Qap (Anatomical Pathology) 

QAP Peer Review

AP265
Case History: M/31,known to have AIDS. Postmortem lung for comment
Intended diagnosis: Necrotising pneumonia in toxoplasmosis. Contributed by:JKCC
Code Diagnosis Comment Score
anonymous Opportunistic infection, differential diagnoses include toxoplasmosis, histoplasmosis and leishmaniasis. (100%) Grocott and Giemsa stains for further assessment, correlate with culture result.  100
anonymous Pneumocystic carinii nil  80
anonymous Necrotising inflamation and acute lung injury Special stains with Grocott, PAS, mucicarmine, Warthin-Starry and Dieterle to exclude different fungal organisms, Legionella pneumonia, Rhodococcus Equi, cryptococcus and Pneumocystis jiroveci. Immunostains with CMV and herpes.  80
anonymous Necrosis, favor toxoplasmosis (70%); Ddx Histoplasma (10%), Mycobacteria (10%), Fungus (10%). Immunohistochemical studies for toxoplasma. Special stains for mycobacteria (acid-fast), fungus (grocott).  100
anonymous NECROTIZING LESIONS SUGGESTIVE OF TOXOPLASMOSIS. CONFIRM BY IMMUNOSTAIN. ALSO IMMUNOSTAINS AND GROCOTT STAIN TO EXCLUDE OTHER OPPURTUNISTIC INFECTION EG. ADENOVIRUS, CMV, ASPERGILLOSIS, PCP etc.  100
anonymous Necrotic nodules, favor infective causes, e.g. pneumocystitis, toxoplasma, etc. 100% Do infective stains, e.g. Grocott, Ziehl Neelsen, Gram, mucicarmine stains; also pneumocystis immunostain.  100
anonymous Necrotizing pneumonia 100% Pending special stains for identification of causative organisms: Toxoplasma (70%), Pneumocystis (20%), cryptococcus (9%), adenovirus (1%)  100
anonymous Infective microorganism present, suggestive of toxoplasmosis To perform Ziehl Neelsen, Gram and Warthin Starry to rule out other infectious causes  100
anonymous necrotizing pneumonia, rule out infective agents: toxoplasmosis, cytomegalovirus nil  100
anonymous Presence of multifocal miliary small nodular area with sign of necrosis of alveolar wall surrounded by reactive pneumocytes, suggestive of viral infection in immunosuppressive patient. Also seen in superimposed with other infection. nil  80
anonymous Necrotizing inflammation Infection especially opportunistic ones such as fungal infection due to Pneumocystis carinii and viral infection need to be excluded. Ancillary studies including special stains (Grocott, PAS and Ziehl Neelsen stains) and immunohistochemical studies for viral inclusion (such as CMV) are suggested. Correlation with microbiological and viral culture is also mandatory.  80
anonymous Multiple pulmonary necrosis and infarct Consistent with infection; need to consider toxoplasmosis  100
anonymous Necrotising pneumonia and diffuse alveolar damage, to exclude infective organisms such as toxoplasmosis (100%). Immunostaining for toxoplasma, and special stains to rule out acid fast bacilli, fungi and pneumocystis will be useful.  100
anonymous 265 necrotizing pneumonia, perform ZN, PASD, grocott to exclude TB, Nocardia, PCP and fungal infection (100% Probability) nil  80
anonymous Pneumocystis carinii pnenmonia 100% Perform special stains to confirm the diagnosis, and to rule out other bacterial and fungal infections.  80
anonymous Necrotizing pneumonia Need to perform panel of infective stains (e.g. gram; fungal, ZN), especially look for nocardia, legionella infection.  80