Yan Z, Nguyen S, Poles M, Melamed J, Scholes J V
Department of Pathology, Tisch Hospital, New York University Medical Center, New York 10016, USA.
Am J Surg Pathol. 1998 Sep;22(9):1101-6. doi: 10.1097/00000478-199809000-00009.
Adenovirus infection of the gastrointestinal tract in human immunodeficiency virus (HIV)-infected patients is rarely reported, probably because of a lack of familiarity of most pathologists with diagnostic criteria during routine light microscopy and possible misidentification as cytomegalovirus infection. We studied colonoscopic biopsy specimens from 135 HIV-infected patients with clinically suspected cytomegalovirus colitis during a 4.5-year period to morphologically identify the presence of adenovirus infection. Immunohistochemical staining for adenovirus was performed for confirmation on all suspected cases. Adenovirus infected cells showed characteristic amphophilic or eosinophilic nuclear inclusions, predominantly affecting the surface epithelium and characteristically involving goblet cells. Sixteen cases showed morphologic features of adenovirus infection, all confirmed by immunohistochemistry. Twelve cases also showed cytomegalovirus infection, whereas 4 showed adenovirus alone. In 10 cases, adenovirus colitis was not recognized during initial routine histopathologic diagnostic evaluation. Adenovirus inclusions also were discovered in the stomach, the duodenum, and the liver in single cases. Conclusions are as follows: (1) Adenovirus colitis has been underdiagnosed at our institution and, we suspect, in general. (2) The morphologic features and nuclear inclusions of adenovirus colitis are characteristic and can be identified reliably by routine light microscopy. (3) Adenovirus infection also may be diagnosed morphologically in extracolonic sites, such as the stomach, the small intestine, and the liver. (4) Coinfection of adenovirus with cytomegalovirus and other agents is seen frequently, but, less frequently, adenovirus may be identified as a sole pathogen.
人类免疫缺陷病毒（HIV）感染患者胃肠道的腺病毒感染鲜有报道，可能是因为大多数病理学家在常规光学显微镜检查时对诊断标准不够熟悉，且可能误将其鉴定为巨细胞病毒感染。我们研究了135例临床疑似巨细胞病毒性结肠炎的HIV感染患者在4.5年期间的结肠镜活检标本，以形态学方法确定是否存在腺病毒感染。对所有疑似病例均进行腺病毒免疫组织化学染色以确诊。腺病毒感染的细胞表现出特征性的嗜双色性或嗜酸性核内包涵体，主要影响表面上皮，且特征性地累及杯状细胞。16例呈现腺病毒感染的形态学特征，均经免疫组织化学证实。12例还显示有巨细胞病毒感染，而4例仅显示腺病毒感染。在10例中，初始常规组织病理学诊断评估时未识别出腺病毒结肠炎。单例在胃、十二指肠和肝脏中也发现了腺病毒包涵体。结论如下：（1）在我们机构以及我们怀疑在总体上，腺病毒结肠炎一直未得到充分诊断。（2）腺病毒结肠炎的形态学特征和核内包涵体具有特征性，可通过常规光学显微镜可靠识别。（3）在结肠外部位，如胃、小肠和肝脏，也可通过形态学诊断腺病毒感染。（4）腺病毒常与巨细胞病毒及其他病原体合并感染，但较少情况下，腺病毒可被鉴定为唯一病原体。
