Diagnosis: Schistosomiasis and Pipestem Fibrosis
• Symmers fibrosis refers to the dense, rounded, and fibrotic portal tracts that are seen on the cut surface of the liver in late schistosomiasis.
• Early changes in schistosomiasis include schistosomal granulomas within portal vein branches, sometimes with an extensive surrounding eosinophil infiltrate and corona of degranulated bright red eosinophil granules (Hoeppli-Splendore effect).
• Later changes in schistosomiasis include portal tract fibrosis, loss of portal vein lumina, and acquisition of schistosomal finely granular black pigment in Kupffer cells and portal macrophages.
• Acid-fast stain is useful to apply to suspected schistosomal granulomas or other suspicious areas because the outer cuticle and lateral spike of Schistosoma mansoni and other species are positive on acid-fast bacilli.
