Cytoplasmic Fibrillar Aggregates in Gallbladder Epithelium Are a Frequent Mimic of Cystoisospora in Pediatric Cholecystectomy Specimens.

Autor: Rose GS; From the Department of Pathology, University of Maryland Medical Center, Baltimore (Dr Rose); the Department of Pathology, The Ohio State University Wexner Medical Center, Columbus (Drs C. A. Arnold, Badizadegan, Carter, Conces, Kahwash, Nicol, and M. A. Arnold); and the Department of Pathology and Laboratory Medicine, Nationwide Children's Hospital, Columbus, Ohio (Drs Badizadegan, Carter, Conces, Kahwash, Nicol, and M. A. Arnold). Dr Carter is now with Indiana University Health, Southern Indiana Pathologists, Bloomington., Arnold CA; From the Department of Pathology, University of Maryland Medical Center, Baltimore (Dr Rose); the Department of Pathology, The Ohio State University Wexner Medical Center, Columbus (Drs C. A. Arnold, Badizadegan, Carter, Conces, Kahwash, Nicol, and M. A. Arnold); and the Department of Pathology and Laboratory Medicine, Nationwide Children's Hospital, Columbus, Ohio (Drs Badizadegan, Carter, Conces, Kahwash, Nicol, and M. A. Arnold). Dr Carter is now with Indiana University Health, Southern Indiana Pathologists, Bloomington., Badizadegan K; From the Department of Pathology, University of Maryland Medical Center, Baltimore (Dr Rose); the Department of Pathology, The Ohio State University Wexner Medical Center, Columbus (Drs C. A. Arnold, Badizadegan, Carter, Conces, Kahwash, Nicol, and M. A. Arnold); and the Department of Pathology and Laboratory Medicine, Nationwide Children's Hospital, Columbus, Ohio (Drs Badizadegan, Carter, Conces, Kahwash, Nicol, and M. A. Arnold). Dr Carter is now with Indiana University Health, Southern Indiana Pathologists, Bloomington., Carter CM; From the Department of Pathology, University of Maryland Medical Center, Baltimore (Dr Rose); the Department of Pathology, The Ohio State University Wexner Medical Center, Columbus (Drs C. A. Arnold, Badizadegan, Carter, Conces, Kahwash, Nicol, and M. A. Arnold); and the Department of Pathology and Laboratory Medicine, Nationwide Children's Hospital, Columbus, Ohio (Drs Badizadegan, Carter, Conces, Kahwash, Nicol, and M. A. Arnold). Dr Carter is now with Indiana University Health, Southern Indiana Pathologists, Bloomington., Conces MR; From the Department of Pathology, University of Maryland Medical Center, Baltimore (Dr Rose); the Department of Pathology, The Ohio State University Wexner Medical Center, Columbus (Drs C. A. Arnold, Badizadegan, Carter, Conces, Kahwash, Nicol, and M. A. Arnold); and the Department of Pathology and Laboratory Medicine, Nationwide Children's Hospital, Columbus, Ohio (Drs Badizadegan, Carter, Conces, Kahwash, Nicol, and M. A. Arnold). Dr Carter is now with Indiana University Health, Southern Indiana Pathologists, Bloomington., Kahwash SB; From the Department of Pathology, University of Maryland Medical Center, Baltimore (Dr Rose); the Department of Pathology, The Ohio State University Wexner Medical Center, Columbus (Drs C. A. Arnold, Badizadegan, Carter, Conces, Kahwash, Nicol, and M. A. Arnold); and the Department of Pathology and Laboratory Medicine, Nationwide Children's Hospital, Columbus, Ohio (Drs Badizadegan, Carter, Conces, Kahwash, Nicol, and M. A. Arnold). Dr Carter is now with Indiana University Health, Southern Indiana Pathologists, Bloomington., Nicol KK; From the Department of Pathology, University of Maryland Medical Center, Baltimore (Dr Rose); the Department of Pathology, The Ohio State University Wexner Medical Center, Columbus (Drs C. A. Arnold, Badizadegan, Carter, Conces, Kahwash, Nicol, and M. A. Arnold); and the Department of Pathology and Laboratory Medicine, Nationwide Children's Hospital, Columbus, Ohio (Drs Badizadegan, Carter, Conces, Kahwash, Nicol, and M. A. Arnold). Dr Carter is now with Indiana University Health, Southern Indiana Pathologists, Bloomington., Arnold MA; From the Department of Pathology, University of Maryland Medical Center, Baltimore (Dr Rose); the Department of Pathology, The Ohio State University Wexner Medical Center, Columbus (Drs C. A. Arnold, Badizadegan, Carter, Conces, Kahwash, Nicol, and M. A. Arnold); and the Department of Pathology and Laboratory Medicine, Nationwide Children's Hospital, Columbus, Ohio (Drs Badizadegan, Carter, Conces, Kahwash, Nicol, and M. A. Arnold). Dr Carter is now with Indiana University Health, Southern Indiana Pathologists, Bloomington.
Jazyk: angličtina
Zdroj: Archives of pathology & laboratory medicine [Arch Pathol Lab Med] 2019 Oct; Vol. 143 (10), pp. 1259-1264. Date of Electronic Publication: 2019 Apr 10.
DOI: 10.5858/arpa.2018-0335-OA
Abstrakt: Context.—: Cystoisospora belli is an intracellular parasite associated with gastrointestinal disease in immunocompromised hosts. Although infection has been classically associated with intestinal disease, studies have identified Cystoisospora in the gallbladder of immunocompetent patients based on hematoxylin-eosin morphology. Recently, the identity of this histologic finding as Cystoisospora has been questioned based on negative results of nucleic acid studies.
Objective.—: To determine the prevalence of this histologic feature in pediatric patients, we retrospectively reviewed all cholecystectomy specimens from a pediatric hospital during a 24-month period.
Design.—: In 180 cholecystectomy specimens, we identified 11 cases (6.1%) with classical histologic features previously described to represent Cystoisospora organisms. To further investigate these structures, we retrieved tissue from paraffin-embedded blocks and performed electron microscopy.
Results.—: Ultrastructural examination identified ovoid perinuclear cytoplasmic structures composed of dense fibrillar aggregates rather than organisms. Patients with positive cases were similar in age to controls (positive cases: mean patient age 13.4 years [range, 2-23 years]; negative cases: mean patient age 14.7 years [range, 12 weeks-31 years]; P = .35). There was no significant association of this finding with cholelithiasis (54.5% versus 65.1%, P = .52), cholesterolosis (0% versus 22.5%, P = .12), acute cholecystitis (9.1% versus 10.1%, P > .99), or chronic cholecystitis (45.5% versus 66.3%, P = .20).
Conclusions.—: To our knowledge, this is the first positive identification of these structures as cytoplasmic fibrillar aggregates rather than parasitic inclusions by ultrastructural examination, and the first study of this histologic finding in pediatric cholecystectomies.
Databáze: MEDLINE
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