Histoplasmosis Colon
Endoscopic View of Histoplasmosis of the Colon and Condyloma Accuminata.

Video Endoscopic Sequence 1 of 11.

Endoscopic View of Histoplasmosis of the Colon and Condyloma Accuminata.

This 28 year-old homosexual man present with diarreic syndrome of one month and fetid hematoquezia of 3 days.
At colonoscopy displays a small multilobulated lesion in the pectine line and an irregular large rectal ulcer.

This image has to rule out several lesion like intestinal tuberculosis, Crohn disease etc. The biopsies display hystoplasma capsulatum.

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All endoscopic images shown in this Atlas contains video clip.

 

 

 

Condyloma Accuminata.

Video Endoscopic Sequence 2 of 11.

Condyloma Accuminata.

Condyloma acuminatum refers to an epidermal manifestation attributed to the epidermotropic human papillomavirus (HPV). More than 100 types of double-stranded HPV papovavirus have been isolated to date. Many of these have been related directly to an increased neoplastic risk in men and women.

Approximately 90% of condyloma acuminata are related to HPV types 6 and 11. These 2 types are the least likely to have a neoplastic potential. Risk for neoplastic conversion has been determined to be moderate (types 33, 35, 39, 40, 43, 45, 51-56, 58) or high (types 16, 18), with many other isolated types.

The picture is complicated by proven coexistence of many of these types in the same patient (10-15% of patients), the lack of adequate information on the oncogenic potential of many other types, and ongoing identification of additional HPV-related clinical pathology.

 

 

 

Image and Video Clip of Large and irregular Rectal Ulcer due a histoplasmosis.

Video Endoscopic Sequence 3 of 11.

Image and Video Clip of Large and irregular Rectal Ulcer due a histoplasmosis.

Histoplasma capsulatum is an important pathogen that is the most commonly diagnosed endemic mycosis in the gastrointestinal tract of immunocompromised hosts. Failure to recognize and treat disseminated histoplasmosis in AIDS patients invariably leads to death.

Gastrointestinal manifestations frequently involve the terminal ileum and cecum, and depending on the layer of bowel wall involved present as bleeding, obstruction, perforation, or peritonitis.

Because they can be variable in appearance, they may be mistaken for Crohn's disease or malignant tumors. Four distinct pathologic patterns of GI histoplasmosis have been described that all have differing clinical presentations.

 

 

 

Endoscopy image of of Histoplasmosis of the Colon and Condyloma Accuminata

Video Endoscopic Sequence 4 of 11.

Endoscopy image of of Histoplasmosis of the Colon and Condyloma Accuminata.

Histoplasmosis is a granulomatous disease

The endoscopist should be aware of the possibility of histoplasmosis in the differential diagnosis of inflammatory bowel disease, malignancy and other intestinal disorders like TB.

Co-existence of GIH with GI tuberculosis has also been reported in an HIV patient.7 Importantly GIH has excellent long term survival with aggressive therapy with antifungal drugs. Untreated histoplasmosis can be fatal especially in immunocompromised patients.

 

 

 

Endoscopic View of Histoplasmosis of the Colon and Condyloma Accuminata

Video Endoscopic Sequence 5 of 11.

Endoscopic View of Histoplasmosis of the Colon and Condyloma Accuminata.

Video Endoscopic Sequence 6 of 11.

Stain Gomori methenamine

The organisms were highlighted with a silver histochemical staining technique (B, Gomori methenamine silver.

In pathology, the Gömöri methenamine silver stain, abbreviated GMS, is a popular staining method in histology It is used widely as a screen for fungal organisms.
Particularly useful in staining carbohydrates.

It can be used to identify the yeast-like fungus Pneumocystis jiroveci which causes a form of pneumonia called Pneumocystis Pneumonia (PCP) or Pneumocystosis.

The cell walls of these organisms are outlined by the brown to black stain.

Video Endoscopic Sequence 7 of 11.

P 16 Positive for Condyloma Accuminata

Video Endoscopic Sequence 8 of 11.

Pas Positive for Hystoplasma

Video Endoscopic Sequence 9 of 11.

There are nonspecific inflammation

Video Endoscopic Sequence 10 of 11.

Extensive ulceration with necrosis and polymorphonuclear exudate and lymphocyte with macrophages, there are structures consisting with Histoplasma capsulaptum.

Video Endoscopic Sequence 11 of 11.

There papillomatosis with acanthosis and koilocytosis

Endoscopic View of Histoplasmosis of the Colon.

Video Endoscopic Sequence 1 of 3.

Endoscopic View of Histoplasmosis of the Colon.

A 3 year-old boy with abdominal pain and diarrhea of six months. The patient suffered of congenital humoral immunodeficiency IgG, IgA.

Endoscopic Image of Histoplasmosis of the Colon.

Video Endoscopic Sequence 2 of 3.

Endoscopic Image of Histoplasmosis of the Colon.

The video clip displays two ulcerated lesions.
The biopsies, serologic test, as well as the clinical course, revealed histoplasma capsulatum.

Endoscopic Appearance of Histoplasmosis of the Colon.

Video Endoscopic Sequence 3 of 3.

Endoscopic Appearance of Histoplasmosis of the Colon.

More images and video clips.

Stenosis of rectosigmoid junction due to histoplasmosis.

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