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Chapter 29 : Surgical Pathologic Diagnosis

Authors: Mary K. Klassen-Fischer1, Ronald C. Neafie2
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Affiliations: 1: Joint Pathology Center, Silver Spring, MD 20910; 2: Joint Pathology Center, Silver Spring, MD 20910
Content Type: Monograph
Publication Year: 2016

Category: Clinical Microbiology

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Abstract:

Surgical pathology results can play a crucial role in the management of immunocompromised patients. A number of factors contribute to the complexity of histologic diagnosis in these patients. The most obvious difference is that the inflammatory response to pathogens differs from that of immunocompetent hosts. Pathologists must remember to perform special stains for microorganisms, even if there is little or no inflammation in a biopsy specimen. Noticing the lack of inflammatory cells, such as the lack of plasma cells in patients with common-variable immunodeficiency, in tissues where they are normally present can lead to a diagnosis of immunodeficiency.

Citation: Klassen-Fischer M, Neafie R. 2016. Surgical Pathologic Diagnosis, p 759-780. In Hayden R, Wolk D, Carroll K, Tang Y (ed),

Diagnostic Microbiology of the Immunocompromised Host, Second Edition

. ASM Press, Washington, DC. doi: 10.1128/microbiolspec.DMIH2-0023-2015
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Surgical Pathologic Diagnosis
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Citation: Klassen-Fischer M, Neafie R. 2016. Surgical Pathologic Diagnosis, p 759-780. In Hayden R, Wolk D, Carroll K, Tang Y (ed),

Diagnostic Microbiology of the Immunocompromised Host, Second Edition

. ASM Press, Washington, DC. doi: 10.1128/microbiolspec.DMIH2-0023-2015
/content/10.1128/9781555819040.chap29.fig29-1
Figure 1

Duodenal biopsy from a patient with CVID showing blunt villi and increased intraepithelial lymphocytes.

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Figure 1

Duodenal biopsy from a patient with CVID showing blunt villi and increased intraepithelial lymphocytes.

Citation: Klassen-Fischer M, Neafie R. 2016. Surgical Pathologic Diagnosis, p 759-780. In Hayden R, Wolk D, Carroll K, Tang Y (ed),

Diagnostic Microbiology of the Immunocompromised Host, Second Edition

. ASM Press, Washington, DC. doi: 10.1128/microbiolspec.DMIH2-0023-2015
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Figure 2

Higher-power view of duodenal biopsy shown in Fig. 1 . Note the paucity of plasma cells.

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Figure 2

Higher-power view of duodenal biopsy shown in Fig. 1 . Note the paucity of plasma cells.

Citation: Klassen-Fischer M, Neafie R. 2016. Surgical Pathologic Diagnosis, p 759-780. In Hayden R, Wolk D, Carroll K, Tang Y (ed),

Diagnostic Microbiology of the Immunocompromised Host, Second Edition

. ASM Press, Washington, DC. doi: 10.1128/microbiolspec.DMIH2-0023-2015
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Figure 3

Kaposi sarcoma of the skin with ectatic blood-filled spaces.

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Figure 3

Kaposi sarcoma of the skin with ectatic blood-filled spaces.

Citation: Klassen-Fischer M, Neafie R. 2016. Surgical Pathologic Diagnosis, p 759-780. In Hayden R, Wolk D, Carroll K, Tang Y (ed),

Diagnostic Microbiology of the Immunocompromised Host, Second Edition

. ASM Press, Washington, DC. doi: 10.1128/microbiolspec.DMIH2-0023-2015
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Figure 4

Same biopsy as Fig. 3 stained with immunohistochemical stain for CD34, which outlines the vascular spaces.

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Figure 4

Same biopsy as Fig. 3 stained with immunohistochemical stain for CD34, which outlines the vascular spaces.

Citation: Klassen-Fischer M, Neafie R. 2016. Surgical Pathologic Diagnosis, p 759-780. In Hayden R, Wolk D, Carroll K, Tang Y (ed),

Diagnostic Microbiology of the Immunocompromised Host, Second Edition

. ASM Press, Washington, DC. doi: 10.1128/microbiolspec.DMIH2-0023-2015
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Figure 5

Same biopsy as Fig. 3 stained with immunohistochemical stain for HHV8, which highlights the nuclei of virally infected cells.

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Figure 5

Same biopsy as Fig. 3 stained with immunohistochemical stain for HHV8, which highlights the nuclei of virally infected cells.

Citation: Klassen-Fischer M, Neafie R. 2016. Surgical Pathologic Diagnosis, p 759-780. In Hayden R, Wolk D, Carroll K, Tang Y (ed),

Diagnostic Microbiology of the Immunocompromised Host, Second Edition

. ASM Press, Washington, DC. doi: 10.1128/microbiolspec.DMIH2-0023-2015
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Figure 6

hybridization for EBER showing positive nuclei in a lymph node.

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Figure 6

hybridization for EBER showing positive nuclei in a lymph node.

Citation: Klassen-Fischer M, Neafie R. 2016. Surgical Pathologic Diagnosis, p 759-780. In Hayden R, Wolk D, Carroll K, Tang Y (ed),

Diagnostic Microbiology of the Immunocompromised Host, Second Edition

. ASM Press, Washington, DC. doi: 10.1128/microbiolspec.DMIH2-0023-2015
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Figure 7

Anal condyloma due to HPV.

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Figure 7

Anal condyloma due to HPV.

Citation: Klassen-Fischer M, Neafie R. 2016. Surgical Pathologic Diagnosis, p 759-780. In Hayden R, Wolk D, Carroll K, Tang Y (ed),

Diagnostic Microbiology of the Immunocompromised Host, Second Edition

. ASM Press, Washington, DC. doi: 10.1128/microbiolspec.DMIH2-0023-2015
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Figure 8

Viral inclusions of HPV in a plantar wart.

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Figure 8

Viral inclusions of HPV in a plantar wart.

Citation: Klassen-Fischer M, Neafie R. 2016. Surgical Pathologic Diagnosis, p 759-780. In Hayden R, Wolk D, Carroll K, Tang Y (ed),

Diagnostic Microbiology of the Immunocompromised Host, Second Edition

. ASM Press, Washington, DC. doi: 10.1128/microbiolspec.DMIH2-0023-2015
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Figure 9

Lymphocytic infiltrate in brain due to PML.

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Figure 9

Lymphocytic infiltrate in brain due to PML.

Citation: Klassen-Fischer M, Neafie R. 2016. Surgical Pathologic Diagnosis, p 759-780. In Hayden R, Wolk D, Carroll K, Tang Y (ed),

Diagnostic Microbiology of the Immunocompromised Host, Second Edition

. ASM Press, Washington, DC. doi: 10.1128/microbiolspec.DMIH2-0023-2015
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Figure 10

Renal tubule with intranuclear inclusions of polyoma virus.

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Figure 10

Renal tubule with intranuclear inclusions of polyoma virus.

Citation: Klassen-Fischer M, Neafie R. 2016. Surgical Pathologic Diagnosis, p 759-780. In Hayden R, Wolk D, Carroll K, Tang Y (ed),

Diagnostic Microbiology of the Immunocompromised Host, Second Edition

. ASM Press, Washington, DC. doi: 10.1128/microbiolspec.DMIH2-0023-2015
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Figure 11

Intranuclear and intracytoplasmic inclusions of CMV in gastric epithelial cell of a patient with AIDS.

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Figure 11

Intranuclear and intracytoplasmic inclusions of CMV in gastric epithelial cell of a patient with AIDS.

Citation: Klassen-Fischer M, Neafie R. 2016. Surgical Pathologic Diagnosis, p 759-780. In Hayden R, Wolk D, Carroll K, Tang Y (ed),

Diagnostic Microbiology of the Immunocompromised Host, Second Edition

. ASM Press, Washington, DC. doi: 10.1128/microbiolspec.DMIH2-0023-2015
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Figure 12

Positive nuclear staining with immunohistochemical stain for CMV from a skin biopsy from a transplant patient.

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Figure 12

Positive nuclear staining with immunohistochemical stain for CMV from a skin biopsy from a transplant patient.

Citation: Klassen-Fischer M, Neafie R. 2016. Surgical Pathologic Diagnosis, p 759-780. In Hayden R, Wolk D, Carroll K, Tang Y (ed),

Diagnostic Microbiology of the Immunocompromised Host, Second Edition

. ASM Press, Washington, DC. doi: 10.1128/microbiolspec.DMIH2-0023-2015
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Figure 13

Intranuclear inclusions of HSV within syncytia.

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Figure 13

Intranuclear inclusions of HSV within syncytia.

Citation: Klassen-Fischer M, Neafie R. 2016. Surgical Pathologic Diagnosis, p 759-780. In Hayden R, Wolk D, Carroll K, Tang Y (ed),

Diagnostic Microbiology of the Immunocompromised Host, Second Edition

. ASM Press, Washington, DC. doi: 10.1128/microbiolspec.DMIH2-0023-2015
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Figure 14

Intranuclear inclusions of varicella-zoster virus in skin in a patient with chicken pox.

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Figure 14

Intranuclear inclusions of varicella-zoster virus in skin in a patient with chicken pox.

Citation: Klassen-Fischer M, Neafie R. 2016. Surgical Pathologic Diagnosis, p 759-780. In Hayden R, Wolk D, Carroll K, Tang Y (ed),

Diagnostic Microbiology of the Immunocompromised Host, Second Edition

. ASM Press, Washington, DC. doi: 10.1128/microbiolspec.DMIH2-0023-2015
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Figure 15

Intranuclear inclusions of adenovirus infection in liver.

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Figure 15

Intranuclear inclusions of adenovirus infection in liver.

Citation: Klassen-Fischer M, Neafie R. 2016. Surgical Pathologic Diagnosis, p 759-780. In Hayden R, Wolk D, Carroll K, Tang Y (ed),

Diagnostic Microbiology of the Immunocompromised Host, Second Edition

. ASM Press, Washington, DC. doi: 10.1128/microbiolspec.DMIH2-0023-2015
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Figure 16

Intracellular Gram-positive bacteria of in pulmonary malakoplakia (Brown-Hopps stain).

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Figure 16

Intracellular Gram-positive bacteria of in pulmonary malakoplakia (Brown-Hopps stain).

Citation: Klassen-Fischer M, Neafie R. 2016. Surgical Pathologic Diagnosis, p 759-780. In Hayden R, Wolk D, Carroll K, Tang Y (ed),

Diagnostic Microbiology of the Immunocompromised Host, Second Edition

. ASM Press, Washington, DC. doi: 10.1128/microbiolspec.DMIH2-0023-2015
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Figure 17

Michaelis-Gutmann bodies in pulmonary malakoplakia.

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Figure 17

Michaelis-Gutmann bodies in pulmonary malakoplakia.

Citation: Klassen-Fischer M, Neafie R. 2016. Surgical Pathologic Diagnosis, p 759-780. In Hayden R, Wolk D, Carroll K, Tang Y (ed),

Diagnostic Microbiology of the Immunocompromised Host, Second Edition

. ASM Press, Washington, DC. doi: 10.1128/microbiolspec.DMIH2-0023-2015
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Figure 18

Fascicles of spindle cells in mycobacterial spindle-cell pseudotumor.

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Figure 18

Fascicles of spindle cells in mycobacterial spindle-cell pseudotumor.

Citation: Klassen-Fischer M, Neafie R. 2016. Surgical Pathologic Diagnosis, p 759-780. In Hayden R, Wolk D, Carroll K, Tang Y (ed),

Diagnostic Microbiology of the Immunocompromised Host, Second Edition

. ASM Press, Washington, DC. doi: 10.1128/microbiolspec.DMIH2-0023-2015
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Figure 19

Same tissue as in Fig. 17 demonstrating numerous acid-fast bacilli (Ziehl-Neelsen stain).

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Figure 19

Same tissue as in Fig. 17 demonstrating numerous acid-fast bacilli (Ziehl-Neelsen stain).

Citation: Klassen-Fischer M, Neafie R. 2016. Surgical Pathologic Diagnosis, p 759-780. In Hayden R, Wolk D, Carroll K, Tang Y (ed),

Diagnostic Microbiology of the Immunocompromised Host, Second Edition

. ASM Press, Washington, DC. doi: 10.1128/microbiolspec.DMIH2-0023-2015
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Figure 20

Pleomorphic rods of (Warthin-Starry stain).

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Figure 20

Pleomorphic rods of (Warthin-Starry stain).

Citation: Klassen-Fischer M, Neafie R. 2016. Surgical Pathologic Diagnosis, p 759-780. In Hayden R, Wolk D, Carroll K, Tang Y (ed),

Diagnostic Microbiology of the Immunocompromised Host, Second Edition

. ASM Press, Washington, DC. doi: 10.1128/microbiolspec.DMIH2-0023-2015
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Figure 21

Myriad acid-fast bacilli of in an anergic patient.

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Figure 21

Myriad acid-fast bacilli of in an anergic patient.

Citation: Klassen-Fischer M, Neafie R. 2016. Surgical Pathologic Diagnosis, p 759-780. In Hayden R, Wolk D, Carroll K, Tang Y (ed),

Diagnostic Microbiology of the Immunocompromised Host, Second Edition

. ASM Press, Washington, DC. doi: 10.1128/microbiolspec.DMIH2-0023-2015
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Figure 22

Hyphae of spp. invading an artery.

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Figure 22

Hyphae of spp. invading an artery.

Citation: Klassen-Fischer M, Neafie R. 2016. Surgical Pathologic Diagnosis, p 759-780. In Hayden R, Wolk D, Carroll K, Tang Y (ed),

Diagnostic Microbiology of the Immunocompromised Host, Second Edition

. ASM Press, Washington, DC. doi: 10.1128/microbiolspec.DMIH2-0023-2015
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Figure 23

Lung cavities due to PCP.

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Figure 23

Lung cavities due to PCP.

Citation: Klassen-Fischer M, Neafie R. 2016. Surgical Pathologic Diagnosis, p 759-780. In Hayden R, Wolk D, Carroll K, Tang Y (ed),

Diagnostic Microbiology of the Immunocompromised Host, Second Edition

. ASM Press, Washington, DC. doi: 10.1128/microbiolspec.DMIH2-0023-2015
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Figure 24

cysts. Note the large darkly stained capsular dot (GMS stain).

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Figure 24

cysts. Note the large darkly stained capsular dot (GMS stain).

Citation: Klassen-Fischer M, Neafie R. 2016. Surgical Pathologic Diagnosis, p 759-780. In Hayden R, Wolk D, Carroll K, Tang Y (ed),

Diagnostic Microbiology of the Immunocompromised Host, Second Edition

. ASM Press, Washington, DC. doi: 10.1128/microbiolspec.DMIH2-0023-2015
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Figure 25

. Note the presence of narrow-neck budding (GMS stain).

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Figure 25

. Note the presence of narrow-neck budding (GMS stain).

Citation: Klassen-Fischer M, Neafie R. 2016. Surgical Pathologic Diagnosis, p 759-780. In Hayden R, Wolk D, Carroll K, Tang Y (ed),

Diagnostic Microbiology of the Immunocompromised Host, Second Edition

. ASM Press, Washington, DC. doi: 10.1128/microbiolspec.DMIH2-0023-2015
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Figure 26

Granulomatous response to .

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Figure 26

Granulomatous response to .

Citation: Klassen-Fischer M, Neafie R. 2016. Surgical Pathologic Diagnosis, p 759-780. In Hayden R, Wolk D, Carroll K, Tang Y (ed),

Diagnostic Microbiology of the Immunocompromised Host, Second Edition

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Figure 27

spp. within intestinal-epithelial cells, but appearing to be on the surface.

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Figure 27

spp. within intestinal-epithelial cells, but appearing to be on the surface.

Citation: Klassen-Fischer M, Neafie R. 2016. Surgical Pathologic Diagnosis, p 759-780. In Hayden R, Wolk D, Carroll K, Tang Y (ed),

Diagnostic Microbiology of the Immunocompromised Host, Second Edition

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Figure 28

organisms within intestinal-epithelial cells.

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Figure 28

organisms within intestinal-epithelial cells.

Citation: Klassen-Fischer M, Neafie R. 2016. Surgical Pathologic Diagnosis, p 759-780. In Hayden R, Wolk D, Carroll K, Tang Y (ed),

Diagnostic Microbiology of the Immunocompromised Host, Second Edition

. ASM Press, Washington, DC. doi: 10.1128/microbiolspec.DMIH2-0023-2015
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Figure 29

Free tachyzoites of in brain.

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Figure 29

Free tachyzoites of in brain.

Citation: Klassen-Fischer M, Neafie R. 2016. Surgical Pathologic Diagnosis, p 759-780. In Hayden R, Wolk D, Carroll K, Tang Y (ed),

Diagnostic Microbiology of the Immunocompromised Host, Second Edition

. ASM Press, Washington, DC. doi: 10.1128/microbiolspec.DMIH2-0023-2015
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Figure 30

Bradyzoites of in a cyst in brain.

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Figure 30

Bradyzoites of in a cyst in brain.

Citation: Klassen-Fischer M, Neafie R. 2016. Surgical Pathologic Diagnosis, p 759-780. In Hayden R, Wolk D, Carroll K, Tang Y (ed),

Diagnostic Microbiology of the Immunocompromised Host, Second Edition

. ASM Press, Washington, DC. doi: 10.1128/microbiolspec.DMIH2-0023-2015
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Figure 31

trophozoites in a duodenal biopsy.

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Figure 31

trophozoites in a duodenal biopsy.

Citation: Klassen-Fischer M, Neafie R. 2016. Surgical Pathologic Diagnosis, p 759-780. In Hayden R, Wolk D, Carroll K, Tang Y (ed),

Diagnostic Microbiology of the Immunocompromised Host, Second Edition

. ASM Press, Washington, DC. doi: 10.1128/microbiolspec.DMIH2-0023-2015
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Figure 32

Gram-positive spores within epithelial cells (Brown-Brenn stain).

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Image of Figure 32
Figure 32

Gram-positive spores within epithelial cells (Brown-Brenn stain).

Citation: Klassen-Fischer M, Neafie R. 2016. Surgical Pathologic Diagnosis, p 759-780. In Hayden R, Wolk D, Carroll K, Tang Y (ed),

Diagnostic Microbiology of the Immunocompromised Host, Second Edition

. ASM Press, Washington, DC. doi: 10.1128/microbiolspec.DMIH2-0023-2015
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Figure 33

Acid-fast spores within epithelial cells (Ziehl-Neelsen stain).

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Figure 33

Acid-fast spores within epithelial cells (Ziehl-Neelsen stain).

Citation: Klassen-Fischer M, Neafie R. 2016. Surgical Pathologic Diagnosis, p 759-780. In Hayden R, Wolk D, Carroll K, Tang Y (ed),

Diagnostic Microbiology of the Immunocompromised Host, Second Edition

. ASM Press, Washington, DC. doi: 10.1128/microbiolspec.DMIH2-0023-2015
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Figure 34

spp. spores depicting pink-staining polar granule (PAS stain).

10.1128/9781555819040/fig29-34_thmb.gif
10.1128/9781555819040/fig29-34.gif
Image of Figure 34
Figure 34

spp. spores depicting pink-staining polar granule (PAS stain).

Citation: Klassen-Fischer M, Neafie R. 2016. Surgical Pathologic Diagnosis, p 759-780. In Hayden R, Wolk D, Carroll K, Tang Y (ed),

Diagnostic Microbiology of the Immunocompromised Host, Second Edition

. ASM Press, Washington, DC. doi: 10.1128/microbiolspec.DMIH2-0023-2015
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Figure 35

Birefringent spp. spores.

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10.1128/9781555819040/fig29-35.gif
Image of Figure 35
Figure 35

Birefringent spp. spores.

Citation: Klassen-Fischer M, Neafie R. 2016. Surgical Pathologic Diagnosis, p 759-780. In Hayden R, Wolk D, Carroll K, Tang Y (ed),

Diagnostic Microbiology of the Immunocompromised Host, Second Edition

. ASM Press, Washington, DC. doi: 10.1128/microbiolspec.DMIH2-0023-2015
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Figure 36

spores within duodenal-epithelial cells (Brown-Brenn stain).

10.1128/9781555819040/fig29-36_thmb.gif
10.1128/9781555819040/fig29-36.gif
Image of Figure 36
Figure 36

spores within duodenal-epithelial cells (Brown-Brenn stain).

Citation: Klassen-Fischer M, Neafie R. 2016. Surgical Pathologic Diagnosis, p 759-780. In Hayden R, Wolk D, Carroll K, Tang Y (ed),

Diagnostic Microbiology of the Immunocompromised Host, Second Edition

. ASM Press, Washington, DC. doi: 10.1128/microbiolspec.DMIH2-0023-2015
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Figure 37

Normal eosinophilic Paneth cells at bases of intestinal crypts.

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10.1128/9781555819040/fig29-37.gif
Image of Figure 37
Figure 37

Normal eosinophilic Paneth cells at bases of intestinal crypts.

Citation: Klassen-Fischer M, Neafie R. 2016. Surgical Pathologic Diagnosis, p 759-780. In Hayden R, Wolk D, Carroll K, Tang Y (ed),

Diagnostic Microbiology of the Immunocompromised Host, Second Edition

. ASM Press, Washington, DC. doi: 10.1128/microbiolspec.DMIH2-0023-2015
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Figure 38

Invasive filariform larvae invoking an inflammatory reaction.

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10.1128/9781555819040/fig29-38.gif
Image of Figure 38
Figure 38

Invasive filariform larvae invoking an inflammatory reaction.

Citation: Klassen-Fischer M, Neafie R. 2016. Surgical Pathologic Diagnosis, p 759-780. In Hayden R, Wolk D, Carroll K, Tang Y (ed),

Diagnostic Microbiology of the Immunocompromised Host, Second Edition

. ASM Press, Washington, DC. doi: 10.1128/microbiolspec.DMIH2-0023-2015
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Figure 39

Cross-section through one coiled larva showing paired lateral alae.

10.1128/9781555819040/fig29-39_thmb.gif
10.1128/9781555819040/fig29-39.gif
Image of Figure 39
Figure 39

Cross-section through one coiled larva showing paired lateral alae.

Citation: Klassen-Fischer M, Neafie R. 2016. Surgical Pathologic Diagnosis, p 759-780. In Hayden R, Wolk D, Carroll K, Tang Y (ed),

Diagnostic Microbiology of the Immunocompromised Host, Second Edition

. ASM Press, Washington, DC. doi: 10.1128/microbiolspec.DMIH2-0023-2015
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