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Pinworms and Postmenopausal Bleeding J Clin Pathol: First Published As 10.1136/Jcp.51.5.401 on 1 May 1998

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Pinworms and Postmenopausal Bleeding J Clin Pathol: First Published As 10.1136/Jcp.51.5.401 on 1 May 1998 J Clin Pathol 1998;51:401–402 401 Pinworms and postmenopausal bleeding J Clin Pathol: first published as 10.1136/jcp.51.5.401 on 1 May 1998. Downloaded from H K Al-Rufaie, G H Rix, M P Pérez Clemente, T Al-Shawaf Abstract glandular cystic type. The endometrial stroma The human pinworm Enterobius ver- showed non-specific focal inflammation. Some micularis is normally found within the dilated endometrial glands contained both live human gastrointestinal tract. Pregnant and degenerated calcified pinworms (fig 1). females migrate out of their host’s anus at The patient was prescribed a course of night to lay their eggs perianally. As a mebendazole and the general practitioner was consequence of this nocturnal migration informed in order to treat the rest of the some worms find their way into adjacent household. Two years later the patient remains orifices, most commonly the female geni- asymptomatic. tourinary tract, producing irritative symptoms such as vulvovaginitis. A case Discussion of pinworm infestation of the uterus The life cycle of the human pinworm Enterobius presented as postmenopausal bleeding. vermicularis takes place within the human gas- (J Clin Pathol 1998;51:401–402) trointestinal tract. Infection occurs faeco-orally and ingested ova hatch in the duodenum, Keywords: Enterobius vermicularis; endometrium; postmenopausal bleeding developing into adult worms that colonise the large bowel, where fertilisation takes place. Department of Pregnant females migrate out of the anus at Case report night, lay their eggs perianally, and die.1 Histopathology, West A 77 year old woman presented to her general SuVolk Hospital, Bury Nocturnal errors of navigation by gravid St Edmunds, UK practitioner with two episodes of vaginal females can lead to their entry into adjacent H K Al-Rufaie bleeding over a period of six weeks. He orifices so that they have been found in the uri- G H Rix diagnosed atrophic vaginitis and prescribed nary tract as far as the kidney and in the female M P Pérez Clemente oestrogen vaginal cream. The bleeding became genital tract as far as the peritoneal cavity.2 more persistent, so she was referred to the out- Many carriers remain asymptomatic but the Directorate of patient gynaecology clinic for a second opin- Women’s Services, commonest symptoms are nocturnal pruritus Fertility Centre, St ion. Apart from perineal irritation, the patient ani. Bartholomew’s had no other symptoms. She lived with her The most usual gynaecological presentation Hospital, West husband and had undergone the menopause is either the accidental finding of ova on cervi- http://jcp.bmj.com/ Smithfield, London over 25 years previously. cal smears3 or as vulvovaginitis, especially in EC1, UK On vaginal inspection marked atrophic 24 T Al-Shawaf children. Other presentations include changes were noted and on pelvic examination salpingo-oophoritis,25 a pelvic or ovarian Correspondence to: the uterus was small with no detectable masses mass,26 pelvic pain,7 and in one reported case Dr H K Al-Rufaie, present. The perineal area was unremarkable. pinworms were found in a macerated embryo.8 consultant pathologist, A hysteroscopy was performed under general Department of There are only two other reported cases of Histopathology, West SuVolk anaesthetic. The uterine cavity was noted to be vaginal bleeding associated with pinworms; Hospital, Hardwick Lane, small with an atrophic endometrium. Anteri- Simons9 found a pinworm in the cervix of a 42 on September 29, 2021 by guest. Protected copyright. Bury St Edmunds, SuVolk orly a 1–2 cm benign looking polyp was present IP33 2QZ, UK. year old multipara with a six month history of and a small submucous fibroid posteriorly. The blood stained vaginal discharge, while Klee10 Accepted for publication polyp was removed and sent for analysis. discovered a pinworm granuloma associated 30 January 1998 Microscopy revealed an endometrial polyp of with a squamous carcinoma of the cervix in a 59 year old woman with two episodes of post- menopausal bleeding. To our knowledge, ours is the first reported case of pinworms in the endometrium presenting as postmenopausal bleeding. Live and degenerated pinworms were only seen in the dilated endometrial glands in this case. No pinworms were seen in the stroma, nor were there any ova or granuloma- tous reactions, although pinworms and par- ticularly their ova can produce inflammatory granulomas at various sites, including the endometrium.611 The presence of the worms may have led to dilatation of glandular tissue, non-specific inflammation, and polyp forma- tion. 1 Faust E, Russell PF, Jung RC. Clinical parasitology. Philadel- phia: Lea and Febiger, 1970. 2 Symmers W St C. Pathology of oxyuriasis. Arch Pathol 1950;50:475–516. Figure 1 Dilated endometrial glands containing live (LP) and dead calcified (DP) 3 Langlinais PC. Enterobius vermicularis in a vaginal smear. pinworms. Acta Cytol 1969;13:40–1. 402 Rufaie, Rix, Pérez Clemente, et al 4 Pierce AM, Hart CA. Vulvovaginitis: causes and manage- 8 Mendoza E, Jorda M, Rafel E, et al. Invasion of human ment. Arch Dis Child 1992;67:509–12. embryo by Enterobius vermicularis. Arch Pathol Lab Med 5 Schnell VL, Yandell R, Van Zandt S, et al. Enterobius 1987;111:761–2. J Clin Pathol: first published as 10.1136/jcp.51.5.401 on 1 May 1998. Downloaded from vermicularis salpingitis: a distant episode from precipitat- 9 Simons EM. Entozoen in der Gebärmutter. Zentralbl Gyna- ing appendicitis. 1992;80:553–5. kol 1899;26:777–8. Obstet Gynecol 10 Klee F. Beitrag zur Kenntnis des Verhaltens der Oxyuren in 6 McMahon JN, Connolly CE, Long SV, et al. Enterobius weiblichen Geschlechtsapparat. Zentralbl Gynakol 1920;34: granulomas of the uterus, ovary and pelvic peritoneum. 939–41. Two case reports. Br J Obstet Gynaecol 1984;91:289–90. 11 Schenken JR, Tamisiea J. Enterobius vermicularis infection 7 Mayayo E, Mestres M, Sarmiento J, et al. Pelvic oxyuriasis. of the endometrium. Am J Obstet Gynecol 1956;72: Acta Obstet Gynecol Scand 1986;65:805–6. 913–15. http://jcp.bmj.com/ on September 29, 2021 by guest. Protected copyright..
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