PMC3658239_01
Colonoscopy revealing a friable mass in the ascending colon suspicious for neoplasm.
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The esophagogastroduodenoscopy was unremarkable, but colonoscopy revealed a 4 x 5 cm friable mass with mucosal ulcerations in the ascending colon near the hepatic flexure suspicious for neoplasm (Figure 1).
Hematoxylin and eosin staining of the colonic mass. Note the larger cytomegalovirus-infected cells (arrows) within extensive granulation tissue. Basophilic nuclear inclusion bodies are noted, indicative of active cytomegalovirus replicating nucleoprotein cores.
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Within the granulation tissue were endothelial cells and fibroblasts with basophilic intranuclear inclusion bodies suggestive of CMV infection (Figure 2) which was confirmed by immunohistochemistry staining for CMV antibodies (Figure 3).
Positive immunohistochemistry of the colonic mass with a specific anticytomegalovirus antibody, confirming the diagnosis of cytomegalovirus infection.
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Within the granulation tissue were endothelial cells and fibroblasts with basophilic intranuclear inclusion bodies suggestive of CMV infection (Figure 2) which was confirmed by immunohistochemistry staining for CMV antibodies (Figure 3).
Complete resolution of the colonic mass after ganciclovir treatment.
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Repeat colonoscopy after treatment showed complete resolution of the mass (Figure 4), with significant clinical improvement.