Table 1.

Cases of cytomegalovirus pseudotumor of the gastrointestinal tract in patients with HIV infection

Author (year) [Ref.]	Location	Age	Sex	HIV status/ART	Clinical picture	Method of diagnosis	Characteristics of pseudotumor	Outcome	Treatment
Victoria (1985)6	Stomach, pylorus	16 months	M	A child with AIDS	Pyloric obstruction with nausea, vomiting, fever	Open biopsy from stomach and duodenum. Postmortem examination	Occlusion of the pylorus with thickening of the walls. CMV inclusion bodies on the glandular epithelium and muscle layer of pylorus with extensive inflammatory infiltration	The patient died in his hospital course of progressive respiratory failure	Not described
Elta (1986)7	Stomach (gastric antrum)	29 years	M	Homosexual transmission. AIDS with CD4/CD8 ratio of 0.36	Abdominal pain, watery diarrhea and fever. Nonobstructive prepyloric mass	Submucosal mass was identified in CT abdomen and upper endoscopy. Open biopsy after exploratory laparoscopy	Irregular mass, mucosal sparing, marked inflammation. Infiltrate of predominantly mononuclear cells, edema, and numerous stromal and epithelium cells with CMV inclusion bodies	Patient died 2 months later after diagnosis of CMV infection	Surgery. No information was provided about medical treatment
Dolgin (1990)15	Small bowel	Infant	M	Infant with AIDS	Enteritis presenting with massive hemorrhage and subsequent fatal small bowel obstruction	Laparotomy. Postmortem examination	Striking, diffuse, large yellowish plaques along the entire length of the small bowel. Each of these had a central ulceration. Each eventually caused a partial narrowing resulting in refractory small bowel obstruction. Biopsy of one of these lesions demonstrated many cells with typical cytomegalic inclusion bodies	Patient died of bleeding and small bowel obstruction	Surgery
Wilcox (1990)8	Esophagus	NR	NR	AIDS for 8 months	Epigastric pain for 6 months	Endoscopy	Exophytic mass. Characteristic inclusion bodies mostly in endothelial cells and in fibroblasts, epithelial cells	Could not be evaluated by authors. Patient died after 4 months	Ganciclovir
Duva-Frissora (1991)9	Cecum, ileum	36 years	M	AIDS. No other data specified	One month watery diarrhea and fevers, CT finding	Open biopsy after right side ileocolectomy	Pericolonic mass with adenopathy, mucosal sparing, inflammation. Pathologic examination revealed a cytomegalovirus-mediated inflammatory pseudotumor within the muscularis and submucosa with complete mucosal sparing	NR	Surgery. No information was provided about medical treatment
Rich (1992)10	Stomach (gastric fundus)	41 years	M	Homosexual transmission. HIV seropositivity 5 years prior to diagnosis of AIDS. Other opportunistic infection prior to CMV infection were cerebral toxoplasmosis	Epigastric mass, LUQ palpable mass	Endoscopy. Serology positive for CMV	Polypoid 5-cm wide necrotic mass with ulceration, necrosis, fibrosis. Cytomegalic change was present within glandular epithelial cells, which stained positive for CMV with immunoperoxidase	His gastrointestinal symptoms completely resolved following treatment	Ganciclovir
Rich (1992)10	Cecum	41 years	M	Homosexual transmission. HIV seropositivity 3 years prior to diagnosis of AIDS	Abdominal pain w/o diarrhea	Colonoscopy. Excision biopsy (right colectomy)	Focal polypoid friable, firm near circumferential mass with ulceration, fibrosis. Microscopic examination revealed granulation tissue in the ulcer bed, overlying acute inflammatory exudate, CMV like inclusions identified in endothelial cells and fibroblasts within the granulation tissue. Presence of CMV was confirmed by immunoperoxidase staining	The patient’s pain was completely resolved following surgery and did not recur	Surgery, ganciclovir
Rich (1992)10	Cecum (primary mass), ileum (recurrence)	34 years	M	Homosexual transmission. AIDS diagnosed 1 year prior to presentation. Other opportunistic infection prior to CMV infection was cerebral toxoplasmosis	Abdominal pain w/o diarrhea, fever (primary mass). Recurrence of abdominal pain (relapse)	Colonoscopy. Excision biopsy (right colectomy)	4 cm polypoid mass with ulceration, necrosis, fibrosis (primary mass and relapse). Microscopic examination revealed extensive fibrosis, granulation tissue and chronic inflammation. Numerous CMV like inclusions identified in mesenchymal cells and were confirmed by immunoperoxidase staining. Relapse mass was a 2 cm inflammatory polyp with similar to the previous mass microscopic findings	The abdominal pain resolved after surgery. One year later he developed relapse, which was again successfully treated with ganciclovir and surgery	Surgery for primary mass. Surgery and ganciclovir for recurrent mass
Wisser (1992)11	Cecum/ terminal ileum	36 years	M	Homosexual transmission. AIDS diagnosed 1 year prior to admission. Zidovudine alone for a year	Generalized abdominal pain, bloody diarrhea, night sweats, 1 month h/o tenesmus, 40 lb weight loss	Excision biopsy after right colectomy	Size: 6 5.3 5.1 cm, irregular exophytic mass. Histology showed necrosis and fibrosis, particularly in the muscularis propia, as well as fibroblastic and vascular proliferation with pleomorphic and mononuclear cell infiltrates. CMV inclusion bodies were present in endothelial cells, fibroblasts, muscle, ganglion cells. In situ hybridization confirmed CMV inclusions	Patient died 12 days postoperatively from bacterial sepsis	Surgery. No medical treatment reported
Laguna (1993)12	Stomach (gastric antrum)	42 years	M	Homosexual transmission. AIDS diagnosed 1 year prior to admission. On zidovudine. Other opportunistic infection prior to CMV infection was PCP	Epigastric pain	Endoscopy CMV was cultured in urine	Large rigid folds in the stomach without ulcers. Characteristic large intranuclear inclusions were identified on routine hematoxylin and eosin staining of esophageal and gastric biopsies	3 days after treatment with ganciclovir he developed a psychotic syndrome and treatment was changed to foscarnet. Patient improved after 3 weeks of treatment	Ganciclovir, foscarnet
Laguna (1993)12	Esophagus	40 years	M	Homosexual transmission. AIDS diagnosed 14 months prior to admission. On zidovudine. Other opportunistic infection prior to CMV infection was PCP	Epigastric pain, fever	Endoscopy	Polypoid, exophytic mass without ulceration in the distal esophagus. Immunohistochemical staining with a CMV monoclonal antibody showed intranuclear inclusions in the esophagus biopsies	After 3 weeks of treatment he remained febrile but abdominal pain had improved. Patient died 12 days after cardiac arrest	Ganciclovir (6 weeks), foscarnet (2 weeks)
Swansiger (1996)16	Colon	28 years	M	Homosexual transmission. HIV infection diagnosed 7 years before presentation. Patient was on zidovudine	RLQ abdominal pain of 1-year duration. Weight loss, intermittent fever and chills	Biopsies obtained at first colonoscopy showed intranuclear inclusion bodies, but viral culture was negative. Cultures of biopsies obtained at repeat colonoscopy after 4 months grew CMV	Multilobulated intraluminal mass with an overall length of 4.5 cm. Biopsies from repeat colonoscopy showed chronic inflammation with vascular endothelial thickening, and culture of the biopsy grew CMV	NR	5 mg/kg ganciclovir given IV every 12 h
Chow (1997)13	Colon (ascending colon)	46 years	F	Heterosexual transmission through unprotected sexual exposure to multiple partners. HIV infection diagnosed on presentation. Unknown duration of infection. CD4 count was 129	Abdominal discomfort, weight loss and change of bowel habits of 1-month duration	Barium enema. Excision biopsy after right hemicolectomy	Multiple tiny ulcers in the ascending colon 0.2 to 0.3 cm in diameter. Histologic examination of the resected specimen revealed that the ulcers were superficial involving the mucosa and submucosa. Epithelial cells with CMV inclusion were identified and stained positive for CMV with immunoperoxidase	The patient was readmitted after a few weeks for proctitis	Surgery
Mohan (2007)14	Stomach/ antral region	49 years	M	Heterosexual transmission. HIV infection diagnosed on presentation. Unknown duration of infection. CD4 count could not be obtained	Pseudotumor simulating gastric malignancy with 1-month h/ o epigastric discomfort, loose stools, loss of appetite, weight loss	Excision biopsy after subtotal gastrectomy with Roux-en-Y gastrojejunotomy	Size: 5 3 1.5 cm. Gastric epithelial cells and vascular endothelial cells showed intranuclear inclusions of CMV	Patient died on postoperative day 10 because of overwhelming sepsis	Surgery. No medical treatment reported

ART, antiretroviral therapy; M, male; F, female; NR, not reported; CT, computed tomography; CMV, cytomegalovirus; HIV, human immunodeficiency virus; AIDS, acquired immunodeficiency syndrome; PCP, Pneumocystis carinii pneumonia; LUQ, left upper quadrant; RLQ, right lower quadrant; w/o, without; h/o, history of.