Malignant histiocytosis and ulcerative jejunitis of the small intestine

Jejunum abnormalities at MR enteroclysis

OBJECTIVE

MR enteroclysis has become an important tool to visualize the complete small bowel wall and extramural structures. In many centers, this technique is rapidly becoming the first-line technique for small bowel visualization. MR enteroclysis yields a diagnosis of thickened jejunal loops in some patients. In this paper, we describe an MR enteroclysis protocol and review the literature on jejunum abnormalities with several sample cases.

CONCLUSION

Jejunum abnormalities are not uncommon. These abnormalities can be self-limiting, but some patients suffer from infectious and other pathologic conditions of the small bowel necessitating intervention.

Primary gastrointestinal lymphomas: a radiological-pathological review. Part 2: Small intestine

Primary lymphoma of the small intestine is a heterogeneous group of diseases reflected in its protean imaging features. This review illustrates the widespread appearances seen on imaging methods (primarily CT and barium studies) with pathological correlation.

Early malignant histiocytosis of the intestine: an autopsy report

A 63-year-old man with malignant histiocytosis of the intestine died 3 days after gastrectomy for early gastric adenocarcinoma. Malignant histiocytosis of the intestine was unexpectedly found at autopsy. The intestine was thickened with mucosal erosions. Histologically, a few atypical large histiocyte-like cells were found in focal aggregates in the mucosa. These large cells expressed the T-cell antigen and monoclonality was demonstrated by the polymerase chain reaction showing variable-joining segment rearrangement in the T-cell receptor delta-chain gene. Malignant histiocytosis of the intestine was thus diagnosed.

Malignant histiocytosis of the intestine simulating Crohn's disease. Report of a case

We report a case of malignant histiocytosis of the intestine (MHI) in which clinical and small bowel barium examination led to an initial diagnosis of Crohn's disease. The patient's symptoms and radiologic features improved dramatically with steroid therapy, and the patient remained free of severe symptoms for five years; at this stage, massive rectal bleeding occurred and segmental ileal resection was performed. Pathology findings of the resected specimen revealed nonspecific ulceration of the ileum. The correct diagnosis, MHI, became apparent six months after surgical intervention, on the appearance of multiple lymphadenopathy.

Lymphoma of the small intestine: radiological appearances

The radiological features of small intestinal lymphoma are described in 11 patients examined using the small bowel enema technique. The signs include luminal narrowing with mucosal destruction and occasionally shouldering of the margins and stricture formation, broad based ulceration, cavitation, non-specific thickening of the valvulae conniventes, discrete intraluminal filling defects, and a mass. In one patient, small nodules were scattered throughout the small intestine. Aneurysmal dilatation of a segment of intestine was seen in one case and an extraluminal mesenteric mass in another. A combination of different signs was a frequent finding and multiple intestinal lesions were present in four cases. Predisposing factors were present in five cases including coeliac disease, chronic lymphatic leukaemia, immunoproliferative small intestinal (alpha-chain) disease and previous extraintestinal lymphoma. In another patient there was evidence of extraintestinal lymphoma at the time of presentation.

Clinical features and management of malignant histiocytosis of the intestine

This article documents the clinical course of nine patients diagnosed as having malignant histiocytosis of the intestine (MHI). Five patients had a history of gluten-sensitive enteropathy. This tumor commonly affects the small bowel in a widespread, patchy fashion causing ulceration, stricture formation, and perforation. Metastases to mesenteric nodes, liver, and the bone marrow were common. Although the diagnosis of MHI was often made at laparotomy, surgical resection, even when extensive, was not curative in any case. All nine patients were treated with a variety of chemotherapeutic regimes. This tumor proved chemosensitive, although response was usually brief and difficult to accurately evaluate. Chemotherapy was poorly tolerated because these patients were malnourished. In two cases small bowel perforation occurred, and in one gastrointestinal bleeding occurred after chemotherapy. Eight patients have died of disease from 0 to 16 months after the diagnosis was made, and a single patient is apparently cured 5+ years after completing chemotherapy. Malignant histiocytosis of the intestine has a characteristic clinical course. It is hoped that increased clinical awareness and early diagnosis will improve the outcome.

Celiac sprue complicated by lymphoma presenting with multiple gastric ulcers

A 40-yr-old woman with celiac sprue, which had responded clinically and histologically to gluten elimination, subsequently developed gastrointestinal lymphoma. Although this has been described in the small intestine of patients with celiac sprue, the unique feature in this patient was her initial presentation with multiple gastric ulcers refractory to conventional medical therapy. This case demonstrates that lymphoma complicating celiac sprue may present with multiple refractory gastric ulcers in addition to those occurring in the small intestine.