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27 May 2015 - Case of the Week #353

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Case of the Week #353

Clinical History:
A 47 year old man presented with malaise, fatigue and history of recent urinary tract infection. A urine specimen was submitted for cytologic examination.

Micro images:

What is your diagnosis?

Herpes viral cytopathic effects in urine cytology

The case was reported as "negative for malignant cells; cellular changes compatible with herpes simplex virus noted". There was no clinical suspicion of HSV.

Viral infections of the bladder are usually seen in the immunocompromised setting, and include herpes simplex virus (HSV), cytomegalovirus, polyomavirus and HPV. They may be hemorrhagic. Herpetic cytopathic changes include multinucleation, nuclear molding, margination of chromatin and ground glass chromatin texture. Large, sharply angulated, eosinophilic nuclear inclusions may also be present, as in this case. Infected cells can be greatly enlarged and bizarrely shaped, with dense, opaque cytoplasm.

References: Urologiia 2013;4:16, Diagn Cytopathol 2013;41:61, Infez Med 2009;17:38

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