A case report on bilharziasis  of the Fallopian tube as diagnosed in a Caucasian woman in Zimbabwe.We present a 37 year old, Caucasian woman who presented to a gynaecologist with a history of amenorrhea and subsequent per vaginal bleeding. In her gynaecological history, she was Gravida 3, Para 2, and her youngest child was 12 years old. Her periods had always been regular and she had a copper T contraceptive device in situ. She missed her period and subsequently had a PV bleed. She was found to have an incomplete abortion, for which a D&C and removal of the IUCD, as well as ligation fallopian tubes was arranged. At laparoscopy, she was found to have a 30mm “tumour at” the fimbrial end of her left fallopian tube. A mini-laparotomy was performed to remove the “tumour”, and seedlings on the contralateral fallopian tube, adjacent ovary as well as on the uterine surface. Peritoneal nodules were also seen but no peritoneal fluid was evident. The “tumour” was resected, and the following day post-operatively, the patient was counselled for a TAH and BSO and consent was obtained

Makunike- Mutasa, R.

Phiri, K.

Central African Journal of Medicine

English

Schistosomiasis, also known as bilharzia is an infection caused by trematode flatworms of any species of the genus Schistosoma. At least 261 million people in 74 countries are infected, and of these, 90% are in Sub-Saharan Africa.1 In Zimbabwe, the prevalence is 38,2% for S. haematobium and 8,3% for S. Mansoni.2 A “bilharzioma” is a localised mass of fibrous and inflammatory tissue, which  contains numerous eggs frequently involving the serosa and mesentery.3-4 Schistosomiasis caused by Schistosoma haematobium generally is asymptomatic, and if symptomatic, presents with terminal haematuria and rarely with other symptoms.5 Even in endemic areas, very rarely, will Schistosomiasis result in formation of a “bilharzioma”.³ The most commonly reported site is the intravesical part of the ureter resulting in stricture formation, but rarely bilharziomas are found in other sites including the female genital tract. Here we report a case of a “Bilharzioma” masquerading as a malignant tumour with seedlings in the fallopian tube

Makunike-Mutasa, R

Phiri, K

AJOL - African Journals Online

Bilharzioma of the fallopian tube - A case report

IDS OpenDocs

Vol. 61, Nos. 1/4
ORIGINAL ARTICLES
CONTENTS January/April 2015
Prevalence and the correlates of postnatal depression in 
an urban high density suburb of Harare.........................
Etiology and risk factors of meningitis in patients 
admitted at a Central Hospital in Harare.......................
Effects of different frequencies of loading on healing in 
partial rupture of the Achilles tendon in a rat model........
An echocardiography audit to determine and
characterise rheumatic heart disease lesions seen in
2012........................................................................
J January, H Chivanhu, J Chiwara, T Denga, K Dera, T Dube,
V Chikwasha, TM Chikwanha............................................. 1
A Matubu, S Rusakaniko, V Robertson, L Gwanzura............5
NS Mkumbuzi, HM Chinyanga, W Wood, SKT Mudambo, M 
Gova.................................................................................11
NT Munyandu.................................................................. 17
CASE REPORT
Bilharzioma of the fallopian tube: a case report............. R Makunike-Mutasa, K Phiri............................................ 21
NOTES AND NEWS
Instructions to Authors.
CASE REPORT
Bilharzioma of the fallopian tube - a case report
R MAKUNIKE-MUTASA, K PHIRI
Introduction
Schistosomiasis, also known as bilharzia is an infection caused by trematode flatworms of any species of the 
genus Schistosoma. At least 261 million people in 74 countries are infected, and of these, 90% are in Sub- 
Saharan Africa.' In Zimbabwe, the prevalence is 38,2% for S. haematobium  and 8,3% for S. mansoni: A 
“bilharzioma” is a localised mass of fibrous and inflammatory tissue, which contains numerous eggs 
frequently involving the serosa and mesentery. 4 Schistosomiasis caused by Schistosoma haematobium 
generally is asymptomatic, and if symptomatic, presents with terminal haematuria and rarely with other 
symptoms.5 Even in endemic areas, very rarely, will Schistosomiasis result in formation of a “bilharzioma”.3 
The most commonly reported site is the intravesical part of the ureter resulting in stricture formation, but 
rarely bilharziomas are found in other sites including the female genital tract. Here we report a case of a 
“Bilharzioma” masquerading as a malignant tumour with seedlings in the fallopian tube.
Case Report
We present a 37 year old, Caucasian woman who 
presented to a gynaecologist with a history of 
amenorrhea and subsequent per vaginal bleeding. In 
her gynaecological history, she was Gravida 3, Para 2, 
and her youngest child was 12 years old. Her periods 
had always been regular and she had a copper T 
contraceptive device in situ. She missed her period and 
subsequently had a PV bleed. She was found to have an 
incomplete abortion, for which a D&C and removal of 
the IUCD, as well as ligation fallopian tubes was 
arranged. At laparoscopy, she was found to have a 
30mm “tumour at” the fimbrial end of her left fallopian 
tube. A mini-laparotomy was performed to remove the 
“tumour”, and seedlings on the contralateral fallopian 
tube, adjacent ovary as well as on the uterine surface. 
Peritoneal nodules were also seen but no peritoneal 
fluid was evident. The “tumour” was resected, and the 
following day post-operatively, the patient was 
counselled for a TAH and BSO and consent was 
obtained.
Pathological findings
The resected “tumour” was sent for histological 
analysis. A 25mm by 30mm firm mass with a 
“cauliflower appearance” was received. On cut
Cent A f r J M e d  2015;61 (l/4):21-23
surface, it was white with yellow flecks and a rather 
gritty consistency. Three representative sections of the 
mass were taken. Histology revealed florid peri-serosal 
granulation tissue with chronic inflammation and 
numerous schistosoma ova (Figure I).
Figure I: Fallopian tube mucosa with schistosoma ova 
set in a chronic inflammatory background x  10 
magnification.
Many of the ova were calcified accounting for the gritty 
cut suface, and the ova did not take up the Modified 
Ziehl Neelson stain consistent with Schistosoma
Department o f Histopathology
University o f Zimbabwe, College o f Health Sciences
P 0 Box A178, Avondale, Harare
Zimbabw
Corresponding to:
Dr R Makunike-Mutasa
Department of Histopathology
University o f Zimbabwe, College of Health Sciences
P 0 Box A178, Avondale, Harare
Zimbabwe
Cent Afr J  Med 2015;61 ( 1/4) 21
Haematobium (Figure II). The fimbriae were 
uninvolved, and there was no evidence of malignancy. 
A diagnosis of “Bilharzioma” was made.
Figure II: Schistosoma haematobium, with terminal 
spines x40  magnification.
Discussion
Schistosomiasis is an infection caused by a trematode 
and is endemic in Sub Saharan Africa. There are two 
major forms of Schistosomiasis', intestinal and 
urogenital, caused by five main species of blood flukes,
S. Haematobium, S. Mansoni, S. Japonicum, S. 
Mekongi, S. Guineensis and related intercalatum, with 
Mansoni, Haematobium and Japonicum being the 
com m onest. The e a r l ie s t case  o f  hum an 
Schistosomiasis was described over 5000 years ago 
around 1200 BC, in an Egyptian adolescent mummy.6 
The life cycle of this trematode involves an 
intermediate host (snail) that carries the miracidium 
after the egg has hatched following contact with water, 
releasing the miracidium to enter the snail. The 
miracidium matures into a sporocyst and is released 
into water as cercaria, which penetrate the human skin 
and becomes a schistosom. The schistosom migrates to 
the portal blood and then matures into adult worms. 
The paired adult worms then migrate to the peri-vesical 
blood plexus, and release numerous eggs that penetrate 
tissues. Half of the hatched eggs are excreted in urine, 
and the other half lodge in the genitourinary system 
with a portion being embolised to distant sites. The 
eggs elicit a granulomatous reaction with abundant 
eosinophills.
When the infection results in formation of a tumour 
mass, this is referred to as a “Bilharzioma”. 
“Bilharziomas” are thought to be caused by a reaction 
to eggs produced by one or more pairs of worms in a 
single site, although altered host reactivity may also be 
a factor. The term “Bilharzial polypi” was first coined 
in 1856 in Egypt after a German naturalist, Theodor 
Maximillian Bilharz. Later, in 1950, Michael Gelfand 
working in Zimbabwe (then, Rhodesia), suggested the
term “Bilharzioma” a term, that continues to be used 
worldwide. 7
“Bilharziomas” were classically described as tumour 
masses occurring in the transvesical ureter. Several 
reports have been made of tumour masses occurring in 
other sites including, Breast,8 spinal cord,9 lung,10 
intestine,11 and the genital and perineal areas.12,13 
Bilharziomas are usually asymptomatic until they 
cause obstruction and are often picked up incidentally 
as in this case. They are not generally associated with 
constitutional symptoms, such as weight loss, pyrexia, 
etc., although these have been reported. Sometimes, 
patients have other abnormalities including a raised 
WBC count with eosinophilia, but Michael Gelfand 
reported eosinophilia in only 50% of cases of 
bilharzioma in Zimbabwe.6
Conclusion
We report an unusual case of Schistosomiasis 
presenting as a “tumour”, which is an important 
differential diagnosis for tumour masses seen in the 
adnexae of women living in endemic areas. In the era 
of widespread use of imaging ( Plain X Rays, Ultra 
Sound Scans, CT scans, and MRI Scans) a mass which 
on radiology, exhibits calcification may well be 
confused for a malignant tumour. Calcification is 
used as a marker for malignancy in breast lesions 
as well as in papillary carcinomas of the ovary 
where psammoma bodies are responsible for the 
calcification seen on imaging. One of the authors 
(RM) previously reported a case of Schistosomiasis in 
the breast of a Zimbabwean female that had been 
picked up on mammographic screening for cancer. In 
this case, malignancy was erroneously suspected, not 
only because of the mass, but also the presence of a 
“cauliflower appearance”, calcification, as well as the 
presence of seedlings. These appearances would have 
been typical of a papillary serous carcinoma of ovary 
with psammoma bodies.
This case highlights two important points:
i) The importance of histological evaluation of 
any radiologically diagnosed condition, no 
matter how clinically suspicious it is, and;
ii) That schistosomiasis, an age old disease, 
still exists and may not only cause serious 
morbidity, but may mimic a malignant lesion 
leading to over-treatment, which may 
compromise fertility, and result in unnecessary 
morbidity associated with major operative 
procedures.
References
1. Chitsulo L, Engels D, Montresor A, Savioli L. 
The global status of Schistosomiasis and its 
control. Acta Tropica 2000;77( 1): 41 -51.
Cent Afr J  Med 2015;61 (1 /4) 22
2. Tylor P, Makura O. Prevalence and distribution 
of Schistosomiasis in Zimbabwe. Ann Trap 
MedParasitol 1985 ;79(3 ):287-99.
3. Gelfand M, Juta and Co. Ltd. Schistosomiasis 
in South Central Africa: a clinico-pathological 
study. Cape Town and Johannesburg. 
Schistosomiasis of the female genitalia, 
1950;6:203-8.
4. Al-Ghorab MM. Radiological manifestation 
of genitourinary bilhaziasis. Clin Radiol 
1968; 19(1): 100-11.
5. Gelfand M. The diagnosis and prognosis of 
schistosomiasis. Am J  Trop Med 1949; 
51(6):945-58.
6. Deelder AM, Miller RL. Dejonge N, Krijger 
FW. Detection of schistosoma antigen in 
mummies. Lancet 1990;335:724-5.
7. El-Badawi AA. Bilharzial polypi of urinary 
bladder. BrJ Urol 1966;38( 1):24-35.
8. M a k u n ik e  R, M u ro n d a  C. B reas t
schistosomiasis', a case report. Histopatho 
2002;40(2): 175-6.
9. Antonio CM. Maia Jr MD, Luciano RF 
Silva MD, Matheus D, Guimaraes MD, et al 
Spinal cord compression secondary tc 
epidural bilharzioma: case report, o 
Neuroimaging 2007; 17(4): 367-370.
10. Tompson HT, Pettigrew RR, Johnson EA 
Solitary pulmonary bilharzioma. Thorax 
979;34:401 -2.
11. Elmasaline FN, Raheen MA, Badaw G, 
Suberi SR, Matboul J. Rectosigmoid 
bilharzioma causing intestinal obstruction. 
Paediatr Surg 1979;32(4):631 -3.
12. Diaa Self-Eldin. Bilharziasis of the fallopiar 
tubes and ovaries. Int J  Obstetr Gynaecoi 
2005;65(3):457-9.
13. Mouktar M. Functional disorders due tc 
bilharzial infection of the female genital tract. 
570G2005;73(2):307-10.
Cent Afr J  Med 2015 ;61 (1 /4) 23
This work is licensed under a 
Creative Commons
Attribution -  Noncommercial - NoDerivs 3.0 License.
To view a copy of the license please see: 
http://creativecommons.org/licenses/by-nc-nd/3.0/
This is a download from the BLDS Digital Library on OpenDocs
http://opendocs.ids.ac.uk/opendocs/
Institute o f 
Development Studies


Bilharzioma of the fallopian tube - a case report

https://opendocs.ids.ac.uk/opendocs/bitstream/20.500.12413/11347/1/Makunike-%20Mutasa%2c%20R.%2c%20%26%20Phiri%2c%20K.%2c%20CAJM%20%20vol.%2061%2c%20nos.%201-4..pdf

Bilharzioma of the fallopian tube - a case report

Abstract

Similar works

Full text

Available Versions

AJOL - African Journals Online

IDS OpenDocs