Re: Positive tests for cytomegalovirus in AIDS patients.
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AIDS-Related Opportunistic Infections↗
Biomedical subjects
L A Teot
Publications and source records attributed to L A Teot.
Histiocytoid cardiomyopathy: case report and literature review.
The sudden death of an infant may be due to a variety of causes. In such cases, complete autopsy with radiologic, gross, microscopic, and toxicologic examination is warranted. We present a case of a previously healthy 15-month-old girl with no known disease, who experienced witnessed cardiac arrest, ventricular fibrillation, and death. Complete postmortem examination revealed histiocytoid cardiomyopathy as the cause of death. Histiocytoid cardiomyopathy is a rare infantile cardiac-muscle disorder characterized by the presence of enlarged, polygonal subendocardial myocytes which, by light microscopy, lack normal striations, and instead have granular, faintly eosinophilic cytoplasm. Ultrastructurally, the myocytes contain numerous mitochondria and markedly reduced numbers of myofibrils. Clinically, the disorder is characterized by cardiac arrhythmias and/or sudden death occurring in children under the age of two years. We discuss the differential diagnosis, proposed theories of etiology, and the pathology of this rare entity.
Cardiomyopathies↗
A comparative cytopathologic and histologic study of atypia, dysplasia, and adenocarcinoma in Barrett's esophagus.
As a potentially premalignant condition, Barrett's esophagus has stimulated controversy over the need for surveillance of glandular dysplasia and early carcinoma. This prompted the authors to review their experience with endoscopic cytologic brushings and biopsies from patients with Barrett's esophagus. The authors reviewed 65 consecutive specimens from 42 patients with Barrett's esophagus in which both the concurrently obtained esophageal cytologic brushings and companion biopsy specimens were available. In addition, esophagogastrectomy specimens from 9 nine these patients were reviewed. Cytologic and histologic specimens were assigned to one of four diagnostic categories, based on specifically defined criteria: simple Barrett's esophagus with or without inflammatory atypia; dysplasia; adenocarcinoma; or suspicious for dysplasia or carcinoma. Simple Barrett's esophagus was diagnosed in 38 cytologic brushings and 44 biopsy specimens, dysplasia in 4 brushings and 7 biopsy specimens, and carcinoma in 14 brushings and 10 biopsy specimens. Nine brushings and three biopsy specimens were suspicious. In 13 cases, brushings revealed a higher grade lesion than did histology; in 5 cases, biopsy specimens showed a higher grade lesion. Agreement between the two occurred in 72% (47/65) of all specimens. Accuracy was confirmed in the histologic examinations of the resection specimens. The authors conclude that specific criteria, when consistently applied, allow accurate cytologic diagnoses of epithelial changes in Barrett's esophagus. The use of esophageal brush cytology and biopsy specimens provides two complementary techniques, which detect a greater number of serious lesions than either technique alone.
Adenocarcinoma↗
Gastrointestinal cytology.
Since the development of the fiberoptic endoscope, laboratories have received cytologic specimens obtained from all segments of the gastrointestinal tract in increasing numbers to identify infectious agents and neoplasms. Adenocarcinomas generally are easily diagnosed and distinguished from reparative atypia, but their precursor lesions, dysplasia and adenomas, provide greater interpretive challenges. The same is true for such entities as malignant lymphomas. Most mesenchymal tumors remain outside the diagnostic capabilities of most cytologists.
Cytodiagnosis↗
A case of primary laryngeal T-cell lymphoma in a patient with acquired immunodeficiency syndrome.
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Acquired Immunodeficiency Syndrome↗
Cytologic diagnosis of cytomegaloviral esophagitis. A report of three acquired immunodeficiency syndrome-related cases.
Cytomegalovirus (CMV) is recognized as a common cause of infectious esophagitis in patients with the acquired immunodeficiency syndrome (AIDS). The radiographic and endoscopic findings are variable, and although some features are suggestive of CMV esophagitis, none is specific. The mainstay of the diagnosis of this disease has been histologic demonstration of the characteristic intranuclear and intracytoplasmic inclusions. We report three patients with AIDS-related CMV esophagitis in whom cytologic smears from esophageal brushings contained diagnostic cells characterized by nuclear and cytoplasmic enlargement; marginated chromatin; large, basophilic intranuclear inclusions surrounded by a clear halo; and granular, eosinophilic intracytoplasmic inclusions. In one case the initial diagnosis was made from the biopsies, and only after careful review were cells diagnostic of CMV infection identified in the cytologic smears. In that patient, numerous cells with herpes simplex virus-related changes were present and probably masked the presence of the CMV-infected cells. In contrast, the biopsies from another patient showed only necrotic debris and inflammatory cells, whereas the cytologic preparations revealed cells with the characteristic CMV inclusions. With improved therapy for this often-debilitating opportunistic infection, rapid and accurate diagnosis is imperative. Cytology complements histology, and concurrent use of these diagnostic modalities will detect CMV esophagitis more frequently than will either technique alone.
Acquired Immunodeficiency Syndrome↗