Question

From which area should a biopsy be taken in the case of a viral esophageal ulcer?

• A. Edges
• B. Surrounding mucosa
• C. Base
• D. Indurated area

Hint:

HSV infects the epithelial cells at the ulcer margin, so biopsy the edges, not the necrotic base.

Answer 1

The Correct Option is A

Step 1: Picture what a viral esophageal ulcer looks like.
Viral infections of the esophagus, most often herpes simplex virus (HSV), produce small, shallow, punched out ulcers on the lining of the food pipe.

Step 2: Understand where the virus actually lives in the ulcer.
HSV infects the squamous epithelial cells, the living cells that line the esophagus. These infected cells are found at the edges (margins) of the ulcer, where the epithelium is still present but shows viral damage, such as multinucleated giant cells and Cowdry type A inclusion bodies on microscopy.

Step 3: Explain why the base and other sites give a lower yield.
The base (floor) of the ulcer is usually just necrotic debris, fibrin and inflammatory cells with no live infected epithelium left, so a biopsy from there often misses the diagnostic viral changes. The surrounding mucosa and any indurated (thickened) area are typically normal or non-specifically inflamed tissue that will not show the specific viral inclusions either.

Step 4: Note the CMV exception, for completeness.
This rule is specific to HSV-type viral ulcers. For cytomegalovirus (CMV) esophagitis, the virus instead infects endothelial and stromal cells found deeper, in the ulcer base, so CMV biopsies are best taken from the base rather than the edge. When a question simply says viral esophageal ulcer without naming CMV, the classic teaching point being tested is the HSV rule: biopsy the edge.

Final Answer:
The biopsy should be taken from the edges of the ulcer.
\[ \boxed{\text{Edges}} \]