What's in the Slide? Guess and Win #2 [CLOSED]

Guess what's in the slide? It's exactly what it says. Question is at the first part of the post. Instructions at the second part of the post.

Winner: @nikv with "Biliary obstruction caused by parasites with schistosoma in an unusual location"
Answer: Schistosomiasis spp. infection
2 HBD Bounty for this case.

Let's go over the case:
This was signed out as findings consistent with Schistosomiasis spp. infection. We didn't declare the specific species because the method of collection isn't the optimal way to demonstrate the parasitic ova.

The "omental nodule" was a fibrotic and calcified tissue where the surrounding tissue tried to contain and react to the chronic infection. The purple color here is how calcium stains under Hematoxylin and Eosin stain preparation. I tried to find a group of ova that can show some clear delineation for between the shell and what's inside it.

Leyte is an endemic area for Schistosomiasis cases. The patient travelled to our region and subsequently sought consult to our institution. We usually report these cases to the local health regional center for monitoring. All the signs and symptoms mentioned are consistent with Schistosomiasis infection.



Stem Quest 1.png

Taken at Scanner View (40x).

Stem Quest 2.png

Taken at Low power view (100x).

Stem Quest 3.png

Taken at High power view (400x).

Specimen labelled “Omental nodule”

Patient was a 40-year old male from Leyte, Philippines that presented jaundice due to obstruction in the bile ducts, hematuria, ascites and right upper quadrant pain. Exploratory laparotomy was done and this specimen was taken.

Hint: Specimens can be labelled as anything and look far from what they really are on microscopy.

Notes: I don’t expect anyone to guess the answer soon compared to the previous case in the series. This one requires some high level of suspicion but I left more than enough clues on the above case to narrow down the possible diagnosis. I also added #7 on the mechanics.



I'll be starting with 1 HBD. The first one that guesses this right gets that HBD. The prize gradually increases when no one gets it right for each successive post on the series. At the very least, each post has a 1 HBD bounty on it. I'll prioritize adding more bounties on older questions compared to new questions in the series.

The mechanics of the guessing game:

  1. I post the images and give a small detail about it with a corresponding question.

  2. Comment the answer and whoever gets it right first wins the prize. There's a time stamp on the comment section so it's easy to determine the winner if multiple users got it right.

  3. In the event that no one gets it right, the contest will still be open indefinitely. Feel free to ping me if you backread the previous posts in the series.

  4. I'll add new conditions to the game as needed.

  5. You are free to Google for answers or use whatever means you got at your disposal with a corresponding reason why you think it is so. It's easy to get it right by throwing words around so I want to see whether you studied the image.

  6. Make as many attempts as you want. The only time an attempt isn't allowed is when the contest has been closed. There can only be one winner per post. You can try multiple times but spamming some answers from a bucket list isn't going to be get you a reward.

  7. Since you have the advantage of googling the answer. I'd be requiring a short explanation why. It doesn't need to be the exact rationale but if you're close enough I wouldn't mind. This is to prevent anyone that just answers and win through dumb luck, I'd like to see some conviction on the answers.

Note:

I'll be copypasting the mechanics of the game including this line so that anyone who is new to the series wouldn't have to click more links just to backtrack what's going on. If anyone wants to cry I'm milking the reward pool by posting copy paste posts, understand the images here are from actual cases where I took the time to have them recorded.

I highly encourage you to research the answer in the hopes you can actually learn from the experience. Pathology is fun.

I'm also confident you can't find any image that match exactly as the ones I'm sharing because these are from my personal study slides. You can of course see similar images because they can show the same histomorphologic findings you'd expect from the specimen.

Good Luck!

Case 1

If you made it this far reading, thank you for your time.

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