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Clinical question
A woman in her early 30s presented with perianal purulent discharge. A rectal examination showed a high complex fistula-in-ano. A fistulotomy was performed wherein two fistulous tracts at the 4 o’clock and 8 o’clock position involving the external sphincter muscle were identified, and the granulation tissue was submitted for histopathological evaluation.
What is your diagnosis?
A dense infiltrate of macrophages with an artefact amidst the granulation tissue.
Macrophages exhibiting emperipolesis along with a cotton fibre adjacent to them.
Macrophages exhibiting emperipolesis along with a parasite in the adjacent tissues.
Macrophages exhibiting emperipolesis with a slender vegetable cell adjacent to them.
Discussion
Amidst abundant granulation tissue, without eosinophils, were numerous multinucleated macrophages showing emperipolesis (figure 1). The engulfed cells were lymphocytes, plasma cells and occasional …
Footnotes
Handling editor Iskander Chaudhry.
Contributors AMF identified the parasite. SN performed the surgery and provided clinical inputs. SAP performed the histopathological evaluation of the tissue.
Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.
Competing interests None declared.
Patient consent for publication Obtained.
Provenance and peer review Not commissioned; externally peer reviewed.