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| Year : 1984 | Volume
: 30
| Issue : 1 | Page : 51-2 |
Oxyuric salpingitis (a case report).
Shroff CP, Deodhar LP
How to cite this article:
Shroff C P, Deodhar L P. Oxyuric salpingitis (a case report). J Postgrad Med 1984;30:51 |
Chronic salpingitis due to oxyuris (Enterobius vermicularis) is rare. Symmers,[5] reviewed the world literature and reported six previous cases of granulomatous salpingitis, and added one of his own.[7] Literature review does not bring to light an authentic case of oxyuric salpingitis from India though it is a very common parasitic infestation of the intestinal tract in our country.
A twenty seven year old Hindu female, para four, from a village nearby Bombay sought medical attention for bleeding per vaginum of two months' duration. The patient complained of frequent itching of the skin all over her body. Internal pelvic examination revealed first degree descent of the uterine cervix with minimum cystocoele. External abdominal examination was normal.
Pre-operative investigations
Haemoglobin was 10 gm%; Total leucocyte count was 7,000 per cmm with P-78%, L-20% and E-2%. Stool examination showed ova of Ascaris lumbricoides only. A vaginal hysterectomy was planned. At operation, the left adnexa showed a tubo-ovarian mass, 3 cm x 3 cm in size and hence hysterectomy was performed with left salpingo-oophorectomy.
Pathologic examination
Gross and microscopic appearances of the uterus and cervix were unremarkable except for architectural hyperplasia of the endometrium and chronic non-specific cervicitis respectively.
The left tubo-ovarian mass was firm to feel and measured 3 cm x 3 cm x 2 cm. Cut surface revealed the lumen of the fallopian tube filled with yellowish necrotic foci [Fig. 1]. Histology revealed marked fibrous thickening of the tubal wall, with plasma cell infiltrate and lymphoid aggregates around the blood vessels. The tubal epithelium was completely replaced by chronic granulation tissue rich in plasma cells. There were occasional foci of necrosis; one such field showed cross section of a degenerating worm tail [Fig. 1]. Multiple sections from the tissue were taken and examined which further revealed planoconvex, refractile ova, measuring 50 microns in size, with thin, double-contoured shell containing a folded tadpole like embryo [Fig. 2]. Head of a dead adult worm was also seen [Fig. 1]. Morphologic characteristics of the ova and the worm were that of oxyuris. A histologic diagnosis of oxyuric salpingitis with architectural hyperplasia of endometrium was made. Following the operation, the patient was treated for her anaemia and a course of mebendazole, a broad-spectrum anthelmintic, was instituted for her worm infestation.
Enterobius vermicularis infestation is generally asymptomatic and free of complications. Literature review indicates that majority of the reported cases have been incidental findings at necropsy.,[1],[3],[5],[6] In the present case, this lesion was not suspected in the least; only histology revealed it in the fallopian tube. Most literature reports oxyuris nodules on the serosa of the pelvic organs; over the mesosalpinx; external surface of the uterus and pelvic peritoneum, with very few references to the lesion of the fallopian tube.[7]
It is suggested that the adult worm reaches the fallopian tube via the female genital tract, in cases of women having intestinal infestation. The gravid adult female wanders around the perianal region and invades the genital tract, laying eggs on her course of travel upwards into the endometrial canal, occasionally forming a granulomatous lesion in the endometrium[4] then onto the fallopian tube from where she has free access to the pelvic peritoneum.[2],[5] Bhaskaran et al[2] had demonstrated an ova of oxyuris in a cervical smear during routine cytologic screening suggesting a similar route of infection. In this case also, we agree with other authors in that the fallopian tube infection was an autoinfection from the intestinal tract sometime in the past. Literature review also indicates that many women with oxyuris salpingitis did not have the specific ova in their stools as is seen in the present case.
We thank the Dean, L.T.M. Medical College for allowing us to publish this case report.
| 1. | Arthur, H. R. and Tomlinson, B. E.: Oxyuris granuomata of fallopian tube and peritoneal surface of ovarian cyst. J. Obstet. & Gynaecol. Brit. Empire, 65: 996-997, 1958.  |
| 2. | Bhaskaran, S. C., Reddy, M. M. and Ramalakshmi, P. V. B.: Unusual parasitic infection of the cervix detected by cytology. Ind. J. Pathol. & Microbiol., 23: 51-52, 1980. |
| 3. | Campbell, C. G. and Bowman, J.: Enterobius vermicularis granuloma of the pelvis. Amer. J. Obstet. & Gynaecol., 81: 256-258, 1961. |
| 4. | Schenken, J. R. and Tamisiea, J.: Enterobius vermicularis (pin worm) infection of the endometrium-a case report. Amer. J. Obstet. & Gynaecol., 72: 913-914, 1956. |
| 5. | Symmers, W. St. C.: Pathology of oxyuriasis with special reference to granuloma due to the presence of Oxyuris vercicularis (Enterobius vermicularis) and its ova in tissues. Arch. Pathol., 50: 475-516, 1950. |
| 6. | Vinuela, A., Fenandez-Rojo, F. and Martinez-Merine, A.: Oxyuris granuloma of pelvic peritoneum and appendicular wall. Histopathology, 3: 69-78, 1979. |
| 7. | Woodruff, J. D. and Pauerstein, C. J.: Tuberculous and other granulomatous salpingitis, Chapter 8, 1n, "Fallopian Tube Structure, Function, Pathology and Management." The Williams and Wilkins Co., Baltimore, 1969; pp. 151-181. |
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