Mating Ancylostoma duodenale under magnifying endoscopy

      A 71-year-old man, a farmer, was referred for EGD because he had experienced dysphagia for 4 months. He appeared anemic on physical examination. His laboratory tests showed significantly low hemoglobin, 5.2 g/dL, and an increase in eosinophils to 26.7%. The result of an occult blood test was positive. EGD revealed a mass in the gastric cardia; furthermore, several short red worms were observed in the duodenal bulb (Fig. 1A). Narrow-band imaging (NBI) and magnification were used; the worms turned transparent on NBI, and their heads were attached to the intestinal wall (Video 1, available online at A male worm was coiled around a female worm with his curved area (Fig. 1B; Video 1), in accordance with the reproductive characteristics of Ancylostoma duodenale. According to the endoscopic and magnified views, the diagnosis of gastric cardia cancer with A duodenale was made. Pathologic examination results confirmed the cardia mass to be an adenocarcinoma. The patient was given anthelminthic treatment with mebendazol, 100 mg twice daily for 3 days, and underwent a total gastrectomy. On 3-month follow-up study, there was no sign of hookworm infection.
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      Figure 1A, EGD view showing several red short worms in the duodenal bulb. B, Narrow-band imaging and magnification showing a male worm coiled around a female worm.
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