Department of Pathology, Emory University, Atlanta, GA, US.
Department of Medicine, Division of Infectious Diseases, Emory University, Atlanta, GA, US.
Am J Clin Pathol. 2024 Jan 4;161(1):9-15. doi: 10.1093/ajcp/aqad102.
Mpox is a viral disease caused by monkeypox, a highly contagious orthopoxvirus that resulted in a global outbreak beginning in spring 2022. Diagnosis is confirmed via polymerase chain reaction (PCR) testing of swabs from mucocutaneous lesions. Rare reports have documented the histologic changes of mpox lesions, but the cytologic features have not been described. We present the cytology findings of samples taken from swabs of mucocutaneous mpox lesions in 3 different patients.
The patients were all male, aged 55, 43, and 37 years, all with mpox confirmed by PCR testing. Swabs from chest (cases 1 and 2) and tongue (case 3) lesions were directly sampled and submitted in Aptima (case 1) or PreservCyt solution (cases 2 and 3). Liquid-based preps were prepared and stained using the Papanicolaou method. Specimens were assessed for viral cytopathic changes.
All cases showed nuclear cytopathic changes (enlarged nuclei with open chromatin and prominent red nucleoli), 2 cases demonstrated multinucleated keratinocytes, and 1 case showed potential Guarnieri bodies. The chromatin margination and nuclear molding typical of herpesviruses was not appreciated.
The cytopathic changes of monkeypox are not specific, but their recognition could prompt appropriate PCR testing. Monkeypox shows distinct cytologic changes compared with herpesviruses.
猴痘是一种由猴痘病毒引起的病毒性疾病，猴痘病毒是一种高度传染性的正痘病毒，导致 2022 年春季开始在全球爆发。诊断通过从粘膜皮肤损伤处采集拭子进行聚合酶链反应（PCR）检测来确认。罕见的报告记录了猴痘病变的组织学变化，但细胞特征尚未描述。我们介绍了 3 名不同患者的粘膜皮肤猴痘病变拭子样本的细胞学发现。
患者均为男性，年龄分别为 55 岁、43 岁和 37 岁，均通过 PCR 检测确诊为猴痘。来自胸部（病例 1 和 2）和舌头（病例 3）病变的拭子直接采样并分别置于 Aptima（病例 1）或 PreservCyt 溶液中（病例 2 和 3）。制备液基预制片并用巴氏染色法染色。评估标本是否存在病毒细胞病变。
所有病例均显示核细胞病变（细胞核增大，染色质开放，核仁明显），2 例显示多核角质形成细胞，1 例显示潜在的瓜尔内里氏体。未观察到疱疹病毒典型的染色质边缘化和核模。
猴痘的细胞病变不具有特异性，但认识到这些病变可以提示进行适当的 PCR 检测。与疱疹病毒相比，猴痘显示出明显的细胞形态变化。
