various other parasites have been reported in the Pap smears. [6] Parasitic larva of S. stercoralis is differentiated from that of a hookworm, the latter has a longer buccal cavity and a smaller gential primordium. [1] The buccal cavity of the larva in this case was smaller. The plausible explanation for the presence of larva in a Pap smear, including the present case is a possible result from secondary contamination from the anus. The purpose of this case is to illustrate this rare, incidental finding in a Pap smear and at the same time the need to remain aware of rare parasites in routinely examined cervicovaginal Pap smears.

 
   References Top

1.Fritsche T, Smith JW. Medical parasitology. In: Henry JB, editor. Clinical Diagnosis and Management by Laboratory Methods. 19 th ed. Philadelphia, PA: WB Saunders Co.; 1996. p. 1252-310.  Back to cited text no. 1
    
2.Genta RM, Walzer PD. Strongyloidiasis. In: Walzer PR, Genta RM, editors. Parasitic Infections in the Immunocompromised Host. New York: Marcel Dekker; 1989. p. 463-525.  Back to cited text no. 2
    
3.Avram E, Yakovlevitz M, Schachter A. Cytologic detection of Enterobius vermicularis and Strongyloides stercoralis in routine cervicovaginal smears and urocytograms. Acta Cytol 1984;28:468-70.  Back to cited text no. 3
    
4.Murty DA, Luthra UK, Sehgal K, Sodhani P. Cytologic detection of Strongyloides stercoralis in a routine cervicovaginal smear. A case report. Acta Cytol 1994;38:223-5.  Back to cited text no. 4
    
5.Daneshbod Y, Monabati A, Bedayat GR, Soroor G. Strongyloides stercoralis as a contaminant in a cervicovaginal smear. Acta Cytol 2004;48:768-9.  Back to cited text no. 5
    
6.Kapila K, Pathan SK, Al-Boloushi K. Diagnosis of Strongyloides stercoralis in a routine cervical smear. Diagn Cytopathol 2005;33:31-2.  Back to cited text no. 6
    

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Correspondence Address:
Bharat Rekhi
Department of Pathology, 8th Floor, Annex Building, Tata Memorial Hospital, Dr. E.B. Road, Parel, Mumbai - 400 012, Maharashtra
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0970-9371.126662

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