Enterobius vermicularis infestation masquerading as cervical carcinoma: A cytological diagnosis

Abstract

Although prevalence of Enterobius vermicularis (EV) infestation in Intestines ranges from 35% to 70%, its prevalence in female genital tract is not known despite several incidental findings. Acute inflammatory cells in the background of cervical Pap smear indicate infestation and should not be neglected as contamination. A 40-year-woman presented with white vaginal discharge persistent for past 1 year. Local examination showed hypertrophied cervix with eversion of both lips and hard consistency of the anterior lip of cervix. A clinical diagnosis of cervical carcinoma was made. However, cervical Pap smear indicated EV eggs in an inflammatory background, treatment to which resulted in completely recovery.

Vaginal Enterobius vermicularis diagnosed on liquid‐based cytology during Papanicolaou test cervical cancer screening: A report of two cases and a review of the literature

“…The frequency of involvement of the genital tract is unknown because only scarce reports of extraintestinal enterobiasis, in the ovary, vagina, salpinx, and peritoneal cavity can be found in the available literature . Concerning findings of EV in the vagina reported throughout the world, the literature in English contains ∼30 cases of EV, mostly EV eggs, discovered in vaginal or cervical smears, since the 1970 s (Table ) . Interestingly, the majority of the cases reported come from India, even though enterobiasis seems more prevalent in temperate than tropical countries .…”

“…However, the Pap smear showed a few EV eggs containing larvae, and bacterial vaginitis. The patient was treated with antibiotics and anthelmintics, with a good response …”

“…When carrying out a differential diagnosis, the vaginal samples may be contaminated by eggs deposited in the perineal area, or there may be confusion with other parasitic eggs, pollen grains, contaminant vegetable cells, or fungal spores . A clue to the diagnosis of vaginal enterobiasis versus contamination is the presence of an important acute inflammatory background that should be found in the presence of parasitic infections .…”

“…They consist of two layers containing grains, with an outer layer that may be smooth or rough because of the presence of warts, grains or troughs . The differential diagnosis also comprises other parasitic infections: Entamoeba histolytica, Microfilaria, Strongyloides stercoralis, Schistosoma haematobium, Trichuris trichiura, Ascaris, and Taenia . The diagnosis should be made with clinical correlation and investigations such as stool examination and culture.…”

“…Enterobiasis is the most frequent parasitic infection in humans, with a prevalence of 35–70% . It is more common in temperate countries (United States and Western Europe) .…”