Which histologic findings are characteristic of CMV esophagitis?

Updated: May 28, 2020
  • Author: Deepika Devuni, MD; Chief Editor: BS Anand, MD  more...
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Cytomegalovirus (CMV) infects submucosal fibroblasts and endothelial cells, not the squamous epithelium. Diagnosis depends on biopsies obtained by esophagogastroduodenoscopy (EGD). Superficial erosions with serpiginous nonraised borders in the middle to distal esophagus are observed. With infection progression, shallow ulcerations may deepen and expand for 5-10 cm. Tissue is needed for confirmation of the diagnosis; obtain multiple biopsies from the ulcer base.

The most constant feature of CMV esophagitis is mucosal ulceration; the ulcers may be single or multiple. These lesions can be shallow or deep, and not infrequently, they are several centimeters or more in diameter. Infected epithelial cells in the esophagus become enlarged by a factor of two to four times (hence the term cytomegalic cells), and they contain eccentrically placed intranuclear inclusion bodies with surrounding halos.

In contrast to herpes esophagitis, small granular cytoplasmic inclusions are seen in the endothelial cells or fibroblasts near the base of the ulcers. A lymphomonocytic inflammatory response is also seen at the site of infection.

See Cytomegalovirus Esophagitis for complete information on this topic.

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