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IHC single marker with reporting CMV

Cancer
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Report in 192Hrs

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Tumor marker staining.

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IHC Single Marker with Reporting CMV - Comprehensive Medical Test Guide

  • Why is it done?
    • This test uses Immunohistochemistry (IHC) to detect and identify Cytomegalovirus (CMV) in tissue samples, providing specific viral localization and confirmation of CMV infection in affected tissues.
    • Primary indications include: diagnosis of CMV infection in immunocompromised patients (HIV/AIDS, organ transplant recipients, severely immunosuppressed individuals), investigation of unexplained tissue pathology, confirmation of CMV-related diseases such as CMV colitis, pneumonitis, retinitis, or esophagitis.
    • Typical timing: performed when clinical suspicion of CMV infection exists based on patient symptoms, immunological status, and tissue biopsy results; commonly performed post-organ transplantation or during evaluation of opportunistic infections in immunocompromised patients.
    • Assists in guiding antiviral therapy decisions and monitoring treatment response in patients with confirmed or suspected CMV disease.
  • Normal Range
    • Normal Result (Negative): Absence of CMV antigen staining in tissue samples; no brown or reddish-brown chromogenic precipitate visible in tissue cells; indicates no evidence of CMV infection in the examined tissue.
    • Abnormal Result (Positive): Presence of CMV antigen staining detected through IHC; positive staining appears as brown (DAB) or red (AEC) colored deposits in infected cells; indicates CMV infection present in the tissue sample.
    • Result Interpretation Scale: • Negative (0): No staining present • Positive (1+): Focal or weak staining in few cells • Positive (2+): Moderate staining in multiple cells • Positive (3+): Strong and diffuse staining in numerous cells • Positive (4+): Very strong and extensive staining throughout tissue
    • Units: Qualitative reporting (Positive/Negative) with semi-quantitative grading based on percentage of stained cells and staining intensity (0-4+ scale).
    • Normal vs. Abnormal: Normal indicates absence of CMV infection; abnormal indicates presence of CMV viral antigen, confirming active or recent CMV infection in the tissue.
  • Interpretation
    • Negative Result: No CMV antigen detected; rules out CMV as the causative agent in the examined tissue; does not exclude CMV infection in other organ systems or does not exclude seronegative CMV at very early infection stages.
    • Positive Result: Confirms CMV infection in the tissue examined; magnitude of staining (1+ to 4+) correlates with viral load and extent of infection; strong staining (3-4+) indicates significant viral burden; weak staining (1+) may indicate early infection or focal involvement.
    • Clinical Correlation Required: Results must be correlated with histopathological findings, clinical presentation, and immunological status; tissue location of CMV antigen (epithelial, endothelial, or inflammatory cells) provides prognostic and diagnostic information.
    • Factors Affecting Results: • Quality and adequacy of tissue specimen • Timing of biopsy relative to infection stage • Immunocompetence status of patient • Previous antiviral therapy • Technical factors in staining procedure • Fixation and tissue processing quality
    • Clinical Significance: Positive IHC confirms tissue-specific CMV infection, guiding treatment decisions; identifies CMV as causative agent in tissue-specific diseases; helps differentiate CMV pathology from other infectious or inflammatory processes.
    • Result Patterns: Focal positive staining in small foci may suggest localized infection; diffuse positive staining indicates widespread viral involvement; perivascular staining pattern is common in CMV endovasculitis; epithelial involvement suggests primary site of infection.
  • Associated Organs
    • Primary Organ Systems: Gastrointestinal tract (colon, esophagus, stomach), respiratory system (lungs), eye (retina), nervous system (brain), vasculature, and multiple organs in disseminated disease.
    • Gastrointestinal Involvement: CMV colitis causing severe diarrhea, abdominal pain, and potential perforation; CMV esophagitis presenting with dysphagia and odynophagia; IHC helps confirm CMV as causative agent versus other pathogens.
    • Pulmonary Involvement: CMV pneumonitis causing progressive dyspnea and respiratory compromise; bronchoalveolar lavage (BAL) samples analyzed by IHC aid diagnosis; particularly common in severely immunocompromised patients.
    • Ocular Involvement: CMV retinitis causing progressive visual loss; typically in advanced AIDS; IHC on eye tissue confirms diagnosis; can lead to blindness if untreated.
    • Neurological Involvement: CMV encephalitis, myelitis, or polyradiculopathy; cerebral spinal fluid (CSF) analysis and brain tissue examination by IHC confirms CNS involvement; associated with cognitive decline and neurological deficits.
    • Vascular Involvement: CMV endovasculitis causing inflammatory vasculitis; can lead to vascular rupture and hemorrhage; particularly dangerous in cerebral vessels; IHC demonstrates CMV antigen within vessel walls.
    • Associated Medical Conditions: HIV/AIDS (particularly CD4 count <50 cells/μL), solid organ transplantation (kidney, liver, heart, lung), bone marrow/stem cell transplantation, severe immunosuppressive therapy, congenital CMV in newborns.
    • Potential Complications: Organ dysfunction specific to site of infection, disseminated CMV disease affecting multiple organs, therapeutic complications from prolonged antiviral therapy, secondary infections due to severe immunosuppression, tissue necrosis and perforation in GI involvement.
  • Follow-up Tests
    • CMV PCR (Polymerase Chain Reaction): Quantitative viral load assessment from blood or body fluids; helps monitor treatment efficacy; establishes baseline CMV burden; more sensitive than IHC for detecting circulating virus.
    • CMV Serology (IgM, IgG antibodies): Determines CMV serological status and infection history; IgM indicates acute infection; IgG indicates past exposure or latent infection; helps differentiate primary from reactivation infection.
    • CD4 Count and Immunological Assessment: Essential in HIV patients to determine immune reconstitution status; guides decisions for CMV prophylaxis; CD4 <50 cells/μL indicates high risk for CMV disease.
    • Repeat Biopsy with IHC: Recommended 4-6 weeks after initiating antiviral therapy to assess treatment response; demonstrates reduction in CMV antigen staining; helps determine adequacy of therapy.
    • Histopathology Examination: Concurrent histological analysis identifies tissue damage patterns; distinguishes CMV from other infections; evaluates inflammatory response and tissue necrosis.
    • Viral Culture: Traditional culture of CMV from body fluids or tissue; more time-consuming but allows antiviral susceptibility testing; particularly useful for detecting drug-resistant CMV strains.
    • Antiviral Drug Level Monitoring: Ganciclovir, foscarnet, or cidofovir levels; ensures therapeutic drug concentrations for effective treatment; particularly important in renal compromise.
    • Imaging Studies: CT or endoscopy of affected organs to assess structural damage; retinal examination for CMV retinitis; helps determine extent of disease and guide treatment.
    • IHC with Additional Markers: Multi-panel IHC to exclude other infectious agents (HSV, EBV, fungal organisms); helps establish CMV as sole pathogen or identifies co-infections.
    • Monitoring Schedule: Baseline testing before antiviral initiation; repeat testing at 2-4 weeks to assess treatment response; ongoing monitoring every 4-12 weeks depending on clinical status and immunological recovery.
  • Fasting Required?
    • Fasting Requirement: No - IHC testing is performed on tissue specimens obtained through biopsy procedures and does not require patient fasting.
    • Patient Preparation for Tissue Biopsy: • Fasting may be required if endoscopy or colonoscopy needed to obtain tissue sample (typically 6-8 hours) • NPO (nothing by mouth) status usually 4-6 hours prior to procedure • Bowel preparation required if colonic biopsy planned • Mild sedation or anesthesia commonly used during biopsy procedure
    • Medications to Avoid or Adjust: • Anticoagulants (warfarin, clopidogrel, aspirin) may need temporary discontinuation 3-7 days before biopsy • Consult with physician regarding continuation of antiplatelet agents • Blood thinner medications increase bleeding risk during tissue sampling
    • Special Instructions: • Tissue specimen must be handled properly; place in appropriate fixative (typically 10% neutral buffered formalin) • Specimen labeling and chain of custody documentation essential • Timely delivery to laboratory for optimal antigen preservation • Avoid specimen contamination or dehydration
    • Post-Biopsy Care: • Observe for bleeding complications (particularly with gastrointestinal biopsies) • Monitor for signs of infection at biopsy site • Avoid strenuous activity for 24-48 hours • Report any severe pain, significant bleeding, or fever to physician
    • Results Timeline: Laboratory processing typically 3-7 business days; IHC staining procedure requires 24-48 hours; additional time may be needed for pathologist review and final report generation.

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