Graciela Quijano

OPPORTUNISTIC INFECTIONS IN PEDIATRIC HIV INFECTION: A study of 74 Autopsy Cases from Latin America

A postmortem analysis of opportunistic infections in 74 pediatric AIDS cases from Argentina Brazil and Mexico was conducted to establish a baseline for future monitoring of HIV in children in Latin America. The collaborative study emerged from a 1992 meeting of Latin American pathologists organized by the Pan American Health Organization. The mean age of autopsied children was 2.7 years; 72% of cases were 12 months of age or under. Fungal infections--especially Candida (29 cases 39.18%) and Pneumocystis carinii (15 cases 20.27%)--were the most common opportunistic infections. Viral infections were found in 31 cases 25 (38.7%) of which were cytomegalovirus. Additional infections detected were cryptosporidiosis (6 cases) Mycobacterium avium intracellulare (4 cases) and tuberculosis (1 case). Nonspecific bacterial bronchopneumonia was present in 11 cases. 4 cases of toxoplasmosis 3 of which were localized in the central nervous system were found. Cytomegalovirus and P carinii was the most common combination of infections. Despite a slightly higher frequency of cases of histoplasmosis and brain toxoplasmosis these findings are generally comparable to those of pediatric AIDS autopsies conducted in North America.

Opportunistic Infections in Pediatric HIV Infection: A study of 74 Autopsy Cases from Latin America: The Latin American AIDS Pathology Study Group

The present report describes opportunistic infections found at 74 autopsies of pediatric HIV/AIDS patients performed at several hospitals in Latin American countries. Fungal infections were the most common (53 cases), Candida sp. (39.18%) and Pneumocystis carinii (20.27%) being the most frequently recognized. Other fungal diseases included histoplasmosis, aspergillosis, and cryptococcosis. Viral infections were present in 31 cases, 38.7% being due to cytomegalovirus. Other viruses recognized included herpes simplex and adenovirus. Additional opportunistic infections were due to Mycobacterium avium-intracellulare, toxoplasmosis, and tuberculosis. Nonspecific bacterial bronchopneumonia was present in 11 cases. Cytomegalovirus and P. carinii coinfection was the most common association found. In this series patients died at a younger age (72% at or younger than 1 year old) and there was a slightly higher number of cases of histoplasmosis and brain toxoplasmosis than in other previously published series of infants and children.

Histopathologic Findings in the Lymphoid and Reticuloendothelial System in Pediatric Hiv Infection:. A Postmortem Study

The present report describes the histopathological features of lymphoreticular tissues in 29 pediatric autopsies of human immunodeficiency virus (HIV)-infected patients. Mean age for the whole group was 1.77 years; 68.9% and 62% of the cases were 2 years old or less and 1 year old or less at the time of death, respectively. Twenty-one cases were categorized as acquired immunodeficiency syndrome (AIDS) and the rest included seven HIV-positive newborns and infants and two infants belonging to a high-risk group. The thymus (24 cases) showed severe lymphoid depletion (atrophy) in 16 (66.6%) cases, microcystic transformation of Hassalls corpuscles (HCs) in 4, calcified HCs in 3, absence of HCs in 3, and plasmacytic infiltrates and Warthin-Finkeldey-type multinucleated giant cells (also found in lymph nodes and bowel lymphoid aggregates in the same case) in 1. Lymph nodes (25 cases) revealed extensive lymphocyte depletion (68%); selective follicular (2 cases) or paracortical (3 cases) atrophy; hemophagocytosis (44%); some type of hyperplasia (plasmacytosis, enlarged follicles) in 5 cases; some type of lymphadenitis (12 cases), 5 cases of which were due to opportunistic infections (cytomegalovirus, 2; histoplasmosis, cryptococcosis, Mycobacterium avium-intracellulare, 1 each). Main findings in the spleen (28 cases) were extensive lymphocyte depletion (10 cases), limited to the white pulp in 4 and including the red pulp in 7; some type of lymphoid hyperplasia (limited to white pulp in 6 cases and involving the red pulp in 5); hemophagocytosis (7 cases); and foci exhibiting a peculiar arrangement of spindle-shaped cells combined with capillaries, plasma cells, and occasionally siderophages in 11. These we have termed kaposiform areas due to the resemblance to the so-called inflammatory variant of Kaposis sarcoma. This pattern was also recognized in lymph nodes of two cases. Although atrophy was the main theme, cases with hyperplasia were also noticed. The possible relationship, if it exists at all, between kaposiform areas and Kaposis sarcoma remains to be established. No tumor was found in this series. No specific histopathologic pattern of lymphoid tissues atributable to HIV emerged form this study aside from kaposiform areas, a microscopic feature not previously reported in this circumstance in pediatrics.

Colonic and Duodenal Flat Adenomas in Children with Classical Familial Adenomatous Polyposis

Flat adenomas of the colon and duodenum have been described as associating with familial adenomatous polyposis (FAP), its attenuated variant, and the so-called hereditary nonpolyposis colorectal cancer. There seem to be no report on the occurrence of flat adenomas in pediatric patients with family history of FAP. We are reporting 4 children from 2 cancer-prone families in whom colonic and duodenal moderately dysplastic flat adenomas were found. Gastrointestinal endoscopy and biopsies were performed in 3 female siblings (7, 9, and 11 years old) and 1 male (9 years old) when referred for screening owing to familial history of bowel cancer (family 1) or evidence of bilateral congenital hypertrophy of the retinal pigment epithelium (CHRPE), which is known to be associated with FAP (family 2). Endoscopic visualization of the mucosa was improved by use of 0.2% indigo carmine solution spray. Biopsies were routinely processed for H&E and immunohistochemistry staining. Present patients were asymptomatic, with the exception of 2 weeks rectal bleeding in 1 of them. The colonic videoendoscopy showed in 2/3 siblings hundreds of flat or slightly raised plaques less than 1 cm in diameter as well as some classic polyps throughout the colon. The other sibling showed 40 flat-topped lesions with minimal elevation and central umbilication in the cecum. Upper endoscopy demonstrated a few flat lesions in the nonperiampullary area of the duodenum in 2/4 patients. The colonic videoendoscopy performed on the 9-year-old boy revealed multiple small sessile polyps. Microscopic study demonstrated tubular adenomas with a few neoplastic crypts, slight disarray of the overall architecture, and moderate (low-grade) dysplasia of the epithelium. These features were more obvious at the center and superficial areas of the adenomas. The 4 children had multiple flat adenomas of the colon and duodenum (2/4) matching with those described in adult patients. Flat adenomas in the context of FAP probably represent early stages of the adenoma development. Careful endoscopic-histologic correlation may result in increasing recognition of these lesions at the pediatric age.

Rhabdomyomatous dysplasia of the lung.

This article deals with the presence of nontumoral striated muscle fibers in the lungs of 3 neonates. These cells were diffusely distributed in one lung (case 1) or in both (case 2), or focally localized to the lung parenchyma adjacent to the liver in a case with a large right diaphragmatic hernia (case 3). The striated muscle fibers were located in the walls of small bronchi and bronchioli or in the alveolar interstitium. Other major lung malformations found simultaneously were absence of lobation, hypoplastic lungs, and hypoplastic pulmonary vessels. The origin of striated muscle fibers in the neonatal lung has been attributed to anomalous differentiation of mesoblastic cells (as in cases 1 and 2). The presence of striated muscle cells in the lower margin of a hypoplastic lung associated with a right diaphragmatic hernia (case 3) suggests that intrapulmonary inclusion of diaphragmatic muscle fibers might be a source as well. Striated muscle fibers in the lung are commonly associated with major malformations involving heart and lungs, suggesting a much wider morphogenetic error.

Multiple congenital infantile hemangiomas of the lung in partial trisomy D

The postmortem examination of a multimalformed infant with trisomy D revealed 33 capillary hemangiomas in both lungs, with the microscopic features of the common cutaneous GLUT-1 infantile hemangioma. The finding further expands the spectrum of sites where this type of capillary hemangioma can be found, as it has been reported in the placenta, liver, salivary gland and mammary gland. Its association with the genetic condition trisomy D, already known to occasionally present cutaneous and hepatic hemangiomas, could be a clue to its pathogenesis. Hemangiomas in children are most commonly recognised in the skin and liver. They are infrequent in the respiratory tract, presenting predominantly in the subglottic region, and extremely rare in the lung. Pulmonary hemangiomas include endobronchial and parenchymatous types. In accordance to its structure, they are classified as capillary and cavernous histological types.1 Among the angiomatous lesions of childhood, the so-called infantile hemangioma (IH) shows a peculiar characteristic: its endothelial cells express the antigen GLUT-12–4. This feature allows differential diagnosis with other types of vascular tumours and malformations found at this age. We are reporting the case of an infant with partial trisomy D presenting with a series of malformations already reported in this condition combined with the unique finding of multiple IH in both lungs. This female newborn was referred from another medical centre 15 h after birth under assisted ventilation, with the tentative diagnosis of genetic syndrome and cyanotic congenital heart disease. She was born through caesarean section at 38 weeks gestational age. Birth weight was 2500 g and the Apgar was 4/7. The mother was 30 years old and presented with hypertension. After admission, an echocardiography demonstrated right ventricle with double outlet, pulmonary valve atresia, patent small ductus, subaortic ventricular septal defect with overriding aorta, dilated right atria and ventricle, dilated …

Disseminated Bacillus Calmette-Guérin, Miliary Type: Autopsy Findings and Diagnosis Using Polymerase Chain Reaction

INTRODUCTION Disseminated bacillus Calmette-Guerin (BCG) is a well-known complication found in immunodeficient patients that produces skin, bone, and visceral lesions. Less frequently disseminated BCG vaccination has also been described in seemingly immunocompetent patients [1,2]. We report here the case of an infant in whom disseminated miliary type granulomas were found at postmortem study. Recognition of mycobacteria genomic material was achieved by polymerase chain reaction (PCR). Also discussed is our experience with four other cases of this peculiar infectious disease.

Heterotopic Neurons in the Umbilical Cord

Several types of tissues have been reported to present ectopically in the umbilical cord (UC). Most of these are found in the UC proximal to the fetus. Featuring tissues are developmentally related to the area, thus representing vestigial remnants. In this report we describe the recognition of neurons and nerves within the UC in a stillborn with several malformations, an observation that we did not find in the literature.

Atherosclerosis and Central Adiposity in a Pediatric Patient with AIDS Treated with HAART: Autopsy Findings

Several types of cardiovascular lesions may develop in pediatric human immunodeficiency virus–positive (HIV+)/acquired immunodeficiency syndrome (AIDS) patients, namely myocarditis, dilated cardiomyopathy, pericardial effusion, pericarditis, left ventricle hypertrophy, fibrocalcific arteriopathy, and aneurysms. Additional lesions may be discovered by histological examination. These include fibrocalcific lesions in medium-sized arteries and small vessels, mainly of the heart and brain, and vasculitis. In the large arteries the vasa vasorum may present chronic inflammatory infiltrates or leukocytoclastic vasculitis, resulting in aneurysms. We are reporting the case of a 14-year-old girl with mother-to-infant HIV transmission with a long history of several central nervous system infections and AIDS dementia, who received treatment with the HAART protocol (including a protease inhibitor) for 3 years. A year after beginning this treatment, cholesterol serum levels were 2.8 g/L and 3.8 g/L. Autopsy findings showed gross and microscopic features of adult-type atherosclerosis involving the whole thoracic aorta, its main branches, and the coronary arteries. Remarkably, the abdominal aorta and all its branches were almost completely devoid of these lesions. At the same time, although the body presented extreme cachexia, there were obvious subepericardial, periadrenal, and peripancreatic fat deposits. The referred findings may have resulted from the well-known metabolic-dyslipemic syndrome induced by the HAART therapy and have not been specifically mentioned previously in the literature in the particular setting observed in the case of this patient.

Whose Small Bowel Biopsy Is This? Aids from Molecular Biology: Use of Molecular Techniques for Mismatched Specimen Identification

Accurate and correct identification is of paramount importance when processing biopsies in pathology laboratories. Although extreme care is dedicated to reducing human error in this process, such error is sometimes unavoidable and, occasionally, mislabeling occurs. This may result in harm to the patient not only due to errors in diagnosis but also to the resulting treatment, which may be inappropriate. We report here an episode of mismatched small bowel biopsies that happened in our laboratory, and the way in which it was solved through PCR technique investigation. The procedure allowed a rapid and accurate identification of the samples, avoiding any harm to the patients involved. The first patient was a 2-year-old boy who presented with chronic diarrhea (which he had had since 6 months of age), undernourishment (11.7 kg), and abdominal swelling. There were no familial data of celiac disease. The mother noted that when she stopped feeding the child with flour-containing foods for 1 wk, improvement in the stools resulted. The child’s diet had included wheat flour since the age of 5 months. The second patient was a 5-year-old boy who presented with lower abdominal distention and weight in the 50th percentile (16,250 kg). Serology for endomisial antibodies was positive. Both patients were submitted to peroral small bowel biopsy for villous atrophy, which at this age represents celiac disease in the vast majority of the cases. Samples were received at the pathology laboratory the same day. Mistakenly, the samples were given the same identification number. The problem arose at the time of microscopic reading, since both slides with the same number presented different microscopic features. One showed complete villous atrophy (villous/crypt ratio: 0.5, or enteropathy grade 4), while the other had a normal villous crypt ratio ( 2.5).