Stains & CD markers
HSV
Copyright: 2024, PathologyOutlines.com, Inc.
PubMed Search: HSV
HSV
Author: Nick Baniak, M.D.
Editorial Board Members: Christian M. Schürch, M.D., Ph.D., Stephanie L. Skala, M.D.
Last author update: 26 December 2024
Last staff update: 26 December 2024
Copyright: 2024, PathologyOutlines.com, Inc.
PubMed Search: HSV
Table of Contents
Definition / general | Essential features | Pathophysiology | Clinical features | Interpretation | Uses by pathologists | Microscopic (histologic) description | Microscopic (histologic) images | Virtual slides | Positive staining - disease | Negative staining | Sample pathology report | Board review style question #1 | Board review style answer #1Cite this page: Baniak N. HSV. PathologyOutlines.com website. https://www.pathologyoutlines.com/topic/stainsHSV.html. Accessed January 2nd, 2025.
Definition / general
- Sensitive and specific method for diagnosing herpes simplex virus (HSV) infections (Diagn Pathol 2022;17:17)
- Positive in tissues infected with herpes simplex virus 1 and 2 (HSV1 and HSV2), which belong to the ubiquitous Herpesviridae family of viruses (Am J Dermatopathol 2015;37:1)
Essential features
- Sensitive and specific method for diagnosing HSV infections (Diagn Pathol 2022;17:17)
- Positive in tissues infected with herpes simplex virus 1 and 2 (Am J Dermatopathol 2015;37:1)
- Exact sensitivity of IHC is hard to determine since few concurrent specimens have tissues sent for viral culture, the gold standard for diagnosis (Am J Clin Pathol 2017;147:96)
- Cells exhibit both nuclear and cytoplasmic staining (Am J Dermatopathol 2015;37:1)
Pathophysiology
- Enveloped, double stranded linear DNA virus with an icosahedral capsid and protein tegument (Arch Pathol Lab Med 2011;135:1357, Cancers (Basel) 2023;15:3692)
- Neurocutaneous tropism; replicates and spreads rapidly, causing extensive cell lysis and can establish latent infection primarily in neurosensory ganglia (Diagn Pathol 2022;17:17)
- Rely on the host cell nucleus for DNA replication and transcription via RNA (Arch Pathol Lab Med 2011;135:1357)
- 2 mechanisms are involved in the formation of intraepidermal vesicles: the ballooning of keratinocytes and the reticular degeneration of the epidermis (Am J Dermatopathol 2015;37:1)
Clinical features
- HSV1 and HSV2 are very common and can lead to illness through primary infection or reactivation of latent virus (Am J Clin Pathol 2017;147:96)
- HSV H&E viral cytopathic effects are characterized by multinucleated cells, prominent glassy viral intranuclear inclusions and chromatin margination (Am J Clin Pathol 2017;147:96, Am J Dermatopathol 2015;37:1, Arch Pathol Lab Med 2011;135:1357)
- Is a neurotropic virus and primarily infects neurons in their latent forms (Infect Dis Clin North Am 2010;24:373)
- Reactivation is common among transplant recipients (Infect Dis Clin North Am 2010;24:373)
Interpretation
- Cells exhibit both nuclear and cytoplasmic staining (Am J Dermatopathol 2015;37:1)
- Most intense staining is at the edge of the nuclei (Am J Dermatopathol 2015;37:1)
Uses by pathologists
- To exclude herpes simplex virus infection
- Most ordered on gastrointestinal, dermatologic, oral / head & neck, gynecological, urologic, pulmonary and central nervous system (CNS) specimens (Am J Clin Pathol 2017;147:96, Cancers (Basel) 2023;15:3692)
- IHC detects more cases with virally infected cells than H&E alone; however, the clinical significance in these cases is unclear (Am J Clin Pathol 2017;147:96)
Microscopic (histologic) description
- H&E correlation will reveal cells with HSV cytopathic changes, including marginated chromatin, multinucleated cells, nuclear molding and possibly eosinophilic intranuclear (Cowdry A) inclusions (Am J Dermatopathol 2014;36:609)
Microscopic (histologic) images
Contributed by Nick Baniak, M.D.
HSV IHC
HSV pneumonia
HSV IHC lung
HSV IHC CNS
Virtual slides
Images hosted on other servers:
Skin, H&E, herpes simplex
Skin, HSV stain
Positive staining - disease
- Tissues infected with HSV, including gastrointestinal (e.g., herpes esophagitis, hepatitis), oral / head & neck (e.g., herpes labialis), gynecological / urological (e.g., herpes genitalis), dermatologic (e.g., herpes folliculitis), pulmonary (e.g., herpes pneumonia) and CNS specimens (e.g., herpes encephalitis) (Am J Clin Pathol 2017;147:96, Cancers (Basel) 2023;15:3692)
- Positivity rates will vary based on ordering practices (Am J Clin Pathol 2017;147:96)
- Sensitivity of IHC is hard to determine since few concurrent specimens have tissues sent for viral culture, the gold standard for diagnosis (Am J Clin Pathol 2017;147:96)
Negative staining
- Any tissue not infected by HSV
Sample pathology report
- Right temporal lesion, resection:
- Herpes simplex encephalitis (see comment)
- Comment: There are foci of necrosis and focal hemorrhage with necrotic neurons showing positive staining with HSV.
Board review style question #1
Which of the following is true given the above image?
- Due to cytoplasmic staining, the protocol needs to be adjusted
- Infection is caused by HSV1
- Other viruses may be cross reacting with the stain
- Staining pattern is diagnostic of HSV pneumonia
Board review style answer #1
D. Staining pattern is diagnostic of HSV pneumonia. Diffuse positive staining for HSV is indicative of HSV infection.
Answer B is incorrect because HSV IHC detects both HSV1 and HSV2.
Answer C is incorrect because HSV IHC is specific.
Answer A is incorrect because HSV IHC stains are both nuclear and cytoplasmic.
Comment Here
Reference: HSV
Comment Here
Reference: HSV
