Cytology preparations of formalin fixative aid detection of giardia in duodenal biopsy samples

Nicole C. Panarelli, Nariman Gobara, Rana S. Hoda, Michael Chaump, Jose Jessurun, Rhonda K. Yantiss

Research output: Contribution to journalArticle

5 Citations (Scopus)

Abstract

Giardiasis is the most common intestinal parasitic infection in the United States. The organism elicits no, or minimal, inflammatory changes in duodenal biopsy samples, so it can be easily overlooked. We performed this study to determine whether Giardia could be isolated from the formalin fixative of biopsy samples, and to evaluate the value of fluid analysis in the assessment for potential infection. We prospectively evaluated duodenal biopsy samples from 92 patients with a clinical suspicion of giardiasis or symptoms compatible with that diagnosis (ie, diarrhea, bloating, or abdominal pain) Biopsy samples were routinely processed and stained with hematoxylin and eosin. Histologic diagnoses included giardiasis (5 cases, 4%), normal findings (64 cases, 70%), peptic injury/active duodenitis (12 cases, 13%), and intraepithelial lymphocytosis with villous blunting (10 cases, 12%). Fifteen cases (13%) showed detached degenerated epithelial cells or mucus droplets in the intervillous space that resembled Giardia. Cytology slides were prepared from formalin in the biopsy container using the standard Cytospin protocol and reviewed by a cytopathologist blinded to the biopsy findings. Cytologic evaluation revealed Giardia spp. in all 5 biopsy-proven cases, and identified an additional case that was not detected by biopsy analysis. Organisms were significantly more numerous (mean: 400 trophozoites; range, 120 to 810) and showed better morphologic features in cytology preparations compared with tissue sections (mean: 129 trophozoites; range, 37 to 253 organisms; P=0.05). Our findings suggest that cytology preparations from formalin fixative can resolve diagnostically challenging cases and even enhance Giardia detection in some cases.

Original languageEnglish (US)
Pages (from-to)570-574
Number of pages5
JournalAmerican Journal of Surgical Pathology
Volume41
Issue number4
DOIs
StatePublished - 2017

Fingerprint

Giardia
Fixatives
Formaldehyde
Cell Biology
Biopsy
Giardiasis
Trophozoites
Duodenitis
Lymphocytosis
Parasitic Diseases
Mucus
Hematoxylin
Eosine Yellowish-(YS)
Abdominal Pain
Digestion
Diarrhea
Epithelial Cells
Wounds and Injuries

Keywords

  • Cytospin
  • gastrointestinal disease
  • giardiasis
  • pathology

ASJC Scopus subject areas

  • Anatomy
  • Surgery
  • Pathology and Forensic Medicine

Cite this

Cytology preparations of formalin fixative aid detection of giardia in duodenal biopsy samples. / Panarelli, Nicole C.; Gobara, Nariman; Hoda, Rana S.; Chaump, Michael; Jessurun, Jose; Yantiss, Rhonda K.

In: American Journal of Surgical Pathology, Vol. 41, No. 4, 2017, p. 570-574.

Research output: Contribution to journalArticle

Panarelli, Nicole C. ; Gobara, Nariman ; Hoda, Rana S. ; Chaump, Michael ; Jessurun, Jose ; Yantiss, Rhonda K. / Cytology preparations of formalin fixative aid detection of giardia in duodenal biopsy samples. In: American Journal of Surgical Pathology. 2017 ; Vol. 41, No. 4. pp. 570-574.
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