Case 12

Clinical history

41 year old man, watery diarrhea and abdominal pain.

Site

Colon biopsy.

Primary image

Intermediate magnification. H&E stain.

High magnification
High magnification. H&E stain.

Very high magnification
Very high magnification. H&E stain.

Differential diagnosis

Differential diagnosis
normal colon, cryptosporidiosis, CMV colitis, compatible with infectious diarrhea, ischemic colitis

Additional tests

More history

More history
No family history of IBD. Diarrhea several weeks. Well prior to diarrhea. Medications: one anti-hypertensive.

Ask a friend

Ask a friend
Did you see anything at high magnification?

Stains

Alcian blue/PAS to Bilirubin Test Result Alcian blue/PAS Dr Torres would ask why! Alican blue pH 1.0 Dr Torres would ask why! Alcian blue pH 2.5 Dr Torres would ask why! Auramine Dr Torres would ask why! Bielchowsky Dr Torres would ask why! Bilirubin Dr Torres would ask why!	Colloidal iron to Fontana-Masson Test Result Colloidal iron Dr Torres would ask why! Congo red Dr Torres would ask why! Cresyl violet Dr Torres would ask why! Dieterle Dr Torres would ask why! Diff Quik Dr Torres would ask why! Fontana-Masson Dr Torres would ask why!	Gallyas to Gremelius Test Result Gallyas Dr Torres would ask why! Giemsa Dr Torres would ask why! GMS Dr Torres would ask why! Gomori's trichrome Dr Torres would ask why! Gram Dr Torres would ask why! Gremelius Dr Torres would ask why!	JMS to Mucicarmine Test Result JMS Dr Torres would ask why! Jones Dr Torres would ask why! Kinyoun Dr Torres would ask why! Luxol fast blue Dr Torres would ask why! Masson trichrome Dr Torres would ask why! M-MAS Dr Torres would ask why! Movat Dr Torres would ask why! Mucicarmine Dr Torres would ask why!	Oil red O to Prussian blue Test Result Oil red O Dr Torres would ask why! Orecein Dr Torres would ask why! PAS Dr Torres would ask why! PASD Dr Torres would ask why! PASF Dr Torres would ask why! PTAH Dr Torres would ask why! Prussian blue Dr Torres would ask why!	Reticulin to Ziehl-Neelsen Test Result Reticulin Dr Torres would ask why! Sudan black B Dr Torres would ask why! Toluidine blue Dr Torres would ask why! Verhoeff Dr Torres would ask why! Von Kossa Dr Torres would ask why! Warthin-Starry Spirochetes Ziehl-Neeslen Dr Torres would ask why!

IHC

Alpha-1 AT to Cathepsin K Test Result alpha-1 AT Dr T would ask why! ACTH Dr T would ask why! AE1/AE1 Dr T would ask why! alpha-fetoprotein Dr T would ask why! Alk-I Dr T would ask why! AMACR Dr T would ask why! AR Dr T would ask why! ATRX Dr T would ask why! Beta2-microglobulin Dr T would ask why! B72.3 Dr T would ask why! Beta-catenin Dr T would ask why! BCL2 Dr T would ask why! BCL6 Dr T would ask why! BCLxL Dr T would ask why! C3 comp Dr T would ask why! CA9 Dr T would ask why! Calcitonin Dr T would ask why! Calponin Dr T would ask why! Calretinin Dr T would ask why! CAM5.2 Dr T would ask why! Cathepsin K Dr T would ask why!	CD10 to Chromogranin Test Result CD10 Dr T would ask why! CD117 Dr T would ask why! CD138 Dr T would ask why! CD15 Dr T would ask why! CD1a Dr T would ask why! CD20 Dr T would ask why! CD21 Dr T would ask why! CD23 Dr T would ask why! CD3 Dr T would ask why! CD30 Dr T would ask why! CD31 Dr T would ask why! CD34 Dr T would ask why! CD35 Dr T would ask why! CD4 Dr T would ask why! CD43 Dr T would ask why! CD45 (LCA) Dr T would ask why! CD5 Dr T would ask why! CD56 Dr T would ask why! CD57 Dr T would ask why! CD68 Dr T would ask why! CD7 Dr T would ask why! CD79a Dr T would ask why! CD8 Dr T would ask why! CD99 Dr T would ask why! CDX2 Dr T would ask why! CEA-m Dr T would ask why! Chromogranin Dr T would ask why!	CK17 to Glypican 3 Test Result CK17 Dr T would ask why! CK19 Dr T would ask why! CK20 Dr T would ask why! CK34betaE12 Dr T would ask why! CK5/6 Dr T would ask why! CK7 Dr T would ask why! CMV Dr T would ask why! c-MYC Dr T would ask why! Cyclin D1 Dr T would ask why! D2-40 Dr T would ask why! Desmin Dr T would ask why! DOG1 Dr T would ask why! EBV Dr T would ask why! EMA Dr T would ask why! ER and PR Dr T would ask why! Factor VIII Dr T would ask why! Factor XIIIa Dr T would ask why! Fascin Dr T would ask why! FH Dr T would ask why! FSH Dr T would ask why! Gastrin Dr T would ask why! GATA3 Dr T would ask why! GCDFP-15 (BRST2) Dr T would ask why! GFAP Dr T would ask why! GH Dr T would ask why! Glucagon Dr T would ask why! Glypican-3 Dr T would ask why!	HBME-1 to IgM Test Result HBME-1 Dr T would ask why! HBV core Dr T would ask why! HBV surface Dr T would ask why! H-caldesmon Dr T would ask why! HCG Dr T would ask why! Helicobacter Dr T would ask why! Hepatocyte Dr T would ask why! HER2/neu Dr T would ask why! HHV-8 Dr T would ask why! HMB-45 Dr T would ask why! HNF1beta Dr T would ask why! HPV Dr T would ask why! HSV-I Dr T would ask why! HSV-II Dr T would ask why! IDH-1 Dr T would ask why! Inhibin Dr T would ask why! INI1 (BAF47) Dr T would ask why! Insulin Dr T would ask why! Kappa Dr T would ask why! Ki-67 Dr T would ask why! Lambda Dr T would ask why! Leu 7 Dr T would ask why! IgA Dr T would ask why! IgG Dr T would ask why! IgM Dr T would ask why!	LH to PDGFR Test Result LH Dr T would ask why! LIN28 Dr T would ask why! Lysozyme Dr T would ask why! mammoglobin Dr T would ask why! MAP2 Dr T would ask why! MCV Dr T would ask why! Melanin A Dr T would ask why! MHC class I Dr T would ask why! MITF Dr T would ask why! MUM1 Dr T would ask why! Myeloperoxidase Dr T would ask why! MYO D1 Dr T would ask why! Myoglobin Dr T would ask why! Napsin Dr T would ask why! NF Dr T would ask why! NKX3.1 Dr T would ask why! NSE Dr T would ask why! OCT3/4 Dr T would ask why! p16 Dr T would ask why! P501S Dr T would ask why! p53 Dr T would ask why! p57 Dr T would ask why! p63 Dr T would ask why! Pankeratin Dr T would ask why! PAX2 Dr T would ask why! PAX5 Dr T would ask why! PAX8 Dr T would ask why! PCNA Dr T would ask why! PDGFR Dr T would ask why!	PLAP to WT1 Test Result PLAP Dr T would ask why! PNL-2C Dr T would ask why! Prolactin Dr T would ask why! PSA Dr T would ask why! PSAP Dr T would ask why! RCC Dr T would ask why! S-100 Dr T would ask why! SALL4 Dr T would ask why! Smooth muscle actin Dr T would ask why! Somatostatin Dr T would ask why! STAT6 Dr T would ask why! Synaptophysin Dr T would ask why! TdT Dr T would ask why! TFE3 Dr T would ask why! TFEB Dr T would ask why! Thyroglobulin Dr T would ask why! Toxoplasma Dr T would ask why! TSH Dr T would ask why! TTF-1 Dr T would ask why! Ubiquitin Dr T would ask why! UCHL1 (PGP9.5) Dr T would ask why! Ulex Europaeus Dr T would ask why! Vimentin Dr T would ask why! VIP Dr T would ask why! VZV Dr T would ask why! WT-1 Dr T would ask why!

Diagnosis

Diagnosis
Intestinal spirochetosis.