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Cytomegalovirus
Published in Avindra Nath, Joseph R. Berger, Clinical Neurovirology, 2020
When available, histopathologic examination of samples of brain, spinal cord, or peripheral nerve can also help establish CMV as the etiology of neurologic diseases (Figure 8.2) [51,81]. Infection can be confirmed by the detection of classic histopathologic findings on tissue specimens. The finding of intranuclear inclusions with an “Owl’s eye” appearance is characteristic of CMV and the viral infection can be confirmed with specific stains for viral antigens. Detection of viral antigen or genome in the biopsied tissues, as evidenced by immunofluorescence with monoclonal antibodies and hybridization techniques establishes infection and further supports the identification of CMV as the likely etiology of the patient’s clinical syndrome. Biopsy of peripheral nerves in mononeuritis multiplex or peripheral neuropathy is not routinely performed but can reveal evidence of virions or characteristic pathologic abnormalities in the involved nerves. Electron microscopy (EM) can also demonstrate the presence of viral particles in infected cells (Figure 8.5).
Hodgkin Lymphoma
Published in Dongyou Liu, Tumors and Cancers, 2017
Representing a clonal population, HRSC (20–60 µm in diameter) is a bi- or multi nucleated giant cell with a bilobed nucleus and two large acidophilic nucleoli (a characteristic owl’s eye appearance). Despite its B-cell origin, HRSC has lost much of the B-cell-specific markers, with a typical immunophenotype of CD15+, CD20–, CD30+, and CD45–. HRSC synthesizes TNF-R, produces T helper lymphocytes type 2 (Th2) cytokines and chemokines (e.g., IL-5, IL-7, IL-8, IL-9, CCL-5, CCL-17, CCL-20, and CCL-22), and also expresses a broad range of receptors (e.g., CD30, CD40, IL-7R, IL-9R, IL-13R, TACI, and CCR5). LPC differs from HRSC by its possession of a single, multilobulated, or round nucleus and possesses a typical immunophenotype of CD15–, CD20+, CD30–, and CD45+, suggesting that NLPHL is biologically distinct from CHL [3].
Lymph Node
Published in Wojciech Gorczyca, Atlas of Differential Diagnosis in Neoplastic Hematopathology, 2014
Infectious mononucleosis shows paracortical hyperplasia, focal follicular hyperplasia, and sinus histiocytosis with heterogeneous lymphohistiocytic infiltrate including larger lymphocytes with nucleoli (immunoblasts), plasma cells, eosinophils, and histiocytes (tingible body macrophages). Some follicles may show features of apoptosis and necrosis. Increased numbers of immunoblasts or the presence of large, R–S like cells may resemble DLBCL and HL, respectively, especially in minute core biopsy. The presence of a preserved (albeit distorted) architecture and a heterogeneous B- and T-cell lymphoid population with a spectrum of small, medium, and large cells; reactive follicles; and EBV positivity helps to differentiate infectious mononucleosis from lymphoma. The staining with CD30 by immunoblasts is often weak in contrast to strong membranous and Golgi staining in R–S cells. In addition, reactive immunoblasts are negative for CD15 and positive for CD45. Clinical follow-up with repeated biopsy and/or molecular testing for B-cell clonality may help in difficult cases (e.g., to exclude EBV-associated large B-cell lymphoma). CMV lymphadenitis usually shows changes similar to those of EBV lymphadenitis. Clusters of B cells with a monocytoid appearance may be present. Typical CMV-infected cells have an “owl’s eye” appearance due to viral inclusion within enlarged nuclei.
Cytomegalovirus enteritis with intractable diarrhea in infants from a tertiary care center in China
Published in Scandinavian Journal of Gastroenterology, 2020
Yuhuan Wang, Zhiheng Huang, Ziqing Ye, Cuifang Zheng, Zhinong Jiang, Ying Huang
For children with refractory diarrhea, CMV-colitis should be considered as a differential diagnosis, and appropriate investigations should be conducted. Blood serology for CMV IgG antibody has no diagnostic value for CMV colitis. The CMV IgM antibody and plasma CMV PCR are helpful in diagnosing CMV infection. However, the blood test cannot replace invasive endoscopic procedures for the pathological confirmation of CMV colitis. The gold standard for diagnosing CMV tissue-invasive disease is the identification of CMV inclusions or positive CMV-specific IHC staining on histopathology [25]. The presence of ‘owl eye appearance’ inclusions in the intestine tissue is highly specific for CMV colitis. However, pathological confirmation has a lower sensitivity compared with IHC and tissue polymerase chain reaction. The gold standard for the detection of CMV in GI mucosal biopsies is CMV-specific IHC.