Identification of Enterobius vermicularis in a Cervical Specimen from a Woman with Heavy Menstrual Bleeding: A Case Report

Enterobius vermicularis, commonly known as pinworm, is an intestinal nematode that rarely involves the female genital tract. Cervical identification of this parasite is particularly uncommon and may pose a diagnostic challenge because the precise relationship of the organism to the cervical tissue may not always be established. A 41-year-old married, premenopausal woman presented with a six-month history of prolonged heavy menstrual bleeding. The patient’s menstrual cycles were regular, with bleeding lasting approximately eight days and requiring approximately six pads per day. Papanicolaou smear examination revealed atypical glandular cells of endocervical origin, not otherwise specified. Pelvic Magnetic Resonance Imaging (MRI) demonstrated findings suggestive of adenomyosis, along with a bulky cervix with multiple nabothian cysts. Histopathological examination of endometrial, endocervical and cervical specimens revealed disordered proliferative endometrium and a parasitic structure morphologically consistent with E. vermicularis in the cervical specimen. The organism appeared to be situated within a luminal/tissue space rather than unequivocally embedded within the cervical stroma, and there was no prominent inflammatory or granulomatous tissue response. Therefore, secondary migration or luminal contamination could not be completely excluded. The clinical significance of the parasitic finding in relation to the patient’s heavy menstrual bleeding also remains uncertain, particularly in view of the coexisting disordered proliferative endometrium and MRI findings suggestive of adenomyosis. The present case highlights the importance of careful histopathological evaluation, recognition of parasitic morphology and clinicopathological correlation when E. vermicularis is identified in an unusual cervical specimen.