Schwartz D A, Wilcox C M
Department of Pathology, Emory University School of Medicine, Atlanta, GA.
Hum Pathol. 1992 Sep;23(9):1019-26. doi: 10.1016/0046-8177(92)90263-3.
Cytomegalovirus (CMV) infection of the gastrointestinal tract is a common cause of morbidity and mortality in the acquired immunodeficiency syndrome. The proper recognition of CMV-infected cells in gastrointestinal mucosal biopsies is critical so that effective therapy is not delayed, preventing further viral dissemination. Although the pathology criteria for classic CMV inclusions have been well described, the occurrence of morphologically atypical inclusions has been reported but the inclusions are not well characterized. This study prospectively examined the relative frequency of classic and atypical CMV inclusions in gastrointestinal mucosal biopsy specimens from 13 human immunodeficiency virus-positive symptomatic patients. The results demonstrated that classic inclusions were rarely found, including four esophageal, one gastric, and one colonic biopsy specimens in which none were seen. However, atypical CMV inclusions were identified from all biopsy specimens examined; these inclusions were much more numerous than classic inclusions and could be categorized into three morphologic types. The atypical inclusions were difficult to precisely identify as CMV-infected cells, but in situ DNA hybridization for CMV was valuable in establishing their viral origin, thus permitting the correct etiologic diagnosis.
胃肠道巨细胞病毒（CMV）感染是获得性免疫缺陷综合征发病和死亡的常见原因。正确识别胃肠道黏膜活检中的CMV感染细胞至关重要，这样才能不延误有效治疗，防止病毒进一步传播。尽管经典CMV包涵体的病理学标准已得到充分描述，但形态学非典型包涵体的出现已有报道，但这些包涵体的特征并不明确。本研究前瞻性地检查了13例有症状的人类免疫缺陷病毒阳性患者胃肠道黏膜活检标本中经典和非典型CMV包涵体的相对频率。结果表明，经典包涵体很少见，包括4例食管活检标本、1例胃活检标本和1例结肠活检标本，均未发现经典包涵体。然而，在所有检查的活检标本中均发现了非典型CMV包涵体；这些包涵体比经典包涵体多得多，可分为三种形态学类型。非典型包涵体很难准确鉴定为CMV感染细胞，但CMV原位DNA杂交对于确定其病毒来源很有价值，从而可以做出正确的病因诊断。
