Cytomegalovirus infection of the cervix: morphological observations in five cases of a possibly under-recognised condition

Abstract

Aims: Histologically diagnosed cytomegalovirus (CMV) infection of the cervix is rare and the associated morphological features are not well described. This study describes histopathological findings in five biopsies from four patients with CMV cervicitis. Methods: CMV inclusions were identified in five cervical biopsies from four patients in a single institution over eight months. The clinical notes were reviewed, the morphological features documented, and immunohistochemical staining for CMV performed. CMV immunohistochemical staining was also performed on 30 consecutive cervical biopsies in which inclusions were not seen histologically. Results: None of the patients was immunocompromised but one was postnatal. Numbers of CMV inclusions ranged from occasional to abundant and they were located mainly in endocervical glandular epithelial cells but also in endothelial and mesenchymal cells. Inclusions were not seen in squamous cells. Inclusions were eosinophilic and were intracytoplasmic rather than intranuclear. They were positive immunohistochemically for CMV. Associated morphological features included fibrin thrombi within small blood vessels (three cases), dense active inflammatory infiltrates (five cases), lymphoid follicles (two cases), vacuolation of glandular epithelial cells (two cases), and reactive changes in glandular epithelial cells (two cases). CMV inclusions were not identified in the 30 additional cases that underwent immunohistochemical staining. Conclusions: CMV infection of the cervix may be more common than is thought. Patients are usually immunocompetent and require no treatment. Morphological features such as a dense inflammatory cell infiltrate with lymphoid follicles, and especially fibrin thrombi within small vessels, should alert the pathologist to look closely for the pathognomonic CMV inclusion bodies.H istologically diagnosed cytomegalovirus (CMV) infection of the cervix is rare and the published literature is limited to a few reports, mainly of individual cases or small numbers of cases. [1][2][3][4][5] In this report, we describe the histological features in five biopsies from four patients with CMV infection of the cervix diagnosed in a single institution over an eight month period. By documenting the associated histological appearances we hope to identify features that should alert the pathologist to search for CMV inclusion bodies. We also reviewed the clinical notes to ascertain whether factors predisposing to CMV infection were present and performed CMV immunohistochemical staining on 30 consecutive cervical biopsies where inclusions were not seen to determine whether this might identify additional cases that were not diagnosed on morphological examination. MATERIALS AND METHODSCases were reported by a gynaecological pathologist (WGM) in a single institution over an eight month period. The five cases of CMV cervicitis were from a total of 957 cervical biopsies reported during that period. The associated morphological features were documented.

Multiplex PCR Testing Detection of Higher-than-Expected Rates of Cervical Mycoplasma , Ureaplasma , and Trichomonas and Viral Agent Infections in Sexually Active Australian Women

“…may cause spontaneous abortion, and there is a significant risk of fetal infection with congenital abnormalities (3,8,37). In this study, CMV was detected in 6.3% of female patients tested, which is a prevalence not previously reported in Australian clinics, suggesting the need to consider routine testing in pregnant high-risk patients.…”

“…CMV is not a common cause of cervicitis in immunocompetent women (37). However, studies in China have shown detection rates of 5.1% in a prospective study of women with cervical human papillomavirus (58) and 14.0% in erosive cervicitis (44), possibly as a result of cervical carriage and reactivation by localized inflammation (36).…”

Cervicitis: an Unresolved Gynecological Problem

“…что ДНК цитомегаловируса выявляется в 8,7% патоморфоло-гических образцов, полученных при обследовании о поводу ВПЧ-ассоциированной цервикальной неоплазии [47,48]. Аденовирус был найден у мужчин с негонококковым урет-ритритом, и считается, что он играет определенную роль в этиологии цервицита, но в настоящее время отсутствуют четкие данные в отношении аденовирусов как этиологичес-кого фактора в развитии цервицитов [9].…”

Acute cervicitis and vulvovaginitis may be associated with Cytomegalovirus

“…CMV can be identified in the cervix in a considerable proportion of women (24–29%, and up to 39% among prostitutes) 1 2. However, most cases are asymptomatic and diagnosed fortuitously in cervical cytology.…”