PMC3943712_01
Endoscopy. Ulcerated and obstructing mass in the second portion of the duodenum.
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Endoscopy showed an obstructing duodenal mass (Figure 1).
Duodenal biopsy. (A) GMS stain with budding yeasts consistent with Histoplasma spp. (B) Duodenal mucosa with ulcerated surface with ill-formed granuloma (blue arrow). (C) Fibrinopurulent exudate (blue arrow) with underlying granulation tissue and chronic inflammation with ill-formed granulomas and multinucleated giant cells (black arrows). (D) Higher power multinucleated giant cells.
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Biopsy revealed granulomatous inflammation and budding yeasts consistent with Histoplasma spp. (Figure 2) and multiple non-necrotizing granulomas.
Transverse colon. (A) Gross surgical specimen from transverse colectomy showing an ulcerated lesion (B) Colonic mucosa and submucosa showing non-necrotizing granulomatous inflammation with no evidence of viral cytopathic effect.
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She was also found to have a mass in her transverse colon that showed non-necrotizing granulomatous inflammation with no evidence of viral cytopathic effect (Figure 3).