Difference between revisions of "Viruses"

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#redirect [[Virus]]
This article collects all things '''virus'''.  The more general topic of infective things is dealt with in [[microorganisms]].
 
Many virus afflict humans.  Only a few of them can be diagnosed histologically.
 
==Viral inclusions - types==
Cowdry types:<ref>URL: [http://www.pathconsultddx.com/pathCon/largeImage?pii=S1559-8675%2806%2970864-6&figureId=fig3&ecomponentId=mmc3 http://www.pathconsultddx.com/pathCon/largeImage?pii=S1559-8675%2806%2970864-6&figureId=fig3&ecomponentId=mmc3]. Accessed: 12 January 2010.</ref>
*Cowdry type A inclusion:<ref>URL: [http://www.whonamedit.com/synd.cfm/3495.html http://www.whonamedit.com/synd.cfm/3495.html]. Accessed on: 22 January 2010.</ref>
**Round eosinophilic material surrounded by a clear halo.
*Cowdry type B inclusion:<ref>[http://www.whonamedit.com/synd.cfm/3496.html http://www.whonamedit.com/synd.cfm/3496.html]. Accessed on: 22 January 2010.</ref>
**Neuropathology thingy. (???)
 
Images:
*[http://www.daff.gov.au/animal-plant-health/pests-diseases-weeds/aquatic_animal_diseases_significant_to_australia_identification_field_guide/diseases_of_crustaceans/viral_diseases_of_crustaceans/infectious_hypodermal_and_haematopoietic_necrosis/histological_page_for_infectious_hypodermal_and_haematopoietic_necrosis Cowdry A inclusion (daff.gov.au)].
*[http://focosi.altervista.org/pathohomoprocess_regressive.html Cowdry type A & type B inclusions (altervista.org)].
 
=Viruses=
==Herpes simplex virus==
*Abbreviated ''HSV''.
 
===General===
Several subtypes:
*Canker sores - usually HSV-1.
*Genital herpes - usually HSV-2.
 
===Histology/cytology===
Features:<ref>SM. 11 January 2010.</ref>
*Clear "ground glass" nuclei.
**Rim of peripheral chromatin.
*Nuclear inclusions.
*Multinucleation with nuclear molding, i.e. multiple nuclei that touch over a large surface area.
 
Mnemonic - 3 Ms: Margination, Multinucleation, Molding.
 
Images:
*[http://www.virology.org/sbpgphoto2.html Herpes simplex virus - multinucleation (virology.org)].
*[http://commons.wikimedia.org/wiki/File:Herpes_simplex_virus_pap_test.jpg HSV on a Pap test - showing multinucleation (WC)].
*[http://commons.wikimedia.org/wiki/File:Herpes_esophagitis_-_very_high_mag.jpg HSV esophagitis - very high mag. (WC)].
*[http://commons.wikimedia.org/wiki/File:Herpes_esophagitis_-_intermed_mag.jpg HSV esophagitis - intermed. mag. (WC)].
 
==Cytomegalovirus==
*Abbreviated ''CMV''
===General===
*The name comes from the microscopic appearance.
 
===Microscopic===
Features:
*Very large nucleus (as the name implies) with clearing.
*Granular cytoplasmic inclusions (red on H&E sections).
 
Notes:
*Classically in endothelial cells.
**In the context of [[esophagus|esophageal ulcers]], it is therefore useful to biopsy the base of the ulcer - if this is suspected.
 
Images:
*[http://commons.wikimedia.org/wiki/File:CMV_placentitis2_mini.jpg CMV placentitis (WC)].
*[http://www.asm.org/division/c/photo/cmv1.jpg CMV (asm.org)].
 
===IHC===
*IHC for CMV is available - highlights granular cytoplasmic inclusions; increases [[sensitivity]].
 
==Human papilloma virus==
*Abbreviated ''HPV''.
 
===General===
*Causes a lot of pathology:
**Benign:
***[[Verruca vulgaris]].
***[[Condyloma acuminatum]].
***[[Esophagus#Human_papilloma_virus_esophagitis|HPV esophagitis]].
**Malignant:
***[[Uterine cervix|Cervical cancer]] and precursors ([[LSIL]], [[HSIL]]).
***Anal cancer and precurors ([[Anus#Anal_intraepithelial_neoplasia|AIN]])
***Squamous cell carcinoma in the [[Head & neck pathology|head & neck]].
 
Oncocytic types:
*HPV 18 - predominantly adenocarcinoma.<ref name=pmid15551313>{{Cite journal  | last1 = De Boer | first1 = MA. | last2 = Peters | first2 = LA. | last3 = Aziz | first3 = MF. | last4 = Siregar | first4 = B. | last5 = Cornain | first5 = S. | last6 = Vrede | first6 = MA. | last7 = Jordanova | first7 = ES. | last8 = Fleuren | first8 = GJ. | title = Human papillomavirus type 18 variants: histopathology and E6/E7 polymorphisms in three countries. | journal = Int J Cancer | volume = 114 | issue = 3 | pages = 422-5 | month = Apr | year = 2005 | doi = 10.1002/ijc.20727 | PMID = 15551313 }}</ref>
*HPV 16 - predominantly squamous cell carcinoma.<ref name=pmid15551313/>
 
Recombinant vaccine (Gardasil, Silgard) - covers:<ref name=pmid21942919>{{Cite journal  | last1 = McCormack | first1 = PL. | last2 = Joura | first2 = EA. | title = Spotlight on Quadrivalent Human Papillomavirus(Types 6, 11, 16, 18) Recombinant Vaccine(Gardasil®) in the Prevention of PremalignantGenital Lesions, Genital Cancer, and Genital Warts in Women†. | journal = BioDrugs | volume = 25 | issue = 5 | pages = 339-43 | month = Oct | year = 2011 | doi = 10.2165/11205060-000000000-00000 | PMID = 21942919 }}</ref>
*HPV 6.
*HPV 11.
*HPV 16.
*HPV 18.
 
===Microscopic===
Features:
*Koilocytes:
** Perinuclear clearing.
** Nuclear changes.
*** Size similar (or larger) to those in the basal layer of the epithelium.
*** Nuclear enlargement should be evident on low power, i.e. 25x.
*** Central location - nucleus should be smack in the middle of the cell.
 
Images:
*[http://commons.wikimedia.org/w/index.php?title=File:Low-grade_squamous_intraepithelial_lesion.jpg LSIL (WC)].
*[http://commons.wikimedia.org/wiki/File:Low-grade_sil_and_endocx.jpg LSIL & endocervix (WC)].
 
===IHC===
*p16 +ve -- stains most cells infected by HPV.
 
==Adenovirus==
===General===
*Common in kids.
**May be seen in the context of [[adenovirus appendicitis|(adenovirus) appendicitis]].
 
===Microscopic===
Features:
*"Smudge" cells<ref>URL: [http://www.pathguy.com/lectures/infect.htm http://www.pathguy.com/lectures/infect.htm]. Accessed on: 8 July 2010.</ref> - black/blue blob ~ 10-15 micrometers. (???)
 
Notes:
*May be morphologically similar to ''[[CMV]]'', ''[[HSV]]'', ''[[VZV]]'' inclusions.
 
Images:
*[http://img.medscape.com/fullsize/migrated/438/534/cc438534.haur.fig1.jpg Adenovirus (medscape.com)].<ref>URL:[http://www.medscape.com/viewarticle/438534_2 http://www.medscape.com/viewarticle/438534_2]. Accessed on: 8 July 2010.</ref>
*[http://wiki.medpedia.com/Image:Ab14.jpg?filetimestamp=20091014175858 Smudge cell (medpedia.com)].
*[http://www.flickr.com/photos/ckrishnan/3746778145/in/photostream/ Necrosis in germinal centre - low mag. (flickr.com)].
*[http://www.flickr.com/photos/ckrishnan/3746778007/in/photostream/ Viral inclusions - high mag. (flickr.com)].
*[http://www.flickr.com/photos/ckrishnan/3747567554/in/photostream/ IHC for adenovirus (flickr.com)]
 
==Parvovirus==
*[[AKA]] ''Parvovirus B19''.
===General===
*Most significant in pregnant women.
**Parvovirus attacks the nucleated RBCs of the fetus - causes an ''aplastic [[anemia]]''.
 
Trivia:
*First described in 1975.<ref name=pmid46024>{{Cite journal  | last1 = Cossart | first1 = YE. | last2 = Field | first2 = AM. | last3 = Cant | first3 = B. | last4 = Widdows | first4 = D. | title = Parvovirus-like particles in human sera. | journal = Lancet | volume = 1 | issue = 7898 | pages = 72-3 | month = Jan | year = 1975 | doi =  | PMID = 46024 }}</ref>
**The "B19" part comes from the label for the specimen.<ref name="pmid17304869">{{cite journal |author=Servey JT, Reamy BV, Hodge J |title=Clinical presentations of parvovirus B19 infection |journal=Am Fam Physician |volume=75 |issue=3 |pages=373–6 |year=2007 |month=February |pmid=17304869 |doi= |url=http://www.aafp.org/afp/991001ap/1455.html}}</ref>
 
===Microscopic===
Features:
*Glassy (red) nuclear inclusions.<ref>URL: [http://www.pathguy.com/lectures/infect.htm http://www.pathguy.com/lectures/infect.htm]. Accessed on: 8 July 2010.</ref>
*Nuclear enlargement.
 
Images:
*[[WC]]:
**[http://commons.wikimedia.org/wiki/File:Parvovirus_infection_-_cropped_2_-_very_high_mag.jpg Parvovirus - version 1 - very high mag. (WC)].
**[http://commons.wikimedia.org/wiki/File:Parvovirus_infection_-_cropped_1_-_very_high_mag.jpg Parvovirus - version 2 - very high mag. (WC)].
*www:
**[http://info.fujita-hu.ac.jp/~tsutsumi/photo/photo210-1.htm Parvovirus (fujita-hu.ac.jp)].<ref>URL:[http://info.fujita-hu.ac.jp/~tsutsumi/case/case210.htm http://info.fujita-hu.ac.jp/~tsutsumi/case/case210.htm]. Accessed on: 8 February 2011.</ref>
**[http://www.scielo.br/img/revistas/rimtsp/v49n2/07f1a.jpg Parvovirus - placenta - (scielo.br)].<ref>URL: [http://www.scielo.br/scielo.php?pid=S0036-46652007000200007&script=sci_arttext http://www.scielo.br/scielo.php?pid=S0036-46652007000200007&script=sci_arttext]. Accessed on: 18 August 2011.</ref>
**[http://www.fujita-hu.ac.jp/~tsutsumi/case/case219.htm Parvovirus - several images (fujita-hu.ac.jp)].
 
==Epstein-Barr virus==
*Abbreviated ''EBV''
===General===
*Cases [[mononucleosis]].
*Part of the herpes group of viruses.<ref>URL: [http://www.meddean.luc.edu/lumen/MedEd/orfpath/herpes.htm http://www.meddean.luc.edu/lumen/MedEd/orfpath/herpes.htm]. Accessed on: 14 April 2011.</ref>
 
====Associations====
Cancer:<ref name=Ref_PCPBoD8_169>{{Ref PCPBoD8|169}}</ref>
*Classical [[Hodgkin lymphoma]].
*[[Burkitt lymphoma]].
*[[Nasopharyngeal carcinoma]].
*B cell lymphomas -- in immunosuppressed individuals.
**[[Post-transplant lymphoproliferative disorder]].
 
*[[Hemophagocytic syndrome]].<ref name=pmid20819601>{{cite journal |author=Jin YK, Xie ZD, Yang S, Lu G, Shen KL |title=Epstein-Barr virus-associated hemophagocytic lymphohistiocytosis: a retrospective study of 78 pediatric cases in mainland of China |journal=Chin. Med. J. |volume=123 |issue=11 |pages=1426–30 |year=2010 |month=June |pmid=20819601 |doi= |url=}}</ref>
 
===Microscopic===
Features:
*Variable - see specific pathologies in ''Associations'' section.
**+/-Atypical lymphocytes.
**+/-Hemophagocytosis (uncommon).
 
==Polyomavirus==
May refer to:
#BK virus.
#*See: ''[[Renal_transplant_pathology#Polyomavirus]]'' and ''[[Urine_cytopathology#Human_polyoma_infection]].
#Merkel cell polyomavirus.
#*See: ''[[Merkel cell carcinoma]]''.
 
=See also=
*[[Microorganisms]].
*[[Basics]].
*[[HIV]].
 
=References=
{{Reflist|2}}
 
[[Category:Microorganisms]]

Revision as of 05:16, 15 November 2011

This article collects all things virus. The more general topic of infective things is dealt with in microorganisms.

Many virus afflict humans. Only a few of them can be diagnosed histologically.

Viral inclusions - types

Cowdry types:[1]

  • Cowdry type A inclusion:[2]
    • Round eosinophilic material surrounded by a clear halo.
  • Cowdry type B inclusion:[3]
    • Neuropathology thingy. (???)

Images:

Viruses

Herpes simplex virus

  • Abbreviated HSV.

General

Several subtypes:

  • Canker sores - usually HSV-1.
  • Genital herpes - usually HSV-2.

Histology/cytology

Features:[4]

  • Clear "ground glass" nuclei.
    • Rim of peripheral chromatin.
  • Nuclear inclusions.
  • Multinucleation with nuclear molding, i.e. multiple nuclei that touch over a large surface area.

Mnemonic - 3 Ms: Margination, Multinucleation, Molding.

Images:

Cytomegalovirus

  • Abbreviated CMV

General

  • The name comes from the microscopic appearance.

Microscopic

Features:

  • Very large nucleus (as the name implies) with clearing.
  • Granular cytoplasmic inclusions (red on H&E sections).

Notes:

  • Classically in endothelial cells.
    • In the context of esophageal ulcers, it is therefore useful to biopsy the base of the ulcer - if this is suspected.

Images:

IHC

  • IHC for CMV is available - highlights granular cytoplasmic inclusions; increases sensitivity.

Human papilloma virus

  • Abbreviated HPV.

General

Oncocytic types:

  • HPV 18 - predominantly adenocarcinoma.[5]
  • HPV 16 - predominantly squamous cell carcinoma.[5]

Recombinant vaccine (Gardasil, Silgard) - covers:[6]

  • HPV 6.
  • HPV 11.
  • HPV 16.
  • HPV 18.

Microscopic

Features:

  • Koilocytes:
    • Perinuclear clearing.
    • Nuclear changes.
      • Size similar (or larger) to those in the basal layer of the epithelium.
      • Nuclear enlargement should be evident on low power, i.e. 25x.
      • Central location - nucleus should be smack in the middle of the cell.

Images:

IHC

  • p16 +ve -- stains most cells infected by HPV.

Adenovirus

General

Microscopic

Features:

  • "Smudge" cells[7] - black/blue blob ~ 10-15 micrometers. (???)

Notes:

  • May be morphologically similar to CMV, HSV, VZV inclusions.

Images:

Parvovirus

  • AKA Parvovirus B19.

General

  • Most significant in pregnant women.
    • Parvovirus attacks the nucleated RBCs of the fetus - causes an aplastic anemia.

Trivia:

  • First described in 1975.[9]
    • The "B19" part comes from the label for the specimen.[10]

Microscopic

Features:

  • Glassy (red) nuclear inclusions.[11]
  • Nuclear enlargement.

Images:

Epstein-Barr virus

  • Abbreviated EBV

General

Associations

Cancer:[15]

Microscopic

Features:

  • Variable - see specific pathologies in Associations section.
    • +/-Atypical lymphocytes.
    • +/-Hemophagocytosis (uncommon).

Polyomavirus

May refer to:

  1. BK virus.
  2. Merkel cell polyomavirus.

See also

References

  1. ↑ URL: http://www.pathconsultddx.com/pathCon/largeImage?pii=S1559-8675%2806%2970864-6&figureId=fig3&ecomponentId=mmc3. Accessed: 12 January 2010.
  2. ↑ URL: http://www.whonamedit.com/synd.cfm/3495.html. Accessed on: 22 January 2010.
  3. ↑ http://www.whonamedit.com/synd.cfm/3496.html. Accessed on: 22 January 2010.
  4. ↑ SM. 11 January 2010.
  5. ↑ 5.0 5.1 De Boer, MA.; Peters, LA.; Aziz, MF.; Siregar, B.; Cornain, S.; Vrede, MA.; Jordanova, ES.; Fleuren, GJ. (Apr 2005). "Human papillomavirus type 18 variants: histopathology and E6/E7 polymorphisms in three countries.". Int J Cancer 114 (3): 422-5. doi:10.1002/ijc.20727. PMID 15551313.
  6. ↑ McCormack, PL.; Joura, EA. (Oct 2011). "Spotlight on Quadrivalent Human Papillomavirus(Types 6, 11, 16, 18) Recombinant Vaccine(Gardasil®) in the Prevention of PremalignantGenital Lesions, Genital Cancer, and Genital Warts in Women†.". BioDrugs 25 (5): 339-43. doi:10.2165/11205060-000000000-00000. PMID 21942919.
  7. ↑ URL: http://www.pathguy.com/lectures/infect.htm. Accessed on: 8 July 2010.
  8. ↑ URL:http://www.medscape.com/viewarticle/438534_2. Accessed on: 8 July 2010.
  9. ↑ Cossart, YE.; Field, AM.; Cant, B.; Widdows, D. (Jan 1975). "Parvovirus-like particles in human sera.". Lancet 1 (7898): 72-3. PMID 46024.
  10. ↑ Servey JT, Reamy BV, Hodge J (February 2007). "Clinical presentations of parvovirus B19 infection". Am Fam Physician 75 (3): 373–6. PMID 17304869. http://www.aafp.org/afp/991001ap/1455.html.
  11. ↑ URL: http://www.pathguy.com/lectures/infect.htm. Accessed on: 8 July 2010.
  12. ↑ URL:http://info.fujita-hu.ac.jp/~tsutsumi/case/case210.htm. Accessed on: 8 February 2011.
  13. ↑ URL: http://www.scielo.br/scielo.php?pid=S0036-46652007000200007&script=sci_arttext. Accessed on: 18 August 2011.
  14. ↑ URL: http://www.meddean.luc.edu/lumen/MedEd/orfpath/herpes.htm. Accessed on: 14 April 2011.
  15. ↑ Mitchell, Richard; Kumar, Vinay; Fausto, Nelson; Abbas, Abul K.; Aster, Jon (2011). Pocket Companion to Robbins & Cotran Pathologic Basis of Disease (8th ed.). Elsevier Saunders. pp. 169. ISBN 978-1416054542.
  16. ↑ Jin YK, Xie ZD, Yang S, Lu G, Shen KL (June 2010). "Epstein-Barr virus-associated hemophagocytic lymphohistiocytosis: a retrospective study of 78 pediatric cases in mainland of China". Chin. Med. J. 123 (11): 1426–30. PMID 20819601.
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