Sun Jing, Malhotra Reenu, Ananthakrishnan Lakshmi, Gopal Purva
Department of Pathology, University of Texas Southwestern Medical Center, Dallas, TX, USA.
Propath, Dallas, TX, USA.
Case Rep Pathol. 2023 Jul 27;2023:6947960. doi: 10.1155/2023/6947960. eCollection 2023.
We describe two cases of rectal herpes simplex virus (HSV) infection in men that clinically mimicked rectal adenocarcinoma. Herpes infection in this location more commonly presents as an anal mass with viral inclusions in squamous epithelial cells. We report these cases to increase awareness of the unusual presentation as a proximal rectal mass with viral inclusions in endothelial cell nuclei. One patient was HIV-positive, and the other one had a history of having sex with men (MSM). Both patients had a thickened rectal wall with prominent lymphadenopathy on computed tomography (CT) scan, suspecting for malignancy. Biopsy showed abundant granulation tissue, necrosis, and inflammatory infiltrate composed predominantly of lymphocytes with admixed numerous plasma cells, eosinophils, and neutrophils. Rare granulation tissue vessels were lined by endothelial cells with nuclear molding and chromatin margination, and nuclei that were positive for HSV immunohistochemistry (IHC). One patient had confirmatory viral culture from biopsy of the ulcerated rectal mass. Both patients had symptom resolution following treatment for HSV. HSV should be considered in the differential diagnosis of rectal inflammatory masses, particularly in immunocompromised, HIV-positive, and MSM patients.
我们描述了两例男性直肠单纯疱疹病毒（HSV）感染病例，其临床表现酷似直肠腺癌。该部位的疱疹感染更常见的表现是出现肛门肿物，鳞状上皮细胞中有病毒包涵体。我们报告这两例病例，以提高对这种不寻常表现的认识，即近端直肠肿物且内皮细胞核中有病毒包涵体。一名患者为HIV阳性，另一名有男男性行为（MSM）史。两名患者的直肠壁均增厚，计算机断层扫描（CT）显示有明显的淋巴结病，怀疑为恶性肿瘤。活检显示有大量肉芽组织、坏死及炎症浸润，主要由淋巴细胞组成，并混有大量浆细胞、嗜酸性粒细胞和中性粒细胞。罕见的肉芽组织血管由内皮细胞衬里，有核塑形和染色质边集，且细胞核HSV免疫组化（IHC）呈阳性。一名患者经对溃疡直肠肿物活检进行病毒培养得到确诊。两名患者经HSV治疗后症状均缓解。在直肠炎性肿物的鉴别诊断中应考虑HSV，尤其是在免疫功能低下、HIV阳性和MSM患者中。
