Histo-Meeting 3.09 - Mucosal Immunology...•Esophagectomy and proximal gastrectomy for squamous...
Transcript of Histo-Meeting 3.09 - Mucosal Immunology...•Esophagectomy and proximal gastrectomy for squamous...
Histo-Meeting 3.09.2015
2
HF 64 yr male• Esophagectomy and proximal gastrectomy for squamous
esophageal carcinoma 2013
• 03.2015-dysphagia- upper endoscopy : stenosis at the level of theanastomosis, submucosal tumor with central erosion in antrum
3
Gastroscopy 2015Submucosal antral tumor withcentral erosionStenosis of the anastomosis
4
Atypische Infiltrate von Plattenepithel-Ca Becherzellmetaplasie
5
55yo maleCowden syndrom with PTEN germ line mutation• Father CRC at age 67• 2002 Thyroidectomy• Multiple upper endoscopies and colonoscopies with polypectomy• 07.01.15 Upper endoscopy and colonoscopy multiple
polypectomies in both upper GI tract and colon. • 02.04.15
Morbid obesity• 1998 Mason’s Vertical-banded gastroplasty• 2011 Laparotomy and conversion to Omega-loop-Magenbypass
with subtotal gastrectomy
6
Colonoscopy 01/2015Multiple small polyps were resected
Piecemeal resection of a 2cm polyp by the hepatic flexure
7
Upper endoscopy 01/2015Multiple polyps were resected 1.2 cm polyp in the
gastrojejunal anastomosis with irregular mucosa
8
Endosonography 04/2015• No clear demarcation of the polyp. Muscolaris propria not
demarcated.• EMR
9
Histology Polyp GJ-Anastomosis
Folveolar hyperplasia in theLamina propria Typical histology of a Spindelcell
lesion, Hyperplasia displaces thecrypts
10
Ganglion cells.Findingpathognomonic fora Ganglioneuroma
Histology Polyp GJ-Anastomosis
11
55 yo female• Hospitalisation because of an acute (sub)ileus with a long-
segment stenosis
• St.post. IC-resection 1996, suspected M.Crohnno treatment / symptoms for the past 20 years
12
CT / EUS 01.09.15No thickend wall, no signsof an inflammatory reaction
Dilated intestines, airwithin the colon/rectum
13
Histologie
Terminales Ileum: fissuierendesUlcus
Terminales Ileum: keine transmuralen Entzündungszeichendamit kein M.Crohn
14
77 years old female patient
• Surveillance Colonoscopy 2/15• Tubular Adenoma in Coeocum (low grade) and
Diverticulosis in Sigma
• Re-Colonoscopy 8/15 • 2 Polyps in C.transversum
15
Polyp in C. transversum
Coloscopy 8/15
16
Entzündliche Veränderungen ohne Dysplasie
Gestörte Kryptenarchitektur
17
Granulierende entzündliche Erosion
18
Siegelringzellen
19
Nester von atypischen monomorphen Zellen
20
Panzytokeratin-Färbung
Die Nester sind Lymphgefässe (eine Art lymphogener Tumorthrombus)
21
46 year old male• 2x liver transplantation because of PSC (Prograf & Cellcept)• Pancolitis ulcerosa, Montreal classification E 3
– St.n. total colectomy 05/2009– Relapsing pouchitis (1x/year), clinic: anal blood– Therapy with Salofalk enema & Budenofalk rectal
• Diabetes mellitus• Allergies/Intolerances for multiple antibiotics
– Ciprofloxacin– Cotrimoxazol– Ceftriaxon– Rifampicin– Metronidazol
22
Sigmoidoscopy 12/2014Moderate Pouchitis Histology of Ileum, pouch an cuff No ileitis, BUT: pouchitis, no viral inclusions, PCR for CMV 425
copies/ml Therapy with Augmentin 10-14 d, local therapy Remission
23
Histology• Im Überblick deutliche Architekturstörung• Viele Entzündungszellen (Plasmazellen)• Keine viralen Inclusionen und
Immunhistochemie negativ (kein CMV)• Pouchitis (histologisch nicht differenzierbar,
ob durch IBD oder infektiös verursacht)
24
26yo male• 01/2015 main problem: eosinophil pancolitis, chronification
erythema nodosum, aphtous ulcerations, abdominal pain, postprandial diarrhea, CRP!, >38,5°
OTHER:
• st. p. kidney-contusion 2011• hyporegenerative, microcytic, hypochrome anaemia• malnutrition• hypomagesemia• autosomal dominant, polycystic renal pathology
• 02/2015 septated pleural effusion (total remission)• 03/2015 stress-related bronchial asthma (no therapy needed)
• 07/2015: acute episode with typicial symptomspersisting diarrhea since RITUXIMAB-therapy, occult faecal blood new
medication with decrease of symptoms
25
• colonoscopy/rectoscopy: chronic inflammation of colorectal mucousmembrane
• abdominal MRI/CT: thickened intestinal wall (caecal, ascending colon), mesenterial lymphadenitis
• head MRI: no indication of vasculitis
• gastroscopy: antrum-gastritis, small axial hernia
• PR3-specific-ANCA-positivity
• ETIOLOGY?
26
CU & not-specifiable IBD? vs. ANCA-associated vasculitis?
• CRP up to 280 mg/L• thrombocytosis• Mabthera ≠ effective
• PR3-specific-ANCA-positive• granulomatosis• polyangiitis
27
Colonoscopy 01/2015colitis, crooked neo-formations with pus
28
Recto-sigmoidoscopy 07/2015inflammation, fibrin-coating
29
Infiltration von eosinophilenGranulozyten
C.Ulcerosa mit AktivitätBasale Lymphozytose
30
69yo male• Presentation with hematochezia
PMH: • NSCLC pT3 pN1 L1 V1 Pn1 G3 R0 06/2015; pneumonectomy 07/15• Prostate adeno carcinoma, TUR-P 01/2015• sleep apnea. Epworth Sleepiness Scale 9• atrial fibrillation > therapeutic LMWH• Tubular low grade colon adenoma
Lab: Hb 121g/l>76g/l, Tc 270 G/l, INR 1.0, Lc
normal gastroscopy
31
Colonoscopy 08/2015Non-gangrenous colitis
Sharp demarcation between viable and necrotic colonic mucosa
Edema & focal mucosalhemorrhage
32
Early lesions characterized by superficial mucosal hemorrhage, edema and necrosis. Necrosis usually spares base of crypts and muscularis propria
Histology: Ischemic ColitisLater lesions may exhibit granulation tissue, submucosalfibrosis and atrophy. Frequent hyalinization of lamina propria