Inflammatory Disorders of the Small Intestine

Day, David W.; Jass, Jeremy R.; Price, Ashley B.; Shepherd, Neil A.; Sloan, James M.; Talbot, Ian C.; Warren, Bryan F.; Williams, Geraint T.

doi:10.1002/9780470755983.ch21

Morson and Dawson's Gastrointestinal Pathology 2003

DOI: 10.1002/9780470755983.ch21

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Inflammatory Disorders of the Small Intestine

David W. Day¹,

Jeremy R. Jass²,

Ashley B. Price³

et al.

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Cited by 7 publications

References 473 publications

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Composite Carcinoma of the Stomach Associated with Sarcoid-Like Granulomas

Stojšić

Brašanac

Stojiljković

et al. 2009

Pathol. Oncol. Res.

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Composite glandular/exocrine-endocrine carcinoma of the gastrointestinal tract is a special tumor type composed of common adenocarcinoma and the neuroendocrine component comprising at least one-third of the whole tumor area. These tumors are rare in the stomach and mostly published as case reports. We describe a further case of a 36-year-old man being unique in that it was associated with extensive formation of sarcoid-like granulomas. Tumor consisted of, predominantly poorly differentiated, intestinal-type adenocarcinoma and poorly differentiated neuroendocrine, small cell carcinoma. The adenocarcinomatous and neuroendocrine areas were separated, but closely juxtaposed with focal areas showing gradual transition from one to another. Perigastric lymph node metastases corresponded either to neuroendocrine or adenocarcinomatous component. On immunohistochemistry, the exocrine part was positive for cytokeratin 7, whereas superficial well-differentiated parts showed positivity with cytokeratin 20 as well. The neuroendocrine component was negative with those two types of cytokeratin. Both adenocarcinomatous and neuroendocrine tumor portions showed carcinoembryonic antigen (CEA) immunoexpression. Neuroendocrine markers (chromogranin A, synaptophysin and neuron-specific enolase) were diffusely positive in the neuroendocrine component, and found only in the scattered cells within the neoplastic glands of the adenocarcinoma. Entire gastric mucosa and all perigastric lymph nodes were extensively affected by noncaseating, sarcoid-like granulomas. The absence of any clinical manifestations combined with the negative results of chest radiograph and laboratory test for the serum angiotensin converting enzyme argued against the possibility of systemic sarcoidosis.

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Composite Carcinoma of the Stomach Associated with Sarcoid-Like Granulomas

Stojšić

Brašanac

Stojiljković

et al. 2009

Pathol. Oncol. Res.

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Archaeology dig into the duodenal biopsy

Lugli

2010

Digestive and Liver Disease

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The connective tissue changes of Crohn’s disease

Shelley-Fraser¹,

Borley

Warren

et al. 2011

Histopathology

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Although the inflammatory pathology of Crohn's disease is manifestly its most important attribute, the connective tissue changes are important in the genesis of the more chronic features of the disease, and yet these have received little attention from clinicians, pathologists, and scientists. Fat-wrapping appears to be pathognomonic of Crohn's disease, and is an important marker of disease for surgeons. There is evidence of a complex interplay between the effector inflammatory cells of Crohn's disease and adipocytes, hyperplasia of which results in fat-wrapping. Pathologically, this is exhibited in the close relationship between the transmural inflammation that is so characteristic of Crohn's disease and fat-wrapping. Fibrosis and muscularization are also important components of the chronic changes of intestinal Crohn's disease. Neuronal and vascular changes make up the remaining connective tissue changes: these constitute a distinctive feature, and are even specific for Crohn's disease. For pathologists, the combination of these connective changes will allow a diagnosis of chronic 'burnt-out' Crohn's disease, even in the absence of its highly characteristic inflammatory features. The connective tissue changes of Crohn's disease form an important part of its long-term pathology. They deserve more attention from clinicians, diagnostic pathologists and researchers alike.

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Inflammatory Disorders of the Small Intestine

Cited by 7 publications

References 473 publications

Composite Carcinoma of the Stomach Associated with Sarcoid-Like Granulomas

Composite Carcinoma of the Stomach Associated with Sarcoid-Like Granulomas

Archaeology dig into the duodenal biopsy

The connective tissue changes of Crohn’s disease

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