Discussion

Diagnosis

Sarcina ventriculi

Discussion

Sarcina ventriculi is a gram-positive anaerobic coccus that demonstrates a distinct morphology of basophilic tetrads on H&E-staining that are most frequently observed in stomach biopsy specimens of patients with delay gastric emptying or gastric outlet obstruction. In Haroon Al Rasheed and Senseng’s review of the literature of Sarcina ventriculi, they note that the organism is most frequently identified in gastric biopsy specimens in adult women (2:1, female: male), and the majority of patients have a history of gastrointestinal surgery, gastroparesis, and/or gastric outlet obstruction. 

Histologically, Sarcina are basophilic coccoid to cuboidal bacteria which are arranged in a characteristic packeted tetrad structure. Sarcina may be incidentally identified without an associated inflammatory response or may be seen in association with acute hemorrhagic gastritis. They are not invasive, instead being found in sparse numbers on the luminal surface. In this case, the Sarcina organisms were identified only in the duodenal biopsy specimen, with no such organisms identified in the gastric biopsy specimen. Identification of Sarcina in the duodenum is unusual, with no significant literature available on this presentation.

Importantly, Sarcina have been associated with gastric perforation and emphysematous gastritis, although it is has not been definitively established if Sarcina is the cause of these conditions [2].

References

1. Haroon Al Rasheed MR and Senseng CG. Sarcina ventriculi: Review of the literature. Arch Path Lab Med. 2016;140(12):1441-1445.

2. Lam-Himlin D, Tsiatis AC, Montgomery E, et al. Sarcina organisms in the gastrointestinal tract: a clinicopathologic and molecular study. Am J Surg Pathol. 2011;35(11):1700–1705.

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