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| This article deals with '''viruses'''. The more general topic of infective things is dealt with in [[microorganisms]]. | | 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. | | Many viruses afflict humans. Only a few of them can be diagnosed histologically. |
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| | [[cancer viruses|Several viruses cause cancer]] and seen directly or indirectly by pathologists frequently. |
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| ==Viral inclusions - types== | | ==Viral inclusions - types== |
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| Mnemonic - 3 Ms: Margination, Multinucleation, Molding. | | Mnemonic - 3 Ms: Margination, Multinucleation, Molding. |
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| | ====Images==== |
| | www: |
| | *[http://www.virology.org/sbpgphoto2.html Herpes simplex virus - multinucleation (virology.org)]. |
| | <gallery> |
| | Image:Herpes_simplex_virus_pap_test.jpg | HSV on a Pap test - showing multinucleation. (WC) |
| | Image:Herpes_esophagitis_-_very_high_mag.jpg | HSV esophagitis - very high mag. (WC) |
| | Image:Herpes_esophagitis_-_intermed_mag.jpg | HSV esophagitis - intermed. mag. (WC) |
| | </gallery> |
| | |
| | ===IHC=== |
| | *HSV-1 +ve (cytoplasmic and strong nuclear). |
| | *HSV-2 +ve. |
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| Images: | | Images: |
| *[http://www.virology.org/sbpgphoto2.html Herpes simplex virus - multinucleation (virology.org)]. | | *[http://path.upmc.edu/cases/case120/images/d-1.jpg HSV-1 staining (upmc.edu)].<ref>URL: [http://path.upmc.edu/cases/case120/dx.html http://path.upmc.edu/cases/case120/dx.html]. Accessed on: 28 February 2013.</ref> |
| *[http://commons.wikimedia.org/wiki/File:Herpes_simplex_virus_pap_test.jpg HSV on a Pap test - showing multinucleation (WC)].
| | *[http://www.antibodies-online.com/media/57/images/anti-Herpes+Simplex+Virus+1+HSV1+antibody_original_rp018.jpg HSV-1 staining (antibodies-online.com)].<ref>URL: [http://www.antibodies-online.com/antibody/100405/anti-Herpes+Simplex+Virus+1+HSV1/ http://www.antibodies-online.com/antibody/100405/anti-Herpes+Simplex+Virus+1+HSV1/]. Accessed on: 28 February 2013.</ref> |
| *[http://commons.wikimedia.org/wiki/File:Herpes_esophagitis_-_very_high_mag.jpg HSV esophagitis - very high mag. (WC)]. | |
| *[http://commons.wikimedia.org/wiki/File:Herpes_esophagitis_-_intermed_mag.jpg HSV esophagitis - intermed. mag. (WC)].
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| ==Cytomegalovirus== | | ==Cytomegalovirus== |
| *Abbreviated ''CMV''. | | *Abbreviated ''CMV''. |
| :''For pneumonia caused by CMV - see [[Cytomegalovirus pneumonia]]''. | | :''For pneumonia caused by CMV - see [[Cytomegalovirus pneumonia]]''. |
| | :''For colitis caused by CMV - see [[Cytomegalovirus colitis]]''. |
| ===General=== | | ===General=== |
| *The name comes from the microscopic appearance. | | *The name comes from the microscopic appearance. |
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| **In the context of [[esophagus|esophageal ulcers]], it is therefore useful to biopsy the base of the ulcer - if this is suspected. | | **In the context of [[esophagus|esophageal ulcers]], it is therefore useful to biopsy the base of the ulcer - if this is suspected. |
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| Images: | | ====Images==== |
| *[[WC]]:
| | <gallery> |
| **[http://commons.wikimedia.org/wiki/File:CMV_placentitis2_mini.jpg CMV placentitis (WC)].
| | Image:CMV_placentitis2_mini.jpg | CMV [[acute villitis|placentitis]]. (WC) |
| *www:
| | File:Cmv neuronal inclusions.jpg | CMV [[encephalitis]]. (WC) |
| **[http://www.asm.org/division/c/photo/cmv1.jpg CMV - owl's eye-like (asm.org)].
| | </gallery> |
| **[http://path.upmc.edu/cases/case149.html CMV - case 1 - several images (upmc.edu)].
| | www: |
| **[http://path.upmc.edu/cases/case481.html CMV - case 2 - several images (upmc.edu)].
| | *[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)]. |
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| ===IHC=== | | ===IHC=== |
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| ==Human papillomavirus== | | ==Human papillomavirus== |
| *Abbreviated ''HPV''. | | *Abbreviated ''HPV''. |
| | | {{Main|Human papillomavirus}} |
| ===General===
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| *Sexually transmitted.
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| ====Associated pathology====
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| *Benign:
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| **[[Verruca vulgaris]].
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| **[[Condyloma acuminatum]].
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| **[[Esophagus#Human_papilloma_virus_esophagitis|HPV esophagitis]].
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| *Malignant:
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| *#[[Uterine cervix|Cervical cancer]] and precursors ([[LSIL]], [[HSIL]]).
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| *#Anal cancer and precursors ([[Anus#Anal_intraepithelial_neoplasia|AIN]]).<ref name=pmid21616117>{{Cite journal | last1 = Borget | first1 = I. | last2 = Abramowitz | first2 = L. | last3 = Mathevet | first3 = P. | title = Economic burden of HPV-related cancers in France. | journal = Vaccine | volume = 29 | issue = 32 | pages = 5245-9 | month = Jul | year = 2011 | doi = 10.1016/j.vaccine.2011.05.018 | PMID = 21616117 }}</ref>
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| *#[[Vulva|Vulvar cancer]]].<ref name=pmid21616117/>
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| *#[[Vagina|Vaginal cancer]].<ref name=pmid21616117/>
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| *#[[Penis|Penile cancer]].<ref name=pmid21616117/>
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| *#[[HPV-associated head and neck squamous cell carcinoma]] - oropharynx (specifically - tonsils, base of tongue).
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| **Possibly esophageal carcinoma<ref name=pmid21130683>{{Cite journal | last1 = Zhang | first1 = QY. | last2 = Zhang | first2 = DH. | last3 = Shen | first3 = ZY. | last4 = Xu | first4 = LY. | last5 = Li | first5 = EM. | last6 = Au | first6 = WW. | title = Infection and integration of human papillomavirus in esophageal carcinoma. | journal = Int J Hyg Environ Health | volume = 214 | issue = 2 | pages = 156-61 | month = Mar | year = 2011 | doi = 10.1016/j.ijheh.2010.11.001 | PMID = 21130683 }}</ref> - disputed.<ref name=pmid21169053>{{Cite journal | last1 = Iyer | first1 = A. | last2 = Rajendran | first2 = V. | last3 = Adamson | first3 = CS. | last4 = Peng | first4 = Z. | last5 = Cooper | first5 = K. | last6 = Evans | first6 = MF. | title = Human papillomavirus is detectable in Barrett's esophagus and esophageal carcinoma but is unlikely to be of any etiologic significance. | journal = J Clin Virol | volume = 50 | issue = 3 | pages = 205-8 | month = Mar | year = 2011 | doi = 10.1016/j.jcv.2010.11.015 | PMID = 21169053 }}</ref>
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| ====Oncocytic types====
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| *HPV 18 - predominantly adenocarcinoma.<ref name=pmid15551313>{{Cite journal | last1 = De Boer | first1 = MA. | last2 = Peters | first2 = LA. | last3 = Aziz | first3 = MF. | last4 = Siregar | first4 = B. | last5 = Cornain | first5 = S. | last6 = Vrede | first6 = MA. | last7 = Jordanova | first7 = ES. | last8 = Fleuren | first8 = GJ. | title = Human papillomavirus type 18 variants: histopathology and E6/E7 polymorphisms in three countries. | journal = Int J Cancer | volume = 114 | issue = 3 | pages = 422-5 | month = Apr | year = 2005 | doi = 10.1002/ijc.20727 | PMID = 15551313 }}</ref>
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| **'''Eigh'''teen = '''a'''denocarcinoma.
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| *HPV 16 - predominantly squamous cell carcinoma.<ref name=pmid15551313/>
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| **'''S'''ixteen = '''s'''quamous.
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| ====Oncogenesis====
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| Quick & dirty explanation of pathogenesis:<ref name=pmid12445661>{{Cite journal | last1 = Münger | first1 = K. | last2 = Howley | first2 = PM. | title = Human papillomavirus immortalization and transformation functions. | journal = Virus Res | volume = 89 | issue = 2 | pages = 213-28 | month = Nov | year = 2002 | doi = | PMID = 12445661 }}</ref><ref name=Ref_PCPBoD8_169>{{Ref PCPBoD8|169}}</ref>
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| *Virus integrates into host genome.
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| **This is accompanied by loss of ''viral gene E2'' (which suppresses function of E6 & E7).
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| *''Viral gene E6'' dysregulates ''p53''.
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| *''Viral gene E7'' dysregulates ''RB''.
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| ====Vaccine====
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| Recombinant vaccine (Gardasil, Silgard) - covers:<ref name=pmid21942919>{{Cite journal | last1 = McCormack | first1 = PL. | last2 = Joura | first2 = EA. | title = 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†. | journal = BioDrugs | volume = 25 | issue = 5 | pages = 339-43 | month = Oct | year = 2011 | doi = 10.2165/11205060-000000000-00000 | PMID = 21942919 }}</ref>
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| *HPV 6.
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| *HPV 11.
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| *HPV 16.
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| *HPV 18.
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| ===Microscopic===
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| Features:
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| *Koilocytes:
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| ** Perinuclear clearing.
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| ** Nuclear changes.
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| *** Size similar (or larger) to those in the basal layer of the epithelium.
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| *** Nuclear enlargement should be evident on low power, i.e. 25x.
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| *** Central location - nucleus should be smack in the middle of the cell.
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| Images:
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| *[http://commons.wikimedia.org/w/index.php?title=File:Low-grade_squamous_intraepithelial_lesion.jpg LSIL (WC)].
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| *[http://commons.wikimedia.org/wiki/File:Low-grade_sil_and_endocx.jpg LSIL & endocervix (WC)].
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| ===IHC===
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| *p16 +ve -- stains most cells infected by HPV.
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| ==Adenovirus== | | ==Adenovirus== |
| ===General=== | | ===General=== |
| *Common in kids. | | *Common in kids - usually a mild respiratory infection with fever and pharyngitis. |
| | **Can cause post-infectious [[bronchiolitis obliterans]].<ref name=pmid20717912>{{Cite journal | last1 = Aguerre | first1 = V. | last2 = Castaños | first2 = C. | last3 = Pena | first3 = HG. | last4 = Grenoville | first4 = M. | last5 = Murtagh | first5 = P. | title = Postinfectious bronchiolitis obliterans in children: clinical and pulmonary function findings. | journal = Pediatr Pulmonol | volume = 45 | issue = 12 | pages = 1180-5 | month = Dec | year = 2010 | doi = 10.1002/ppul.21304 | PMID = 20717912 }}</ref> |
| **May be seen in the context of [[adenovirus appendicitis|(adenovirus) appendicitis]]. | | **May be seen in the context of [[adenovirus appendicitis|(adenovirus) appendicitis]]. |
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| *Nuclear enlargement. | | *Nuclear enlargement. |
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| Images: | | ====Images==== |
| *[[WC]]:
| | <gallery> |
| **[http://commons.wikimedia.org/wiki/File:Parvovirus_infection_-_cropped_2_-_very_high_mag.jpg Parvovirus - version 1 - very high mag. (WC)].
| | Image:Parvovirus_infection_-_cropped_2_-_very_high_mag.jpg | Parvovirus - version 1 - very high mag. (WC) |
| **[http://commons.wikimedia.org/wiki/File:Parvovirus_infection_-_cropped_1_-_very_high_mag.jpg Parvovirus - version 2 - very high mag. (WC)].
| | Image:Parvovirus_infection_-_cropped_1_-_very_high_mag.jpg | Parvovirus - version 2 - very high mag. (WC) |
| *www:
| | </gallery> |
| **[http://info.fujita-hu.ac.jp/~tsutsumi/photo/photo210-1.htm Parvovirus (fujita-hu.ac.jp)].<ref>URL:[http://info.fujita-hu.ac.jp/~tsutsumi/case/case210.htm http://info.fujita-hu.ac.jp/~tsutsumi/case/case210.htm]. Accessed on: 8 February 2011.</ref>
| | www: |
| **[http://www.scielo.br/img/revistas/rimtsp/v49n2/07f1a.jpg Parvovirus - placenta - (scielo.br)].<ref>URL: [http://www.scielo.br/scielo.php?pid=S0036-46652007000200007&script=sci_arttext http://www.scielo.br/scielo.php?pid=S0036-46652007000200007&script=sci_arttext]. Accessed on: 18 August 2011.</ref>
| | *[http://info.fujita-hu.ac.jp/~tsutsumi/photo/photo210-1.htm Parvovirus (fujita-hu.ac.jp)].<ref>URL:[http://info.fujita-hu.ac.jp/~tsutsumi/case/case210.htm http://info.fujita-hu.ac.jp/~tsutsumi/case/case210.htm]. Accessed on: 8 February 2011.</ref> |
| **[http://www.fujita-hu.ac.jp/~tsutsumi/case/case219.htm Parvovirus - several images (fujita-hu.ac.jp)].
| | *[http://www.scielo.br/img/revistas/rimtsp/v49n2/07f1a.jpg Parvovirus - placenta - (scielo.br)].<ref>URL: [http://www.scielo.br/scielo.php?pid=S0036-46652007000200007&script=sci_arttext http://www.scielo.br/scielo.php?pid=S0036-46652007000200007&script=sci_arttext]. Accessed on: 18 August 2011.</ref> |
| | *[http://www.fujita-hu.ac.jp/~tsutsumi/case/case219.htm Parvovirus - several images (fujita-hu.ac.jp)]. |
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| ==Epstein-Barr virus== | | ==Epstein-Barr virus== |
| *Abbreviated ''EBV''
| | {{Main|Epstein-Barr virus}} |
| ===General===
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| *Cases [[mononucleosis]].
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| *Part of the herpes group of viruses.<ref>URL: [http://www.meddean.luc.edu/lumen/MedEd/orfpath/herpes.htm http://www.meddean.luc.edu/lumen/MedEd/orfpath/herpes.htm]. Accessed on: 14 April 2011.</ref>
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| Note:
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| *The virus is ''Epstein''... the tricuspid abnormality is ''[[Ebstein anomaly|Ebstein]]''.
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| ====Associations====
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| Cancer:<ref name=Ref_PCPBoD8_169>{{Ref PCPBoD8|169}}</ref>
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| *Classical [[Hodgkin lymphoma]].
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| *[[Burkitt lymphoma]].
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| *[[Nasopharyngeal carcinoma]].
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| *B cell lymphomas -- in immunosuppressed individuals.
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| **[[Post-transplant lymphoproliferative disorder]].
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| *[[Leiomyoma]] and [[leiomyosarcoma]] in the context of [[HIV]].<ref name=pmid8880205>{{Cite journal | last1 = McClain | first1 = KL. | last2 = Joshi | first2 = VV. | last3 = Murphy | first3 = SB. | title = Cancers in children with HIV infection. | journal = Hematol Oncol Clin North Am | volume = 10 | issue = 5 | pages = 1189-201 | month = Oct | year = 1996 | doi = | PMID = 8880205 }}</ref>
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| Other:
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| *[[Hemophagocytic syndrome]].<ref name=pmid20819601>{{cite journal |author=Jin YK, Xie ZD, Yang S, Lu G, Shen KL |title=Epstein-Barr virus-associated hemophagocytic lymphohistiocytosis: a retrospective study of 78 pediatric cases in mainland of China |journal=Chin. Med. J. |volume=123 |issue=11 |pages=1426–30 |year=2010 |month=June |pmid=20819601 |doi= |url=}}</ref>
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| ===Microscopic===
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| Features:
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| *Variable - see specific pathologies in ''Associations'' section.
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| **+/-Atypical lymphocytes.
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| **+/-Hemophagocytosis (uncommon).
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| Images:
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| *[http://path.upmc.edu/cases/case526.html EBV-associated gastritis (upmc.edu)].
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| ===IHC===
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| *EBER +ve -- in situ hybridization.
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| *Mixed population of CD3 & CD20 -- in benign.
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| ==Polyomavirus== | | ==Polyomavirus== |
| May refer to:
| | {{Main|Polyomavirus}} |
| #BK virus.
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| #*See: ''[[Polyomavirus nephropathy]]'' and ''[[Urine_cytopathology#Human_polyoma_infection]].
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| #Merkel cell polyomavirus.
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| #*See: ''[[Merkel cell carcinoma]]''.
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| #JC virus.
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| #*See: ''[[Progressive multifocal leukoencephalopathy]]''.
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| ==Human herpesvirus-8== | | ==Human herpesvirus-8== |
| *Commonly abbreviated ''HHV-8''.
| | {{Main|Human herpesvirus-8}} |
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| ===General===
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| Associated with a number of cancers:
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| *[[Kaposi sarcoma]].
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| *Primary effusion lymphoma.
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| *Body cavity lymphoma.
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| *[[DLBCL|LBCL]] arising in HHV-8 associated multicentric [[Castleman disease]].
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| Other:
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| *[[Castleman disease]], plasma cell variant.
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| ===Microscopic===
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| *No light microscopic changes.
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| ===IHC===
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| *Usually HHV-8 +ve.
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| ==West Nile virus== | | ==West Nile virus== |
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| ==Measles virus== | | ==Measles virus== |
| ===General=== | | ===General=== |
| | *Causes ''Measles''. |
| | **Should '''not''' be confused with ''Rubella'' ([[AKA]] ''German measles''). |
| | *Uncommon due to widespread MMR vaccine. |
| | **However increasing in the last years most likely due to insufficient vaccination. |
| | *May develop weeks to years after infection. |
| *Illness may be complicated by ''subacute sclerosing panencephalitis'' (SSPE) - a chronic neurodegenerative condition.<ref>URL: [http://path.upmc.edu/cases/case595/dx.html http://path.upmc.edu/cases/case595/dx.html]. Accessed on: 26 January 2012.</ref> | | *Illness may be complicated by ''subacute sclerosing panencephalitis'' (SSPE) - a chronic neurodegenerative condition.<ref>URL: [http://path.upmc.edu/cases/case595/dx.html http://path.upmc.edu/cases/case595/dx.html]. Accessed on: 26 January 2012.</ref> |
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| *+/-Intranuclear Cowdry type A inclusions. | | *+/-Intranuclear Cowdry type A inclusions. |
| **Glassy (pink) nucleus. | | **Glassy (pink) nucleus. |
| *Lymphocytes and microglial cells. | | *Lymphocytes and macrophages (microglial cells). |
| | **May be mild in in measles inclusion body encephalitis. |
| | *Multinucleated cells. |
| | *Microglial nodules. |
| *Demyelination. | | *Demyelination. |
| | *Gliosis. |
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| | Notes: |
| | *Measles inclusions are intranuclear. RSV inclusions are intracytoplasmic.{{fact}} |
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| Images: | | ====Images==== |
| | <gallery> |
| | Image:Morbillo.jpg | Measles pneumonia. (WC/CDC) |
| | </gallery> |
| *[http://path.upmc.edu/cases/case595.html SSPE - several images (upmc.edu)]. | | *[http://path.upmc.edu/cases/case595.html SSPE - several images (upmc.edu)]. |
| | |
| | ==Rabies virus== |
| | ===General=== |
| | *Causes rabies. |
| | |
| | Virus affects:<ref>{{Ref APBR|424 Q36}}</ref> |
| | *Cerebral cortex. |
| | *Hippocamus pyramidal cells. |
| | *Purkinje cells. |
| | |
| | ===Microscopic=== |
| | Features: |
| | *[[Negri bodies]]: |
| | **Dense-appearing eosinophilic cytoplasmic bodies with a pale halo. |
| | |
| | ====Images==== |
| | <gallery> |
| | Image:Rabies_encephalitis_Negri_bodies_PHIL_3377_lores.jpg | Negri bodies. (WC/CDC) |
| | Image:Rabies_Virus_EM_PHIL_1876.JPG | Negri bodies - EM. (WC) |
| | File:Rabies negri bodies brain.jpg | Negri bodies in cerebellar Purkinje cells. (WC/CDC). |
| | </gallery> |
| | www: |
| | *[http://www.nature.com/modpathol/journal/v18/n1/fig_tab/3800274f1.html#figure-title Rabies encephalitis (nature.com)].<ref name=pmid15389258>{{Cite journal | last1 = Nuovo | first1 = GJ. | last2 = Defaria | first2 = DL. | last3 = Chanona-Vilchi | first3 = JG. | last4 = Zhang | first4 = Y. | title = Molecular detection of rabies encephalitis and correlation with cytokine expression. | journal = Mod Pathol | volume = 18 | issue = 1 | pages = 62-7 | month = Jan | year = 2005 | doi = 10.1038/modpathol.3800274 | PMID = 15389258 | url = http://www.nature.com/modpathol/journal/v18/n1/full/3800274a.html}}</ref> |
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| =See also= | | =See also= |