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Case 84. Pneumocystosis (3 y-o M)
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| Fatal interstitial pneumonia after chemotherapy for disseminated adrenal neuroblastoma |
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Key words : Pneumocystis
carinii, interstitial pneumonia
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opportunistic infection
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| Diffuse consolidation of the lung parenchyma is characteristic of acute interstitial pneumonitis (gross findings after formalin fixation). | Frothy exudates into the alveolar pace are pathognomonic of pneumocystosis (HE). Septal thickening and swelling alveolar pneumocytes are associated. | |
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| The cyst wall of P. carinii in the frothy exudates is stained black by Grocott's silver. The cysts themselves are not recognizable in H&E preparations. | Grocott-stained cysts in a paraffin section were observed at the ultrastructural level. In addition to the cyst wall, so-called parenthesis-like structure inside the cyst shows argyrophilia. The cyst is often crescent in shape. | |
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| Reference case 84A Pneumocystis carinii in bronchial lavage from an AIDS patient (Papanicolaou). In Papanicolaou-stained preparation, the cysts of P. carinii resemble lysed red blood cells. |
Reference case 84A Pneumocystis carinii in bronchial lavage from an AIDS patient (Grocott). The cyst wall of the microbes is stained by Grocott's silver. The presence of dot-like (parenthesis-like) structure in round or cup-shaped cysts is confirmative and useful for cytological diagnosis. |
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| Reference case 84A Pneumocystis carinii in bronchial lavage from an AIDS patient (immunostaining using a monoclonal antibody). The clustered cysts are immunoreactive for P. carinii antigen. This microbe is now categorized into the fungal genus. |
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