Cheung A N, Ng I O
Department of Pathology, Queen Mary Hospital, University of Hong Kong.
Am J Gastroenterol. 1993 Nov;88(11):1882-6.
Cytomegalovirus infection is usually reported in immunocompromised patients. In this study, 19 patients with cytomegalovirus (CMV) infection of the alimentary tract were reviewed, none of whom had acquired immunodeficiency syndrome. The patients' sex distribution was similar, and their ages ranged from 22 to 84 yr (mean = 61 yr). Only four patients had underlying diseases resulting in immunocompromise. The most common presentation was gastrointestinal bleeding, which occurred in 11 of the 19 patients (58%). Two patients had an unusual presentation of obstructive jaundice due to exuberant growth of granulation tissue at the ampulla of Vater. The majority of the lesions (n = 23) occurred in the large intestine and duodenum. Sixteen of these 23 lesions (69.6%) showed ulceration. Of these 16 lesions, six were diagnosed macroscopically as malignant by the endoscopists. It was observed histologically that a predominant epithelial distribution of the CMV inclusion bodies was associated with no or only mild inflammation, whereas a predominant endothelial distribution of the inclusion bodies was associated with ulcerative, severely inflamed lesions. From these observations, we conclude that ulceration probably is due to an ischemic process resulting from narrowing of capillary lumens by swollen endothelial cells affected by CMV infection. Concomitant infection by Candida species was found in only one patient. One patient had coexistent ulcerative colitis while another also suffered from graft-versus-host disease after bone marrow transplantation. In five of the eight cases with follow-up biopsies, the CMV inclusion bodies disappeared in subsequent biopsies. To conclude, a high degree of alertness is required for the histological diagnosis of unexpected CMV infection of the alimentary tract, in order to warrant correct treatment for the patients.
巨细胞病毒感染通常见于免疫功能低下的患者。本研究回顾了19例患有消化道巨细胞病毒（CMV）感染的患者，其中无一例患有获得性免疫缺陷综合征。患者的性别分布相似，年龄范围为22至84岁（平均61岁）。只有4例患者有导致免疫功能低下的基础疾病。最常见的表现是胃肠道出血，19例患者中有11例（58%）出现此症状。2例患者有不寻常的表现，即由于 Vater壶腹肉芽组织过度生长导致梗阻性黄疸。大多数病变（n = 23）发生在大肠和十二指肠。这23个病变中有16个（69.6%）出现溃疡。在这16个病变中，有6个经内镜医师肉眼诊断为恶性。组织学观察发现，CMV包涵体主要分布在上皮细胞时，炎症不明显或仅有轻度炎症，而包涵体主要分布在内皮细胞时，则与溃疡性、严重炎症性病变相关。根据这些观察结果，我们得出结论，溃疡可能是由于受CMV感染的肿胀内皮细胞使毛细血管腔狭窄导致的缺血过程所致。仅1例患者同时感染念珠菌属。1例患者同时患有溃疡性结肠炎，另1例在骨髓移植后还患有移植物抗宿主病。在8例接受随访活检的病例中，有5例在随后的活检中CMV包涵体消失。总之，对于消化道意外CMV感染的组织学诊断需要高度警惕，以便为患者提供正确的治疗。
