Gastroenterol Res

Gastroenterology Research, ISSN 1918-2805 print, 1918-2813 online, Open Access

Article copyright, the authors; Journal compilation copyright, Gastroenterol Res and Elmer Press Inc

Journal website http://www.gastrores.org

Original Article

Volume 9, Number 6, December 2016, pages 92-98

Immunostaining Detection of Cytomegalovirus in Gastrointestinal Biopsies: Clinicopathological Correlation at a Large Academic Health System

Figure 1. Histopathology of CMV. (A) H&E staining showing CMV cytopathic effect (arrows; magnification: × 400). (B) IHC staining with CMV as positive (> 2 cells stained; magnification: × 400) and (C) rare positive (1 - 2 cells stained; magnification: × 400).

Figure 2. Summary of the total number of GI biopsies, number and percentage of CMV IHC tests performed, number and percentage of CMV positive cases between 2013 and 2015. (A) Table and (B) Bar graph. (C) Organ involvement of CMV positive cases.

**Table 1.** Summary of CMV IHC Tests Ordered by Clinician and Pathologists
Time period	#CMV IHC	Clinician requested	CMV positive per clinician’s request	Pathologist requested	CMV positive per pathologist request
2013 (January 1 - December 31)	272	43	20 (46.5%)	229	14 (6.1%)
2014 (January 1 - December 31)	401	46	16 (37.5%)	355	25 (7.0%)
2015 (January 1 - December 31)	535	63	14 (24.1%)	472	16 (3.4%)
Total	1,208	152	50 (32.9%)	1,056	55 (5.2%)

Table 1. Summary of CMV IHC Tests Ordered by Clinician and Pathologists

Time period

#CMV IHC

Clinician requested

CMV positive per clinician’s request

Pathologist requested

CMV positive per pathologist request

2013 (January 1 - December 31)

272

20 (46.5%)

229

14 (6.1%)

2014 (January 1 - December 31)

401

16 (37.5%)

355

25 (7.0%)

2015 (January 1 - December 31)

535

14 (24.1%)

472

16 (3.4%)

Total

1,208

152

50 (32.9%)

1,056

55 (5.2%)

**Table 2.** Correlation of the Number of Positive Cells Detected by IHC With Systemic Virology (PCR-Based Tests)
	IHC, > 2 cells labeled	IHC, 1 - 2 cells labeled
*VL > 137 IU/mL. Fisher’s exact test: P < 0.05.
#CMV viral load positive*	32 (55.2%)	11 (23.4%)
#CMV viral load negative	10 (17.2%)	12 (25.5%)
#Virology not tested	16 (27.6%)	24 (51.1%)
Total	58	47

Table 2. Correlation of the Number of Positive Cells Detected by IHC With Systemic Virology (PCR-Based Tests)

IHC, > 2 cells labeled

IHC, 1 - 2 cells labeled

*VL > 137 IU/mL. Fisher’s exact test: P < 0.05.

#CMV viral load positive*

32 (55.2%)

11 (23.4%)

#CMV viral load negative

10 (17.2%)

12 (25.5%)

#Virology not tested

16 (27.6%)

24 (51.1%)

Total

**Table 3.** Pre-Existing Conditions Influence Clinical Management of CMV Positivity
Pre-existing disease	# Cases	CMV by IHC	Clinical management for anti-CMV
HIV	20	14 positive	Usually treated regardless of CMV PCR results
6 rare positive
BMT or solid organ transplant	17	10 positive	Usually treated regardless of CMV PCR results
7 rare positive
IBD	40	20 positive	Usually treated
20 rare positive	Usually only treated if CMV PCR positive
Others	28	14 positive	Usually treated
14 rare positive	Usually only treated if CMV PCR positive

Table 3. Pre-Existing Conditions Influence Clinical Management of CMV Positivity

Pre-existing disease

# Cases

CMV by IHC

Clinical management for anti-CMV

HIV

14 positive

Usually treated regardless of CMV PCR results

6 rare positive

BMT or solid organ transplant

10 positive

Usually treated regardless of CMV PCR results

7 rare positive

IBD

20 positive

Usually treated

20 rare positive

Usually only treated if CMV PCR positive

Others

14 positive

Usually treated

14 rare positive

Usually only treated if CMV PCR positive

**Table 4.** Clinical Outcomes Bewteen CD (n = 8) and UC (n = 11) Patients With Positive CMV IHC (> 2 Cells)
	CD (n = 8)	UC (n = 11)*	Statistical test
*Total biopsy case number is 12. However, there are two cases belonging to one single patient.
Age, years (range)	39 (21 - 77)	49 (21 - 79)	P > 0.05
Female	3	5	P > 0.05
Male	5	6
On systemic steroid	7	10	P > 0.05
Not on steroid	1	1
Anti-viral treatment	6	9	P > 0.05
No anti-viral treatment	2	2
Surgery after reported CMV	5	4	P > 0.05
No surgery	3	7
Duration from CMV to surgery if performed	1 - 19 months (1 within 1 month)	0.5 - 6 months (2 within 1 month)

Table 4. Clinical Outcomes Bewteen CD (n = 8) and UC (n = 11) Patients With Positive CMV IHC (> 2 Cells)

CD (n = 8)

UC (n = 11)*

Statistical test

*Total biopsy case number is 12. However, there are two cases belonging to one single patient.

Age, years (range)

39 (21 - 77)

49 (21 - 79)

P > 0.05

Female

P > 0.05

Male

On systemic steroid

P > 0.05

Not on steroid

Anti-viral treatment

P > 0.05

No anti-viral treatment

Surgery after reported CMV

P > 0.05

No surgery

Duration from CMV to surgery if performed

1 - 19 months (1 within 1 month)

0.5 - 6 months (2 within 1 month)