Revision as of 03:48, 12 April 2012

This article deals with viruses. The more general topic of infective things is dealt with in microorganisms. Many viruses afflict humans. Only a few of them can be diagnosed histologically.

Viral inclusions - types

Cowdry types:^[1]

Cowdry type A inclusion:^[2]
- Round eosinophilic material surrounded by a clear halo.
Cowdry type B inclusion:^[3]
- Neuropathology thingy. (???)

Images:

Viruses

Herpes simplex virus

In the context of gynecologic cytopathology see: Gynecologic_cytopathology#Herpes_simplex_virus.

Abbreviated HSV.

General

Several subtypes:

Canker sores - usually HSV-1.
Genital herpes - usually HSV-2.

Histology/cytology

Features:^[4]

Clear "ground glass" nuclei.
- Rim of peripheral chromatin.
Nuclear inclusions.
Multinucleation with nuclear molding, i.e. multiple nuclei that touch over a large surface area.

Mnemonic - 3 Ms: Margination, Multinucleation, Molding.

Images:

Cytomegalovirus

Abbreviated CMV.

For pneumonia caused by CMV - see Cytomegalovirus pneumonia.

General

The name comes from the microscopic appearance.
One of the TORCH infections.
- May cause fetal hydrops and intracerebral hemorrhage.^[5]

Microscopic

Features:

Very large nucleus (as the name implies) with clearing.
- Classically described as owl's eye-like.
Granular cytoplasmic inclusions (red on H&E sections).

Notes:

Classically in endothelial cells.
- In the context of esophageal ulcers, it is therefore useful to biopsy the base of the ulcer - if this is suspected.

Images:

IHC

IHC for CMV is available - highlights granular cytoplasmic inclusions; increases sensitivity.

Human papillomavirus

Abbreviated HPV.

General

Causes a lot of pathology:
- Benign:
- Malignant:
  1. Cervical cancer and precursors (LSIL, HSIL).
  2. Anal cancer and precursors (AIN).^[6]
  3. Vulvar cancer].^[6]
  4. Vaginal cancer.^[6]
  5. Penile cancer.^[6]
  6. Squamous cell carcinoma in the oropharynx, i.e. head & neck.
  - Possibly esophageal carcinoma^[7] - disputed.^[8]

Oncocytic types:

HPV 18 - predominantly adenocarcinoma.^[9]
- Eighteen = adenocarcinoma.
HPV 16 - predominantly squamous cell carcinoma.^[9]
- Sixteen = squamous.

Recombinant vaccine (Gardasil, Silgard) - covers:^[10]

HPV 6.
HPV 11.
HPV 16.
HPV 18.

Microscopic

Features:

Koilocytes:
- Perinuclear clearing.
- Nuclear changes.
  - Size similar (or larger) to those in the basal layer of the epithelium.
  - Nuclear enlargement should be evident on low power, i.e. 25x.
  - Central location - nucleus should be smack in the middle of the cell.

Images:

IHC

p16 +ve -- stains most cells infected by HPV.

Adenovirus

General

Common in kids.
- May be seen in the context of (adenovirus) appendicitis.

Microscopic

Features:

"Smudge" cells^[11] - black/blue blob ~ 10-15 micrometers. (???)

Notes:

May be morphologically similar to CMV, HSV, VZV inclusions.

Images:

Parvovirus

AKA Parvovirus B19.

General

Most significant in pregnant women.
- Parvovirus attacks the nucleated RBCs of the fetus - causes an aplastic anemia.
May cause collapsing glomerulopathy.^[13]

Trivia:

First described in 1975.^[14]
- The "B19" part comes from the label for the specimen.^[15]

Microscopic

Features:

Glassy (red) nuclear inclusions.^[16]
Nuclear enlargement.

Images:

Epstein-Barr virus

Abbreviated EBV

General

Cases mononucleosis.
Part of the herpes group of viruses.^[19]

Note:

The virus is Epstein... the tricuspid abnormality is Ebstein.

Associations

Cancer:^[20]

Classical Hodgkin lymphoma.
Burkitt lymphoma.
Nasopharyngeal carcinoma.
B cell lymphomas -- in immunosuppressed individuals.
- Post-transplant lymphoproliferative disorder.
Leiomyoma and leiomyosarcoma in the context of HIV.^[21]

Other:

Hemophagocytic syndrome.^[22]

Microscopic

Features:

Variable - see specific pathologies in Associations section.
- +/-Atypical lymphocytes.
- +/-Hemophagocytosis (uncommon).

Images:

EBV-associated gastritis (upmc.edu).

IHC

EBER +ve -- in situ hybridization.
Mixed population of CD3 & CD20 -- in benign.

Polyomavirus

May refer to:

BK virus.
- See: Polyomavirus nephropathy and Urine_cytopathology#Human_polyoma_infection.
Merkel cell polyomavirus.
- See: Merkel cell carcinoma.
JC virus.
- See: Progressive multifocal leukoencephalopathy.

Human herpesvirus-8

Commonly abbreviated HHV-8.

General

Associated with a number of cancers:

Kaposi sarcoma.
Primary effusion lymphoma.
Body cavity lymphoma.
LBCL arising in HHV-8 associated multicentric Castleman disease.

Other:

Castleman disease, plasma cell variant.

Microscopic

No light microscopic changes.

IHC

Usually HHV-8 +ve.

West Nile virus

Abbreviated WNV.

General

Uncommon pathologen.

Clinical:

Fever.
Muscle weakness.

Microscopic

Features:^[23]

Perivascular clusters in grey and white matter:
- Mononuclear infiltrates (lymphocytes, plasma cells).
- Microglial nodules (macrophage clusters).

Measles virus

General

Illness may be complicated by subacute sclerosing panencephalitis (SSPE) - a chronic neurodegenerative condition.^[24]

Microscopic

Features:

+/-Intranuclear Cowdry type A inclusions.
- Glassy (pink) nucleus.
Lymphocytes and microglial cells.
Demyelination.

Images:

SSPE - several images (upmc.edu).

References

↑ URL: http://www.pathconsultddx.com/pathCon/largeImage?pii=S1559-8675%2806%2970864-6&figureId=fig3&ecomponentId=mmc3. Accessed: 12 January 2010.
↑ URL: http://www.whonamedit.com/synd.cfm/3495.html. Accessed on: 22 January 2010.
↑ http://www.whonamedit.com/synd.cfm/3496.html. Accessed on: 22 January 2010.
↑ SM. 11 January 2010.
↑ Tongsong, T.; Sukpan, K.; Wanapirak, C.; Phadungkiatwattna, P. (2008). "Fetal cytomegalovirus infection associated with cerebral hemorrhage, hydrops fetalis, and echogenic bowel: case report.". Fetal Diagn Ther 23 (3): 169-72. doi:10.1159/000116737. PMID 18417974.
↑ ^6.0 ^6.1 ^6.2 ^6.3 Borget, I.; Abramowitz, L.; Mathevet, P. (Jul 2011). "Economic burden of HPV-related cancers in France.". Vaccine 29 (32): 5245-9. doi:10.1016/j.vaccine.2011.05.018. PMID 21616117.
↑ Zhang, QY.; Zhang, DH.; Shen, ZY.; Xu, LY.; Li, EM.; Au, WW. (Mar 2011). "Infection and integration of human papillomavirus in esophageal carcinoma.". Int J Hyg Environ Health 214 (2): 156-61. doi:10.1016/j.ijheh.2010.11.001. PMID 21130683.
↑ Iyer, A.; Rajendran, V.; Adamson, CS.; Peng, Z.; Cooper, K.; Evans, MF. (Mar 2011). "Human papillomavirus is detectable in Barrett's esophagus and esophageal carcinoma but is unlikely to be of any etiologic significance.". J Clin Virol 50 (3): 205-8. doi:10.1016/j.jcv.2010.11.015. PMID 21169053.
↑ ^9.0 ^9.1 De Boer, MA.; Peters, LA.; Aziz, MF.; Siregar, B.; Cornain, S.; Vrede, MA.; Jordanova, ES.; Fleuren, GJ. (Apr 2005). "Human papillomavirus type 18 variants: histopathology and E6/E7 polymorphisms in three countries.". Int J Cancer 114 (3): 422-5. doi:10.1002/ijc.20727. PMID 15551313.
↑ McCormack, PL.; Joura, EA. (Oct 2011). "Spotlight on Quadrivalent Human Papillomavirus(Types 6, 11, 16, 18) Recombinant Vaccine(Gardasil®) in the Prevention of PremalignantGenital Lesions, Genital Cancer, and Genital Warts in Women†.". BioDrugs 25 (5): 339-43. doi:10.2165/11205060-000000000-00000. PMID 21942919.
↑ URL: http://www.pathguy.com/lectures/infect.htm. Accessed on: 8 July 2010.
↑ URL:http://www.medscape.com/viewarticle/438534_2. Accessed on: 8 July 2010.
↑ Schwimmer, JA.; Markowitz, GS.; Valeri, A.; Appel, GB. (Mar 2003). "Collapsing glomerulopathy.". Semin Nephrol 23 (2): 209-18. doi:10.1053/snep.2003.50019. PMID 12704581.
↑ Cossart, YE.; Field, AM.; Cant, B.; Widdows, D. (Jan 1975). "Parvovirus-like particles in human sera.". Lancet 1 (7898): 72-3. PMID 46024.
↑ Servey JT, Reamy BV, Hodge J (February 2007). "Clinical presentations of parvovirus B19 infection". Am Fam Physician 75 (3): 373–6. PMID 17304869. http://www.aafp.org/afp/991001ap/1455.html.
↑ URL: http://www.pathguy.com/lectures/infect.htm. Accessed on: 8 July 2010.
↑ URL:http://info.fujita-hu.ac.jp/~tsutsumi/case/case210.htm. Accessed on: 8 February 2011.
↑ URL: http://www.scielo.br/scielo.php?pid=S0036-46652007000200007&script=sci_arttext. Accessed on: 18 August 2011.
↑ URL: http://www.meddean.luc.edu/lumen/MedEd/orfpath/herpes.htm. Accessed on: 14 April 2011.
↑ Mitchell, Richard; Kumar, Vinay; Fausto, Nelson; Abbas, Abul K.; Aster, Jon (2011). Pocket Companion to Robbins & Cotran Pathologic Basis of Disease (8th ed.). Elsevier Saunders. pp. 169. ISBN 978-1416054542.
↑ McClain, KL.; Joshi, VV.; Murphy, SB. (Oct 1996). "Cancers in children with HIV infection.". Hematol Oncol Clin North Am 10 (5): 1189-201. PMID 8880205.
↑ Jin YK, Xie ZD, Yang S, Lu G, Shen KL (June 2010). "Epstein-Barr virus-associated hemophagocytic lymphohistiocytosis: a retrospective study of 78 pediatric cases in mainland of China". Chin. Med. J. 123 (11): 1426–30. PMID 20819601.
↑ Sampson, BA.; Ambrosi, C.; Charlot, A.; Reiber, K.; Veress, JF.; Armbrustmacher, V. (May 2000). "The pathology of human West Nile Virus infection.". Hum Pathol 31 (5): 527-31. PMID 10836291.
↑ URL: http://path.upmc.edu/cases/case595/dx.html. Accessed on: 26 January 2012.

[1] URL: http://www.pathconsultddx.com/pathCon/largeImage?pii=S1559-8675%2806%2970864-6&figureId=fig3&ecomponentId=mmc3. Accessed: 12 January 2010.

[2] URL: http://www.whonamedit.com/synd.cfm/3495.html. Accessed on: 22 January 2010.

[3] ttp://www.whonamedit.com/synd.cfm/3496.html. Accessed on: 22 January 2010.

[4] SM. 11 January 2010.

[pmid18417974-5] Tongsong, T.; Sukpan, K.; Wanapirak, C.; Phadungkiatwattna, P. (2008). "Fetal cytomegalovirus infection associated with cerebral hemorrhage, hydrops fetalis, and echogenic bowel: case report.". Fetal Diagn Ther 23 (3): 169-72. doi:10.1159/000116737. PMID 18417974.

[pmid21616117-6] 6.0 ^6.1 ^6.2 ^6.3 Borget, I.; Abramowitz, L.; Mathevet, P. (Jul 2011). "Economic burden of HPV-related cancers in France.". Vaccine 29 (32): 5245-9. doi:10.1016/j.vaccine.2011.05.018. PMID 21616117.

[pmid21130683-7] Zhang, QY.; Zhang, DH.; Shen, ZY.; Xu, LY.; Li, EM.; Au, WW. (Mar 2011). "Infection and integration of human papillomavirus in esophageal carcinoma.". Int J Hyg Environ Health 214 (2): 156-61. doi:10.1016/j.ijheh.2010.11.001. PMID 21130683.

[pmid21169053-8] Iyer, A.; Rajendran, V.; Adamson, CS.; Peng, Z.; Cooper, K.; Evans, MF. (Mar 2011). "Human papillomavirus is detectable in Barrett's esophagus and esophageal carcinoma but is unlikely to be of any etiologic significance.". J Clin Virol 50 (3): 205-8. doi:10.1016/j.jcv.2010.11.015. PMID 21169053.

[pmid15551313-9] 9.0 ^9.1 De Boer, MA.; Peters, LA.; Aziz, MF.; Siregar, B.; Cornain, S.; Vrede, MA.; Jordanova, ES.; Fleuren, GJ. (Apr 2005). "Human papillomavirus type 18 variants: histopathology and E6/E7 polymorphisms in three countries.". Int J Cancer 114 (3): 422-5. doi:10.1002/ijc.20727. PMID 15551313.

[pmid21942919-10] McCormack, PL.; Joura, EA. (Oct 2011). "Spotlight on Quadrivalent Human Papillomavirus(Types 6, 11, 16, 18) Recombinant Vaccine(Gardasil®) in the Prevention of PremalignantGenital Lesions, Genital Cancer, and Genital Warts in Women†.". BioDrugs 25 (5): 339-43. doi:10.2165/11205060-000000000-00000. PMID 21942919.

[11] URL: http://www.pathguy.com/lectures/infect.htm. Accessed on: 8 July 2010.

[12] URL:http://www.medscape.com/viewarticle/438534_2. Accessed on: 8 July 2010.

[pmid12704581-13] Schwimmer, JA.; Markowitz, GS.; Valeri, A.; Appel, GB. (Mar 2003). "Collapsing glomerulopathy.". Semin Nephrol 23 (2): 209-18. doi:10.1053/snep.2003.50019. PMID 12704581.

[pmid46024-14] Cossart, YE.; Field, AM.; Cant, B.; Widdows, D. (Jan 1975). "Parvovirus-like particles in human sera.". Lancet 1 (7898): 72-3. PMID 46024.

[pmid17304869-15] Servey JT, Reamy BV, Hodge J (February 2007). "Clinical presentations of parvovirus B19 infection". Am Fam Physician 75 (3): 373–6. PMID 17304869. http://www.aafp.org/afp/991001ap/1455.html.

[16] URL: http://www.pathguy.com/lectures/infect.htm. Accessed on: 8 July 2010.

[17] URL:http://info.fujita-hu.ac.jp/~tsutsumi/case/case210.htm. Accessed on: 8 February 2011.

[18] URL: http://www.scielo.br/scielo.php?pid=S0036-46652007000200007&script=sci_arttext. Accessed on: 18 August 2011.

[19] URL: http://www.meddean.luc.edu/lumen/MedEd/orfpath/herpes.htm. Accessed on: 14 April 2011.

[Ref_PCPBoD8_169-20] Mitchell, Richard; Kumar, Vinay; Fausto, Nelson; Abbas, Abul K.; Aster, Jon (2011). Pocket Companion to Robbins & Cotran Pathologic Basis of Disease (8th ed.). Elsevier Saunders. pp. 169. ISBN 978-1416054542.

[pmid8880205-21] McClain, KL.; Joshi, VV.; Murphy, SB. (Oct 1996). "Cancers in children with HIV infection.". Hematol Oncol Clin North Am 10 (5): 1189-201. PMID 8880205.

[pmid20819601-22] Jin YK, Xie ZD, Yang S, Lu G, Shen KL (June 2010). "Epstein-Barr virus-associated hemophagocytic lymphohistiocytosis: a retrospective study of 78 pediatric cases in mainland of China". Chin. Med. J. 123 (11): 1426–30. PMID 20819601.

[23] Sampson, BA.; Ambrosi, C.; Charlot, A.; Reiber, K.; Veress, JF.; Armbrustmacher, V. (May 2000). "The pathology of human West Nile Virus infection.". Hum Pathol 31 (5): 527-31. PMID 10836291.

[24] URL: http://path.upmc.edu/cases/case595/dx.html. Accessed on: 26 January 2012.

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@@ Line 59: / Line 59: @@
 **[http://commons.wikimedia.org/wiki/File:CMV_placentitis2_mini.jpg CMV placentitis (WC)].
 *www:
-**[http://www.asm.org/division/c/photo/cmv1.jpg CMV (asm.org)].
+**[http://www.asm.org/division/c/photo/cmv1.jpg CMV - owl's eye-like (asm.org)].
 **[http://path.upmc.edu/cases/case149.html CMV - case 1 - several images (upmc.edu)].
 **[http://path.upmc.edu/cases/case481.html CMV - case 2 - several images (upmc.edu)].

Difference between revisions of "Viruses"

Revision as of 03:48, 12 April 2012

Viral inclusions - types

Viruses

Herpes simplex virus

General

Histology/cytology

Cytomegalovirus

General

Microscopic

IHC

Human papillomavirus

General

Microscopic

IHC

Adenovirus

General

Microscopic

Parvovirus

General

Microscopic

Epstein-Barr virus

General

Associations

Microscopic

IHC

Polyomavirus

Human herpesvirus-8

General

Microscopic

IHC

West Nile virus

General

Microscopic

Measles virus

General

Microscopic

See also

References

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