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Comorbid gastric adenocarcinoma and gastric and duodenal Strongyloides stercoralis infection: a case report.

Seo AN, Goo YK, Chung DI, Hong Y, Kwon O, Bae HI - Korean J. Parasitol. (2015)

Bottom Line: They were also observed in atypical glands representative of adenocarcinoma and adenoma.A routine stool test failed to detect rhabditiform larvae in the patient's fecal sample; however, S. stercoralis was identified by PCR amplification and 18S rRNA sequencing using genomic DNA extracted from formalin-fixed paraffin-embedded tissues.Postoperatively, the patient had a persistent fever and was treated with albendazole for 7 days, which alleviated the fever.

View Article: PubMed Central - PubMed

Affiliation: Department of Pathology, Kyungpook National University Medical Center, Kyungpook National University School of Medicine, Deagu 700-721, Korea.

ABSTRACT
Strongyloides stercoralis can cause systemic infection, termed strongyloidiasis, and gastrointestinal ulcer disease in immunocompromised patients. However, to our knowledge, there are no reported cases of comorbid gastric adenocarcinoma and S. stercoralis infection. Here, we report a case of an 81-year-old Korean man who presented with S. stercoralis infection coexisting with early gastric adenocarcinoma (T1aN0M0). S. stercoralis eggs, rhabditiform larvae, and adult females were observed in normal gastric and duodenal crypts. They were also observed in atypical glands representative of adenocarcinoma and adenoma. Preliminary laboratory tests revealed mild neutrophilic and eosinophilic leukocytosis. A routine stool test failed to detect rhabditiform larvae in the patient's fecal sample; however, S. stercoralis was identified by PCR amplification and 18S rRNA sequencing using genomic DNA extracted from formalin-fixed paraffin-embedded tissues. Postoperatively, the patient had a persistent fever and was treated with albendazole for 7 days, which alleviated the fever. The patient was followed-up by monitoring and laboratory testing for 4 months postoperatively, and no abnormalities were observed thus far. The fact that S. stercoralis infection may be fatal in immunocompromised patients should be kept in mind when assessing high-risk patients.

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Related in: MedlinePlus

Agarose gel electrophoresis of PCR products amplified using genomic DNA extracted from formalin-fixed, paraffin-embedded gastric tissue, using primers targeting the ribosomal RNA (rRNA) gene. (A) Amplified rRNA gene (114 bp), (B) negative control, (C) amplified rRNA gene (101 bp), (D) negative control, (E) amplified human beta-globulin internal control (110 bp).
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f4-kjp-53-1-95: Agarose gel electrophoresis of PCR products amplified using genomic DNA extracted from formalin-fixed, paraffin-embedded gastric tissue, using primers targeting the ribosomal RNA (rRNA) gene. (A) Amplified rRNA gene (114 bp), (B) negative control, (C) amplified rRNA gene (101 bp), (D) negative control, (E) amplified human beta-globulin internal control (110 bp).

Mentions: As the routine stool test failed to detect filariform larvae in fecal samples, PCR was performed on DNA samples extracted from a formalin-fixed paraffin-embedded gastric tissue block, aiming to identify S. stercoralis. The following 2 pairs of specific primers used to identify the S. stercoralis 18S rRNA gene have been previously described [4,5]: forward 1, 5´-ATCGTGTCGGTGGATCATTC-3´; reverse 1, 5´-CTATTAGCGCCATTTGCATTC-3´ [4]; forward 2, 5´-GAATTCCAAGTAAACGTAAGTCATTAGC-3´; and reverse 2, 5´-TGCCTCTGGATATTGCTCAGTTC-3´ [5]. A positive band was amplified at 114 and 101 bp for the targeted S. stercoralis gene and at 110 bp for the internal amplification control (Fig. 4). The histopathology and molecular results were consistent with the presence of S. stercoralis within the gastric adenocarcinoma. Following surgical intervention, persistent fever developed. The patient was treated with albendazole (400 mg twice daily) for 7 days; the patient’s fever was subsequently alleviated, his inflammatory marker levels returned to within normal ranges, and he was discharged from the hospital. The patient was followed-up by monitoring and additional laboratory testing for 4 months postoperatively. There have since been no observable abnormalities.


Comorbid gastric adenocarcinoma and gastric and duodenal Strongyloides stercoralis infection: a case report.

Seo AN, Goo YK, Chung DI, Hong Y, Kwon O, Bae HI - Korean J. Parasitol. (2015)

Agarose gel electrophoresis of PCR products amplified using genomic DNA extracted from formalin-fixed, paraffin-embedded gastric tissue, using primers targeting the ribosomal RNA (rRNA) gene. (A) Amplified rRNA gene (114 bp), (B) negative control, (C) amplified rRNA gene (101 bp), (D) negative control, (E) amplified human beta-globulin internal control (110 bp).
© Copyright Policy
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4384790&req=5

f4-kjp-53-1-95: Agarose gel electrophoresis of PCR products amplified using genomic DNA extracted from formalin-fixed, paraffin-embedded gastric tissue, using primers targeting the ribosomal RNA (rRNA) gene. (A) Amplified rRNA gene (114 bp), (B) negative control, (C) amplified rRNA gene (101 bp), (D) negative control, (E) amplified human beta-globulin internal control (110 bp).
Mentions: As the routine stool test failed to detect filariform larvae in fecal samples, PCR was performed on DNA samples extracted from a formalin-fixed paraffin-embedded gastric tissue block, aiming to identify S. stercoralis. The following 2 pairs of specific primers used to identify the S. stercoralis 18S rRNA gene have been previously described [4,5]: forward 1, 5´-ATCGTGTCGGTGGATCATTC-3´; reverse 1, 5´-CTATTAGCGCCATTTGCATTC-3´ [4]; forward 2, 5´-GAATTCCAAGTAAACGTAAGTCATTAGC-3´; and reverse 2, 5´-TGCCTCTGGATATTGCTCAGTTC-3´ [5]. A positive band was amplified at 114 and 101 bp for the targeted S. stercoralis gene and at 110 bp for the internal amplification control (Fig. 4). The histopathology and molecular results were consistent with the presence of S. stercoralis within the gastric adenocarcinoma. Following surgical intervention, persistent fever developed. The patient was treated with albendazole (400 mg twice daily) for 7 days; the patient’s fever was subsequently alleviated, his inflammatory marker levels returned to within normal ranges, and he was discharged from the hospital. The patient was followed-up by monitoring and additional laboratory testing for 4 months postoperatively. There have since been no observable abnormalities.

Bottom Line: They were also observed in atypical glands representative of adenocarcinoma and adenoma.A routine stool test failed to detect rhabditiform larvae in the patient's fecal sample; however, S. stercoralis was identified by PCR amplification and 18S rRNA sequencing using genomic DNA extracted from formalin-fixed paraffin-embedded tissues.Postoperatively, the patient had a persistent fever and was treated with albendazole for 7 days, which alleviated the fever.

View Article: PubMed Central - PubMed

Affiliation: Department of Pathology, Kyungpook National University Medical Center, Kyungpook National University School of Medicine, Deagu 700-721, Korea.

ABSTRACT
Strongyloides stercoralis can cause systemic infection, termed strongyloidiasis, and gastrointestinal ulcer disease in immunocompromised patients. However, to our knowledge, there are no reported cases of comorbid gastric adenocarcinoma and S. stercoralis infection. Here, we report a case of an 81-year-old Korean man who presented with S. stercoralis infection coexisting with early gastric adenocarcinoma (T1aN0M0). S. stercoralis eggs, rhabditiform larvae, and adult females were observed in normal gastric and duodenal crypts. They were also observed in atypical glands representative of adenocarcinoma and adenoma. Preliminary laboratory tests revealed mild neutrophilic and eosinophilic leukocytosis. A routine stool test failed to detect rhabditiform larvae in the patient's fecal sample; however, S. stercoralis was identified by PCR amplification and 18S rRNA sequencing using genomic DNA extracted from formalin-fixed paraffin-embedded tissues. Postoperatively, the patient had a persistent fever and was treated with albendazole for 7 days, which alleviated the fever. The patient was followed-up by monitoring and laboratory testing for 4 months postoperatively, and no abnormalities were observed thus far. The fact that S. stercoralis infection may be fatal in immunocompromised patients should be kept in mind when assessing high-risk patients.

Show MeSH
Related in: MedlinePlus