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N Engl J Med. 2015 Nov 5;373(19):1845-52. doi: 10.1056/NEJMoa1505892.

Malignant Transformation of Hymenolepis nana in a Human Host.

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From the Infectious Diseases Pathology Branch, Division of High-Consequence Pathogens and Pathology, National Center for Emerging and Zoonotic Infectious Diseases (A.M., J.B., M.G.M., D.C.R., T.L.J., P.W.G., S.R.Z.), Parasitic Diseases Branch, Division of Parasitic Diseases and Malaria, Center for Global Health (M.L.E., B.A.M.), Biotechnology Core Facility, Division of Scientific Resources, National Center for Emerging and Zoonotic Infectious Diseases (M.A.F.), Waterborne Disease Prevention Branch, Division of Foodborne, Waterborne, and Environmental Diseases, National Center for Emerging and Zoonotic Infectious Diseases (G.S.V.), and Mycotic Diseases Branch (C.D.P.), Centers for Disease Control and Prevention (CDC), and Emory University School of Medicine (A.H.) - all in Atlanta; Universidad Pontificia Bolivariana School of Health Sciences (C.A.A., A.H., A.V.H., L.R.D.), Clínica Universitaria Bolivariana (C.A.A.), and Hospital Pablo Tobón Uribe (A.H., A.V.H.), Medellín, and Centros Especializados de San Vicente Fundación, Rionegro (C.A.A.) - all in Colombia; Asahikawa Medical University, Asahikawa, Japan (A.I.); and the Department of Life Sciences, Division of Parasites and Vectors, Natural History Museum, London (P.D.O.).


Neoplasms occur naturally in invertebrates but are not known to develop in tapeworms. We observed nests of monomorphic, undifferentiated cells in samples from lymph-node and lung biopsies in a man infected with the human immunodeficiency virus (HIV). The morphologic features and invasive behavior of the cells were characteristic of cancer, but their small size suggested a nonhuman origin. A polymerase-chain-reaction (PCR) assay targeting eukaryotes identified Hymenolepis nana DNA. Although the cells were unrecognizable as tapeworm tissue, immunohistochemical staining and probe hybridization labeled the cells in situ. Comparative deep sequencing identified H. nana structural genomic variants that are compatible with mutations described in cancer. Invasion of human tissue by abnormal, proliferating, genetically altered tapeworm cells is a novel disease mechanism that links infection and cancer.

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