Department of Pathology and Laboratory Medicine, Cedars-Sinai Medical Center, Los Angeles, CA, USA.
Department of Pathology, The Johns Hopkins Hospital, Baltimore, MD, USA.
Histopathology. 2021 Feb;78(3):392-400. doi: 10.1111/his.14232. Epub 2020 Oct 14.
Recent studies from multiple global regions have reported a resurgence of lymphogranuloma venereum (LGV) proctitis, which is caused by Chlamydia trachomatis (CT). LGV proctitis is histologically indistinguishable from other forms of sexually transmitted proctitis and is difficult to differentiate from inflammatory bowel disease. While immunohistochemical stains are available for syphilis, there is no commonly available stain for the tissue identification of CT.
From 200 positive CT nucleic acid tests (NAT) from anorectal swabs, we identified 12 patients with biopsies collected from the distal colorectum or anus within 90 days of the positive NAT. We collected basic demographic information and tabulated clinical and histological findings. We examined the performance of a novel RNA in-situ hybridisation (ISH) stain targeting CT 23s rRNA on these 12 cases and 10 controls from the anorectum.
All 12 patients were male; nine were HIV+, two had concurrent gonococcal infection, one had concurrent syphilis and one had cytomegalovirus co-infection. The majority of biopsies (11 of 12) showed mild or moderate acute inflammation, had a prominent lymphoplasmacytic infiltrate (eight of 11) and lacked marked crypt distortion (10 of 10). The RNA ISH stain was positive in 10 of 12 cases (sensitivity 83%). One case showed equivocal staining. No controls showed definitive positive staining (specificity 100%). One had equivocal staining.
Our series showed that anorectal LGV had similar histological findings to those of prior STI proctitis series predominantly comprised of syphilis. The novel RNA ISH stain was sensitive and specific and may show utility in differentiating types of STI proctitis.
最近来自多个全球地区的研究报告称，淋球菌肉芽肿性直肠炎（LGV）再次流行，该病由沙眼衣原体（CT）引起。LGV 直肠炎在组织学上与其他形式的性传播直肠炎无法区分，并且难以与炎症性肠病区分。虽然有用于梅毒的免疫组织化学染色，但没有用于 CT 组织鉴定的常用染色。
从直肠拭子的 120 例 CT 核酸检测（NAT）阳性中，我们确定了 12 例在阳性 NAT 后 90 天内从远端结直肠或肛门采集活检的患者。我们收集了基本的人口统计学信息，并列出了临床和组织学发现。我们检查了针对 CT 23s rRNA 的新型 RNA 原位杂交（ISH）染色在这 12 例病例和 10 例肛门对照中的表现。
所有 12 例患者均为男性；9 例 HIV 阳性，2 例合并淋球菌感染，1 例合并梅毒，1 例合并巨细胞病毒合并感染。大多数活检（12 例中的 11 例）显示轻度或中度急性炎症，有明显的淋巴浆细胞浸润（11 例中的 8 例），缺乏明显的隐窝变形（10 例中的 10 例）。10 例中的 12 例（敏感性 83%）RNA ISH 染色阳性。1 例呈不确定染色。无对照显示明确的阳性染色（特异性 100%）。1 例呈不确定染色。
我们的系列研究表明，肛门直肠 LGV 的组织学表现与先前主要由梅毒组成的性传播直肠炎系列相似。新型 RNA ISH 染色具有敏感性和特异性，可能有助于区分不同类型的性传播直肠炎。
