Epithelial Inclusions in Gallbladder Specimens Mimic Parasite Infection: Histologic and Molecular Examination of Reported Cystoisospora belli Infection in Gallbladders of Immunocompetent Patients

The American Journal of Surgical Pathology
Eric A SwansonKimberley J Evason

Abstract

Recent publications have described epithelial cytoplasmic vacuoles and inclusions incidentally noted within gallbladder epithelium and concluded that they represent coccidian parasite infection, in particular, Cystoisospora belli. We identified 8 gallbladder specimens from our institution in the past 3 years in which this diagnosis was suggested or in which similar epithelial alterations were prominent. Molecular analysis was performed on the 8 gallbladder specimens and on 3 positive control specimens: small bowel biopsies from acquired immunodeficiency syndrome patients with diarrhea. Polymerase chain reaction using primers designed to amplify an internal transcribed spacer (ITS2) in the C. belli ribosomal gene cluster was performed on the DNA samples. All 8 gallbladder specimens were negative for amplification, while a product consistent with C. belli was amplified from all 3 positive controls. Histologically, the gallbladder cytoplasmic inclusions stained diffusely positive for Grocott-Gomori's methenamine silver and Periodic acid-Schiff with diastase. In contrast, sections from a positive control small bowel biopsy demonstrated organisms that were negative for Grocott-Gomori's methenamine silver and showed a distinct capsul...Continue Reading

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Citations

Aug 2, 2019·American Journal of Clinical Pathology·Michael G DrageLaura W Lamps
Jun 13, 2019·American Journal of Clinical Pathology·Kimberley J Evason, Eric A Swanson
Oct 11, 2019·American Journal of Clinical Pathology·Arun GopinathAhmad Alkhasawneh
Jan 28, 2020·International Journal of Surgical Pathology·Daniel J RowanBobbi S Pritt
Jul 16, 2019·Parasitology·J P Dubey, S Almeria
Oct 6, 2020·International Journal of Surgical Pathology·Arun GopinathBrett Baskovich

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Methods Mentioned

BETA
biopsies
PCR

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