title: Cytomegalovirus infection of the upper gastrointestinal tract: a clinical and pathological study of 30 cases.
abstract: OBJECTIVE
  The study reviews the endoscopic and histological features of human cytomegalovirus (HCMV) infections of the upper gastrointestinal (UGI) tract.
  
  
  METHODS
  Clinical histories, endoscopic findings and bioptic specimens of 30 cases of HCMV infection of the UGI tract, diagnosed in a University Hospital in a 10-year period, were reviewed. In all cases, viral inclusion bodies were detected in routine histopathological sections and the diagnosis was confirmed with immunohistochemistry.
  
  
  RESULTS
  Six patients were HIV+, whereas four had received organ transplantations, one was affected by common variable immunodeficiency and four had a recent history of malignancy. No other pathologic condition was evidenced in the remaining 15 cases. Mucosal alterations were endoscopically observed in the stomach (19 cases), esophagus (9), cardias (6) and duodenum (1), and multiple organs being synchronously affected in five patients (3 HIV+, 2 with history of malignancy). The antropyloric area was the most frequently affected site. Single ulcers were detected in 11 cases and multiple ulcers in 8, whereas mucosal thickenings (in the form of localized thickenings, polyps or rugal hypertrophy) were present in 13 patients. Thickenings of the mucosa were detected only in the stomach. At histology, necrotic material and granulation tissue were associated with moderate or marked lympho-plasmacytic infiltrate and foveolar hyperplasia in ulcerative lesions, whereas lesions labeled as mucosal thickenings showed mild or moderate chronic inflammatory infiltrate and foveolar hyperplasia.
  
  
  CONCLUSIONS
  Endoscopic manifestations of UGI tract involvement in HCMV infection are not specific, varying from erythematous mucosa to ulcers to mucosal thickenings.
authors.affiliation: Section of Pathologic Anatomy, Azienda Ospedaliera-Universitaria, Policlinico, Modena, Italy. reggiani.luca@policlinico.mo.it
authors.forename: Luca
authors.initials: L
authors.lastname: Reggiani Bonetti
authors.forename: Luisa
authors.initials: L
authors.lastname: Losi
authors.forename: Carmela
authors.initials: C
authors.lastname: Di Gregorio
authors.forename: Angela
authors.initials: A
authors.lastname: Bertani
authors.forename: Antonio
authors.initials: A
authors.lastname: Merighi
authors.forename: Stefania
authors.initials: S
authors.lastname: Bettelli
authors.forename: Monica
authors.initials: M
authors.lastname: Scuri
authors.forename: Antonio
authors.initials: A
authors.lastname: Maiorana
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000914:Antibodies, Viral / Q000097:blood; D017074:Common Variable Immunodeficiency / Q000150:complications; D003587:Cytomegalovirus / Q000276:immunology; D003586:Cytomegalovirus Infections / Q000150:complications / Q000276:immunology / Q000473:pathology*; D004067:Digestive System Neoplasms / Q000150:complications; D004378:Duodenal Diseases / Q000473:pathology* / Q000821:virology; D016099:Endoscopy, Gastrointestinal; D004935:Esophageal Diseases / Q000473:pathology* / Q000821:virology; D005260:Female; D006679:HIV Seropositivity / Q000150:complications; D006801:Humans; D016867:Immunocompromised Host; D016030:Kidney Transplantation / Q000276:immunology; D016031:Liver Transplantation / Q000276:immunology; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D013272:Stomach Diseases / Q000473:pathology* / Q000821:virology
chemical_list: D000914:Antibodies, Viral