Which histologic findings are characteristic of herpes esophagitis?

Updated: May 02, 2019
  • Author: Deepika Devuni, MBBS; Chief Editor: BS Anand, MD  more...
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The diagnosis of herpes simplex virus (HSV) esophagitis is made at endoscopy. The earliest esophageal lesions are rounded 1- to 3-mm vesicles in the middle to distal esophagus. The centers slough to form discrete circumscribed ulcers with raised edges.

Advanced HSV esophagitis may be indistinguishable from candidal esophagitis. Plaques, cobblestoning, or a shaggy ulcerative appearance is observed.

HSV preferentially infects epithelial cells. Biopsy should be performed from ulcer margins of islands of squamous mucosa for histology and culture. The ulcer base is devoid of epithelial cells and is inadequate to diagnose HSV esophagitis.

The epithelial cells at the edge of the ulcers are characterized by the following:

  • Multinucleated giant cells
  • Ballooning degeneration
  • Ground glass intranuclear Cowdry type A inclusion bodies
  • Margination of chromatin

Immunologic staining of centrifugation cultures is more sensitive than routine histology. Immunohistologic stains using monoclonal antibodies to HSV antigens or in situ hybridization techniques may improve the yield in difficult cases.

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