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Enterobius vermicularis (pinworm) infection of the endometrium
ENTEltOBIUS
VEBBBICULABXS (PINWOBBI) OF THE EHDOMETRIUM A
INFECTION
Case Report
JOHN R. SCHENKEN, M.D., AND JERRY TAMISIEA, M.D., OMAHA,NEB. (From
the
Departments
of
Pathology, Nebraska
Nebraska College
NFECTION of the Fallopian tube ported several times. The route through the uterus but in no instance either the worms or the ova have been We wish to report such a case.
I
of
Methodist Medicine)
Hospital
and
the
Gnirsrsity
of
by Enterobius vermicularis has been reof the infection has been presumed to be has an observation been recorded in which seen in the endometrium.
A 34-year-old white woman, the mother of 2 children, missed 2 successive menstrual periods in July and August, 1951. Associated with the amenorrhea were lower abdominal cramping pains which lasted for 1 day at the time the menses were expected. Previously the menses had been normal and regular. The patient had had a curettage at the age of 14 years for menometrorrhagia, a uterine suspension for dysmenorrhea at 20, and removal of an ovarian cyst at 27. Physical examination was essentially negative except for the uterus, which was twice normal size. There was some tenderness of the left adnexa but no masses were palpable. A hemogram showed a leukocyte count of 6,600, 64 per cent segmented forms, 1 per cent staff forms, 35 per cent lymphocytes; 4.26 million erythrocytes and 11.5 Gm. (75 per cent) hemoglobin. Following admission to the hospital, the patient had a partial hysterectomy with complete relief of symptoms. Multiple intramural leiomyomas, each Grossly the uterus measured 8 by 6 by 3 cm. measuring less than 1 cm. in diameter, were present. IYo other abnormalities were noted. lesions containing well-preserved Microscopic examination showed granulomatous gravid female pinworms within the basal portion of the endometrium. The worms werr’ identified by the eosinophilic chitinous membrane with the lateral spines, the internal organs, and the ova. Surrounding the parasite was a central zone of coagulation-type necrosis. A middle zone contained many eosinophils, epithelioid cells, and lymphocytes. The surrounding In the outer zone there was evidence of a fibroblastic response. endometrial stroma was compressed by the granuloma (Fig. 1). Further inquiry revealed that a daughter had had pinworms in 1946.
Comment Previously, several reports of enterobiasis of the female genital tract have appeared in the literature,l-14 but none has described infection of the endometrium. In the case reported by Fatheree, Carrera, and Beaver,l* there was an Enterobius granuloma located deep in the myometrium, but the mode of entry could not be demonstrated. It has always been surmised that the parasite accidentally enters the vaginal orifice during its nocturnal migrations, and then ascends why the pinthrough the vagina, uterus, and tubes. A possible explanation worm has been seen in the vaginal canal and tubes but not in the endometrial cavity may be that the organism, having little invasive power, infects tho 913
914
SCHENKEN
AND
TAMISIEA
\Ki. .I. Othl. & C,ymc. October. IQ<0
endometrium and then is sloughed out during normal menstruation. Thus, it would be difficult for the parasite to establish itself in the endometrium permanently as it may in the tube.
Fig. l.-Photomicrogragh the fragments of degenerating reaction.
of
endometrium Enterobius
at the vermicularis
endometrial-myometrial and the surrounding
junction. Note inflammatory
summary
Invasion of the endometrium by Enterobius verrnicularis is reported. This occurrence in all likelihood is more common than the literature indicates, and it is probable that the organism does not establish itself in the endometrium because of sloughing of the lesion with normal menses. In the present case the lesion remained intact, probably because it was located in the basal portion of the endometrium. References 1. Chomet, B. : Arch. Path. 34: 742,1942. Deeds, D. D.: Aa6.J. OBST.& GYNEC.~~: 890,1947. Fingerland, A., and Marsalek, J.: Casop. Iek. Eesk. 80: 532, 1941. Goodale. R. H.. and Krischner. H.: Arch. Path. 9: 631. 1930. i: Jones, pb. J., and Bunting, C. H.: Arch. Path. 11: 229; 1931. 6. Kolb, Zentralbl. Bakt. 31: 268, 1902. R.: Ku. D. Y.: Far East A. Tron. Med.. Tr. Ninth Coneress 1: 605, 1934. ii: Marro, G.: Gior. d. r. Accad. di med. di Torino 64:-251, 1901. ’ 9. Schneider, P.: Zentralbl. Bakt. 1 abst. 36: 550, 1904; Zentralbl. Chir. 58: 1301, 1931. AM. J. OBST. & GYNEC. 16: 205, 1928. 10. Smith, W. S., and Denton, J.: 11. Strada, F. : Arch. per le se. med., Torino 31: 418, 1907. Symmers, W. S. C.: Arch. Path. 60: 475,195O. :32: Wegner, H.: Peritonitis Oxyurica mit Bekanntgave eines akuten, Klinische Erscheinungen machenden Falles, Inaugural Dissertation (Heidelberg), Walldorf bei Heidelberg, 1933, Friedrich Lamade. 14. Fatheree, 5. P., Carrera, G. M., and Beaver, Paul C.: Mississippi Doctor 29: 159, 1951. i:
VEBBBICULABXS (PINWOBBI) OF THE EHDOMETRIUM A
INFECTION
Case Report
JOHN R. SCHENKEN, M.D., AND JERRY TAMISIEA, M.D., OMAHA,NEB. (From
the
Departments
of
Pathology, Nebraska
Nebraska College
NFECTION of the Fallopian tube ported several times. The route through the uterus but in no instance either the worms or the ova have been We wish to report such a case.
I
of
Methodist Medicine)
Hospital
and
the
Gnirsrsity
of
by Enterobius vermicularis has been reof the infection has been presumed to be has an observation been recorded in which seen in the endometrium.
A 34-year-old white woman, the mother of 2 children, missed 2 successive menstrual periods in July and August, 1951. Associated with the amenorrhea were lower abdominal cramping pains which lasted for 1 day at the time the menses were expected. Previously the menses had been normal and regular. The patient had had a curettage at the age of 14 years for menometrorrhagia, a uterine suspension for dysmenorrhea at 20, and removal of an ovarian cyst at 27. Physical examination was essentially negative except for the uterus, which was twice normal size. There was some tenderness of the left adnexa but no masses were palpable. A hemogram showed a leukocyte count of 6,600, 64 per cent segmented forms, 1 per cent staff forms, 35 per cent lymphocytes; 4.26 million erythrocytes and 11.5 Gm. (75 per cent) hemoglobin. Following admission to the hospital, the patient had a partial hysterectomy with complete relief of symptoms. Multiple intramural leiomyomas, each Grossly the uterus measured 8 by 6 by 3 cm. measuring less than 1 cm. in diameter, were present. IYo other abnormalities were noted. lesions containing well-preserved Microscopic examination showed granulomatous gravid female pinworms within the basal portion of the endometrium. The worms werr’ identified by the eosinophilic chitinous membrane with the lateral spines, the internal organs, and the ova. Surrounding the parasite was a central zone of coagulation-type necrosis. A middle zone contained many eosinophils, epithelioid cells, and lymphocytes. The surrounding In the outer zone there was evidence of a fibroblastic response. endometrial stroma was compressed by the granuloma (Fig. 1). Further inquiry revealed that a daughter had had pinworms in 1946.
Comment Previously, several reports of enterobiasis of the female genital tract have appeared in the literature,l-14 but none has described infection of the endometrium. In the case reported by Fatheree, Carrera, and Beaver,l* there was an Enterobius granuloma located deep in the myometrium, but the mode of entry could not be demonstrated. It has always been surmised that the parasite accidentally enters the vaginal orifice during its nocturnal migrations, and then ascends why the pinthrough the vagina, uterus, and tubes. A possible explanation worm has been seen in the vaginal canal and tubes but not in the endometrial cavity may be that the organism, having little invasive power, infects tho 913
914
SCHENKEN
AND
TAMISIEA
\Ki. .I. Othl. & C,ymc. October. IQ<0
endometrium and then is sloughed out during normal menstruation. Thus, it would be difficult for the parasite to establish itself in the endometrium permanently as it may in the tube.
Fig. l.-Photomicrogragh the fragments of degenerating reaction.
of
endometrium Enterobius
at the vermicularis
endometrial-myometrial and the surrounding
junction. Note inflammatory
summary
Invasion of the endometrium by Enterobius verrnicularis is reported. This occurrence in all likelihood is more common than the literature indicates, and it is probable that the organism does not establish itself in the endometrium because of sloughing of the lesion with normal menses. In the present case the lesion remained intact, probably because it was located in the basal portion of the endometrium. References 1. Chomet, B. : Arch. Path. 34: 742,1942. Deeds, D. D.: Aa6.J. OBST.& GYNEC.~~: 890,1947. Fingerland, A., and Marsalek, J.: Casop. Iek. Eesk. 80: 532, 1941. Goodale. R. H.. and Krischner. H.: Arch. Path. 9: 631. 1930. i: Jones, pb. J., and Bunting, C. H.: Arch. Path. 11: 229; 1931. 6. Kolb, Zentralbl. Bakt. 31: 268, 1902. R.: Ku. D. Y.: Far East A. Tron. Med.. Tr. Ninth Coneress 1: 605, 1934. ii: Marro, G.: Gior. d. r. Accad. di med. di Torino 64:-251, 1901. ’ 9. Schneider, P.: Zentralbl. Bakt. 1 abst. 36: 550, 1904; Zentralbl. Chir. 58: 1301, 1931. AM. J. OBST. & GYNEC. 16: 205, 1928. 10. Smith, W. S., and Denton, J.: 11. Strada, F. : Arch. per le se. med., Torino 31: 418, 1907. Symmers, W. S. C.: Arch. Path. 60: 475,195O. :32: Wegner, H.: Peritonitis Oxyurica mit Bekanntgave eines akuten, Klinische Erscheinungen machenden Falles, Inaugural Dissertation (Heidelberg), Walldorf bei Heidelberg, 1933, Friedrich Lamade. 14. Fatheree, 5. P., Carrera, G. M., and Beaver, Paul C.: Mississippi Doctor 29: 159, 1951. i: