Sarcina

Sarcina organisms are occasionally seen in the gastrointestinal tract. They are reported in urine.^[1]

Micrograph showing Sarcina. H&E stain. (WC/Librepath)

General

Probably a commensal organism.^[2]
Gram positive coccus.^[1]
Uncommonly seen.
Associated with gastroparesis,^[2] as may be seen in diabetes mellitus.

Described complications:^[2]

Gastric perforation.
Emphysematous gastritis.

Notes:

Sarcina ventriculi = Gram-positive organism.^[2]

Gross

Features:

Erythema.
+/-Gastric ulcer.
+/-Retained food.

Microscopic

Features:^[3]

Small essentially spherical micro-organisms.
- Each micro-organism 1.8-3 micrometres - purple on H&E stain.
- Arranged in clusters of 4, 8 or more - classically in a tetrad - key feature.

DDx:

Micrococcus - form larger clusters.^[3]

Images

Case 1

Sarcina - low mag.
Sarcina - intermed. mag.
Sarcina - intermed. mag.
Sarcina - high mag.
Sarcina - high mag.
Sarcina - very high mag.
Sarcina - very high mag.

Case 2

Sarcina - urine cytology - intermed. mag.
Sarcina - urine cytology - high mag.
Sarcina - urine cytology - high mag.
Sarcina - urine cytology - very high mag.
Sarcina - urine cytology - extremely high mag.

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Urine cytology

Abundant micro-organisms compatible with Sarcina, see comment.
Acute inflammation.
NEGATIVE for High-Grade Urothelial Carcinoma.

Comment:
The micro-organisms are arranged in distinctive tetrads, as is typical for Sarcina.
This is an uncommon finding.[1] Treatment should be considered within the clinical context.

1. Bommannan K, Gaspar BL, Sachdeva MUS. BMJ Case Rep. 2016 Oct 13;2016:bcr2016216991. doi:10.1136/bcr-2016-216991
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5073697/pdf/bcr-2016-216991.pdf

References

↑ ^1.0 ^1.1 Bommannan K, Gaspar BL, Sachdeva MU (October 2016). "Pathogenic Sarcina in urine". BMJ Case Rep 2016. doi:10.1136/bcr-2016-216991. PMC 5073697. PMID 27737866. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5073697/.
↑ ^2.0 ^2.1 ^2.2 ^2.3 ^2.4 Ratuapli, SK.; Lam-Himlin, DM.; Heigh, RI. (2013). "Sarcina ventriculi of the stomach: a case report.". World J Gastroenterol 19 (14): 2282-5. doi:10.3748/wjg.v19.i14.2282. PMID 23599657.
↑ ^3.0 ^3.1 Lam-Himlin, D.; Tsiatis, AC.; Montgomery, E.; Pai, RK.; Brown, JA.; Razavi, M.; Lamps, L.; Eshleman, JR. et al. (Nov 2011). "Sarcina organisms in the gastrointestinal tract: a clinicopathologic and molecular study.". Am J Surg Pathol 35 (11): 1700-5. doi:10.1097/PAS.0b013e31822911e6. PMID 21997690.

[pmid27737866-1] 1.0 ^1.1 Bommannan K, Gaspar BL, Sachdeva MU (October 2016). "Pathogenic Sarcina in urine". BMJ Case Rep 2016. doi:10.1136/bcr-2016-216991. PMC 5073697. PMID 27737866. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5073697/.

[pmid23599657-2] 2.0 ^2.1 ^2.2 ^2.3 ^2.4 Ratuapli, SK.; Lam-Himlin, DM.; Heigh, RI. (2013). "Sarcina ventriculi of the stomach: a case report.". World J Gastroenterol 19 (14): 2282-5. doi:10.3748/wjg.v19.i14.2282. PMID 23599657.

[pmid21997690-3] 3.0 ^3.1 Lam-Himlin, D.; Tsiatis, AC.; Montgomery, E.; Pai, RK.; Brown, JA.; Razavi, M.; Lamps, L.; Eshleman, JR. et al. (Nov 2011). "Sarcina organisms in the gastrointestinal tract: a clinicopathologic and molecular study.". Am J Surg Pathol 35 (11): 1700-5. doi:10.1097/PAS.0b013e31822911e6. PMID 21997690.

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