Enterocolic Lymphocytic Phlebitis: Statistical Analysis of Histology Features in Viable and Ischemic Bowel

Abstract

Enterocolic lymphocytic phlebitis is a rare cause of segmental ischemic enterocolitis. This artery-sparing transmural vasculitis is classically a circumferential phlebitis with perivenular lymphocyte cuffing and thrombi in the absence of systemic manifestations. Myointimal hyperplasia may represent a chronic phase of enterocolic lymphocytic phlebitis. Subclinical or early stage enterocolic lymphocytic phlebitis is not well delineated. We analyzed 600 submucosal and subserosal veins from both ischemic and intact bowel segments to discern if vascular morphology varied between sites. Crescentic and circumferential lymphocytic phlebitis is more common in viable bowel than in the ischemic segment. A nonsignificant trend was found for increased crescentic morphology between intact bowel remote from the ischemic focus compared with that adjacent to the ischemic focus. Hallmarks of ischemic bowel are necrotizing phlebitis and thrombi formation. Thrombophlebitis morphology is distinctly different in viable and ischemic bowel, changing from the classic lymphocytic to necrotizing lesions respectively.

Lymphocytic Phlebitis of the Stomach - A Case Report with Literature Review -

“…The histological appearance of ELP shows extensive phlebitis of the submucosal, mural, and serosal veins with complete arterial sparing. Some reports have described thromboses and fibrinoid necrosis in the wall of the vein, 7,[11][12][13]16 but this was not present in the case reported here. Other authors have mentioned that even in cases in which the macroscopic appearance of the mucosa is normal, microscopic changes have been found at the surgical resection margin.…”

“…Abraham et al 9 and Paik et al 13 reported that the majority of the lymphocytes were T-cells, whereas Tuppy et al 12 found no zonal distribution of B-and T-cells. And Medlicott et al 16 described T-cell dominance in ischemic areas and no zonal distribution in the margins and intact areas.…”

“…8,12 On gross examination, lesions appeared to be edematous with wall thickening and some of them showed granular mucosa, hemorrhage, and/or ulcers. 8,9,[11][12][13][14]16 It seems difficult to distinguish lymphocytic phlebitis of the GI tract from carcinoma clinically and radiologically when it forms a mass-like lesion due to edema and inflammation. Therefore, the lack of cases is one of the reasons that a large group study would be helpful for indicating a diagnosis of lymphocytic phlebitis of the GI tract using endoscopy and radiology.…”

Flebitis enterocólica linfocítica granulomatosa idiopática: presentación de un caso y revisión de la literatura

“…El infiltrado de la FLE se caracteriza, por un lado, por acúmulos linfocíticos alrededor de las venas, no estando afectadas las arterias ni arteriolas como en otras enfermedades (vasculitis sistémicas) y por otro, por la ausencia de otro tipo de células típicas de inflamaciones agudas (neutrófilos) o reacciones alérgicas y de hipersensibilidad (eosinófilos) (4,10).…”

Enterocolic Lymphocytic Phlebitis as a Newly Recognized Manifestation of IgG4-Related Disease

“…In most cases, ELP is refractory to pharmacological treatment and surgical resection of the involved bowel segment is both diagnostic and curative without any recurrence. 1-4…”