Clinicopathological and Ileocolonoscopic Characteristics in Patients with Nodular Lymphoid Hyperplasia in the Terminal Ileum

Abstract

Nodular lymphoid hyperplasia (NLH) in the small intestine is a rare benign lesion, characterized by the presence of multiple small nodules on the surface of the intestine. To define the clinicopathological and colonoscopic characteristics in Chinese patients with ileal NLH, we collected 65 patients with NLH in the terminal ileum from the endoscopic database in our hospital and clinical data from medical records. Histology and immunohistochemical staining were performed in the biopsies. The results demonstrated that the main symptoms included diarrhea (70.8%), abdominal pain (60.0%), hematochezia (46.2%), anemia (40.0%), and hypoproteinemia (21.5%). Enteroscopy revealed multiple, sporadic, granular or round-shaped nodules with diameters between 2 and 5 mm in the terminal ileum. The histology revealed the nodules consisted of mass lymphoid follicles in the lamina propria and submucosa of the terminal ileum. The follicles contained mitotically active germinal centers surrounded by well-defined lymphocyte mantles and composed predominantly of CD20+ B cells. The diseases found in patients with NLH included chronic diarrhea, Crohn's disease, ischemic enterocolitis and allergic purpura. The level of hemoglobin in NLH patients who had diarrhea and hematochezia remarkably decreased as compared with those in patients with chronic diarrhea. In conclusion, ileocolonoscopic screening is an important step to find the NLH in terminal ileum patients with diarrhea, abdominal pain, hematochezia, and hypoproteinemia. Histological examination is necessary for the exclusion of malignancy and chronic inflammation.

Mucosal bacterial dysbiosis in patients with nodular lymphoid hyperplasia in the terminal ileum

“…Second, the male-female ratio in the NLH group was not balanced in this study due to the nature of terminal ileal NLH, which is thought to be significantly more common in men than women. Although the incidence of terminal ileal NLH in both men and women has not been investigated through a large-scale study, Lin et al observed that males outnumbered females by approximately four to one in a small-scale study[ 3 ]; their results support, to a certain degree, the suggestion that there is a higher frequence of terminal ileal NLH in males than females. We also performed a correlation analysis to compare the intestinal flora with gender using the Multivariable Association with Linear Models2, and we found that there was no correlation between the intestinal floras and gender at the phylum, genus, or OTU levels.…”

“…The diagnosis of NLH is mainly based on endoscopic and histological examinations, markedly including the presence of hyperplastic lymphoid follicles and mitotically active germinal centers with well-defined lymphocytic mantles[ 2 ]. Terminal ileal NLH is a type of NLH, and patients with terminal ileal NLH demonstrate multiple symptoms that seriously reduce the individual’s quality of life, such as chronic diarrhea, abdominal pain, hematochezia, anemia, hypoproteinemia, among other symptoms[ 3 ]. Patients with irritable bowel syndrome are more likely to accompany with NLH[ 4 ].…”

Algorithmic Approach to Inflammatory Disorders of Ileum

“…This condition does not necessitate any intervention, and treatment is mainly relevant to the associated conditions (38).…”

Immunohistochemical features lymphoid tissue colonic mucosa of children with different phenotypic variants of Crohn’s disease

“…Известно, что лимфоидная ткань слизистой оболочки толстой кишки включает в себя интраэпителиальные лимфоциты покровного и криптального эпителия, лимфоциты собственной пластинки СО и лимфоидных узелков и состоит из основных популяций Т-лимфоцитов, экспрессирующих CD4 и CD8 маркёры. Лимфоциты поверхностного эпителия в подавляющем большинстве являются CD8+ Т-лимфоцитами (80-90%-антигенный маркёр супрессорных и цитотоксических Т-киллеров с угнетением иммунного ответа, торможением выработки антител В -лимфоцитами), в то время как основная масса CD4+ Т-лимфоцитов находится в собственной пластинке СО и является представителем эффекторных лимфоцитов при воспалительном процессе (маркёр Т-хелперов с распознаванием молекул процессированного антигена [5]. При этом большое значение в оценке состояния иммунной системы имеет не столько абсолютное значение содержания популяции CD4+ и CD8+ Т-лимфоцитов, а их соотношение CD4/ CD8, что выражается иммунорегуляторным индексом -ИРИ, характеризующим интенсивность иммунного ответа.…”