1
|
Enterocolic Lymphocytic Phlebitis Treated Preoperatively with Biologics and Immunosuppressive Agents. Case Rep Pathol 2022; 2022:5120607. [PMID: 35295675 PMCID: PMC8920688 DOI: 10.1155/2022/5120607] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2021] [Accepted: 02/11/2022] [Indexed: 11/30/2022] Open
Abstract
Enterocolic lymphocytic phlebitis is phlebitis of unknown etiology in which lymphocytes affect veins without arteries and shows evidence of systemic vasculitis in the intestinal wall and mesentery, mainly in the small intestine and colon. Although patients present with a variety of gastrointestinal symptoms and findings like those of inflammatory bowel disease or ischemic bowel disease, there are no specific findings for enterocolic lymphocytic phlebitis. As a result, a diagnosis tends to be made after surgery. There are few case reports of enterocolic lymphocytic phlebitis, and the impact of chronic courses and immunosuppressive drugs on enterocolic lymphocytic phlebitis is not well known. A 47-year-old man was treated with infliximab and steroids for unexplained ulceration and narrowing of the ileocecal area, which was suspected to be inflammatory bowel disease with atypical findings. Lymphocytic phlebitis was noted in the surgical specimen, and enterocolic lymphocytic phlebitis was diagnosed. No recurrence of enterocolic lymphocytic phlebitis was observed postoperatively. This disease should also be considered among patients with inflammatory bowel disease-like lesions that do not respond to infliximab or steroids.
Collapse
|
2
|
Nasher O, Alizai N. Enterocolic lymphocytic phlebitis: a rare pathology in children. BMJ Case Rep 2021; 14:e243826. [PMID: 34426428 PMCID: PMC8383883 DOI: 10.1136/bcr-2021-243826] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/05/2021] [Indexed: 11/04/2022] Open
Abstract
Enterocolic lymphocytic phlebitis (ELP) is a rare pathology, usually seen in the adult population. The condition affects the venous vasculature of the intestine sparing the arteries and lymphatics. It is commonly identified histologically after surgical resection making the preoperative diagnosis a clinical challenge. As the condition can lead to intestinal ischaemia and necrosis, surgical resection of the affected segment is the treatment of choice. We report the case of a 9-year-old girl who presented with a 2-day history of lower abdominal pain and anorexia. The initial diagnosis of appendicitis was made clinically and the patient underwent a diagnostic laparoscopy . The appendix was macroscopically normal and there were no other obvious intra-abdominal pathologies to account for her presenting complaints . The appendix was removed, as per the preoperative discussion and consent from parents. She recovered well and was discharged home the following day. The histological examination of the appendix demonstrated ELP. We describe this rare clinical entity in a child especially in view of the scarce published literature in the paediatric population.
Collapse
Affiliation(s)
- Omar Nasher
- Paediatric Surgery, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - Naved Alizai
- Paediatric Surgery, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| |
Collapse
|
3
|
Farber ON, Weingarden A, Lee C, Braxton DR, Bingham D, Scott G, Fernandez-Becker N, Goff D, Shelton A, Kin C. Not in the Same Vein: Inflammatory Bowel Disease, Malignancy, and Enterocolic Lymphocytic Phlebitis. Dig Dis Sci 2021; 66:413-418. [PMID: 32594463 DOI: 10.1007/s10620-020-06425-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/09/2022]
Affiliation(s)
- Orly N Farber
- Department of Surgery, Stanford University School of Medicine, 300 Pasteur Drive, H3690, Stanford, CA, 94305, USA
| | - Alexa Weingarden
- Department of Medicine, Division of Gastroenterology and Hepatology, Stanford University School of Medicine, 430 Broadway, Pavilion C, 3rd Floor, Redwood City, CA, 94063, USA
| | - Christopher Lee
- Department of Gastroenterology and Hepatology, Hoag Memorial Hospital Presbyterian, 520 Superior Ave. Suite 290, Newport Beach, CA, 92663, USA
| | - David R Braxton
- Department of Pathology, Hoag Memorial Hospital Presbyterian, 1 Hoag Drive, Newport Beach, CA, 92663, USA
| | - David Bingham
- Department of Pathology, Stanford University School of Medicine, 300 Pasteur Drive, H2210, Stanford, CA, 94305, USA
| | - Gregory Scott
- Department of Pathology, Stanford University School of Medicine, 300 Pasteur Drive, H2210, Stanford, CA, 94305, USA
| | - Nielsen Fernandez-Becker
- Department of Medicine, Division of Gastroenterology and Hepatology, Stanford University School of Medicine, 430 Broadway, Pavilion C, 3rd Floor, Redwood City, CA, 94063, USA
| | - Daniel Goff
- Department of Radiology, Stanford University School of Medicine, 300 Pasteur Drive, Stanford, CA, 94305, USA
| | - Andrew Shelton
- Department of Surgery, Stanford University School of Medicine, 300 Pasteur Drive, H3690, Stanford, CA, 94305, USA
| | - Cindy Kin
- Department of Surgery, Stanford University School of Medicine, 300 Pasteur Drive, H3690, Stanford, CA, 94305, USA.
| |
Collapse
|
4
|
Mora-Guzmán I, Alonso-Casado AP. Enterocolic Lymphocytic Phlebitis: A Mimicking Entity. Int J Surg Pathol 2018; 27:526. [PMID: 30370827 DOI: 10.1177/1066896918809511] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
|
5
|
Yamada Y, Sugimoto K, Yoshizawa Y, Arai Y, Otsuki Y, Arai T, Kobayashi Y, Sato Y, Hosoda Y. Mesenteric inflammatory veno-occlusive disease occurring during the course of ulcerative colitis: a case report. BMC Gastroenterol 2018; 18:9. [PMID: 29325532 PMCID: PMC5765608 DOI: 10.1186/s12876-018-0737-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2017] [Accepted: 01/02/2018] [Indexed: 12/17/2022] Open
Abstract
Background Mesenteric inflammatory veno-occlusive disease (MIVOD) is difficult to diagnose because of its rarity, nonspecific clinical findings, and frequent confusion with other diseases including inflammatory bowel disease. This report presents a very rare case of MIVOD that occurred during the course of ulcerative colitis (UC). Case presentation A 32-year-old man, who had been diagnosed with UC at the age of 29 and was in remission maintained by oral administration of 5-aminosalicylic acid (5-ASA), showed exacerbation of diarrhea and was admitted to the hospital. Since it was deemed an exacerbation of UC, intravenous steroid therapy and oral administration of tacrolimus were initiated, but his condition continued to worsen. Abdominal computed tomography (CT) was performed and showed intraperitoneal free air, leading to a diagnosis of gastrointestinal perforation and the performance of emergency surgery (subtotal colectomy and ileostomy). Histopathological examination of the resected colon of the patient showed mucosal inflammatory findings that were not typical of UC, including multiple organized thrombi with recanalization in the veins existing in the submucosal layer to the subserosal layer and an increased infiltration of inflammatory cells. These findings led to the pathological diagnosis of MIVOD. Conclusion We report a very rare case in which MIVOD occurred during the course of UC.
Collapse
Affiliation(s)
- Yosuke Yamada
- Department of Gastroenterology, Seirei Hamamatsu General Hospital, Hamamatsu, 430-8558, Japan
| | - Ken Sugimoto
- First Department of Medicine, Hamamatsu University School of Medicine, 1-20-1 Handayama, Hamamatsu, 431-3192, Japan.
| | - Yashiro Yoshizawa
- Department of Gastroenterology, Seirei Hamamatsu General Hospital, Hamamatsu, 430-8558, Japan
| | - Yoshifumi Arai
- Department of Pathology, Seirei Hamamatsu General Hospital, Hamamatsu, 430-8558, Japan
| | - Yoshiro Otsuki
- Department of Pathology, Seirei Hamamatsu General Hospital, Hamamatsu, 430-8558, Japan
| | - Tomio Arai
- Department of Pathology, Tokyo Metropolitan Geriatric Hospital and Institute of Gerontology, Tokyo, 173-0015, Japan
| | - Yasuyuki Kobayashi
- Department of Surgery, Seirei Hamamatsu General Hospital, Hamamatsu, 430-8558, Japan
| | - Yoshihiko Sato
- Department of Gastroenterology, Seirei Hamamatsu General Hospital, Hamamatsu, 430-8558, Japan
| | - Yoshisuke Hosoda
- Department of Gastroenterology, Seirei Hamamatsu General Hospital, Hamamatsu, 430-8558, Japan
| |
Collapse
|
6
|
Allali D, Puppa G, Chizzolini C. Mesenteric inflammatory veno-occlusive disease of the spleen metasynchronous with two arterial thrombotic events in systemic lupus erythematosus. Lupus 2017; 27:150-153. [PMID: 28355983 DOI: 10.1177/0961203317700980] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Vasculitides, particularly those affecting small vessels, are known to complicate systemic lupus erythematosus (SLE); however, isolated venulitis of the mesenteric bed has rarely been reported. Here we relate the case of a 46-year-old woman with SLE who presented with acute abdominal pain due to artery thrombosis and extended splenic ischemia requiring splenectomy. The histological examination revealed diffuse venulitis in the absence of arterial vasculitis consistent with the definition of mesenteric inflammatory veno-occlusive disease (MIVOD). Furthermore, arterial wall thickening suggestive of uncomplicated atherosclerosis was observed. Two months later, the patient suffered of severe myocardial infarction (MI) resulting from thrombosis of the anterior interventricular coronary artery with otherwise no signs of coronary disease at coronarography. Extensive work-up to establish the cause of MI was negative, with the exception of marginal, isolated and transient elevation of cardiolipin IgG (14.5 GPL, n.v. 0-5 GPL). This patient's SLE history is dramatically marked by the previously non-described association of MIVOD and two arterial thrombotic events (splenic and coronary) occurring within a two months period, and stresses the need of better understanding and prevention of vascular complications in SLE.
Collapse
Affiliation(s)
- D Allali
- 1 Immunology and Allergy, Department of Internal Medicine Specialties, University Hospital and School of Medicine, Geneva, Switzerland
| | - G Puppa
- 2 Department of Pathology, University Hospital and School of Medicine, Geneva, Switzerland
| | - C Chizzolini
- 1 Immunology and Allergy, Department of Internal Medicine Specialties, University Hospital and School of Medicine, Geneva, Switzerland
| |
Collapse
|
7
|
Mesenteric Inflammatory Venoocclusive Disease in a Patient with Sjögren's Syndrome. Case Rep Med 2014; 2014:423420. [PMID: 25477970 PMCID: PMC4248484 DOI: 10.1155/2014/423420] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2014] [Revised: 09/19/2014] [Accepted: 10/03/2014] [Indexed: 11/17/2022] Open
Abstract
Mesenteric inflammatory venoocclusive disease is an uncommon cause of intestinal ischemia. Certain diseases, such as hypercoagulation disorders, autoimmune diseases, or drugs have been associated with the pathogenesis of mesenteric inflammatory venoocclusive disease. Here, we report a patient with Sjögren's syndrome who underwent surgery for suspected acute appendicitis with a subsequent pathological diagnosis of mesenteric inflammatory venoocclusive disease.
Collapse
|
8
|
Huiberts AAM, Donkervoort SC, Blok WL, Blaauwgeers HLG. Enterocolic lymphocytic phlebitis: an oncologic surgical resection without a preoperative pathologic diagnosis. J Surg Case Rep 2014; 2014:rju037. [PMID: 24876508 PMCID: PMC4021381 DOI: 10.1093/jscr/rju037] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
A patient with complaints of an abdominal (mesenteric) mass is presented. Differential diagnosis included neoplastic processes, such as malignant lymphoma, desmoid tumour, a carcinoid or a gastro-intestinal stromal cell tumour. An oncological resection was performed. Despite the malignant appearance of the tumour no malignancy was found with histopathological examination. Vasculitic lesions were seen in venous structures, resembling veno-occlusive disease with signs of recanalization and with the presence of inflammatory cells, mainly lymphocytes. A diagnosis of enterocolic lymphocytic phlebitis was made. This benign condition can mimic malignancy, necessitating a wide excision, also because obtaining a pre-operative histopathological diagnosis is hardly possible.
Collapse
Affiliation(s)
| | | | - Willem L Blok
- Department of Internal Medicine, OLVG, Amsterdam, The Netherlands
| | | |
Collapse
|
9
|
Kunieda T, Murayama M, Ikeda T, Yamakita N. Giant cell phlebitis: a potentially lethal clinical entity. BMJ Case Rep 2012; 2012:bcr-2012-006914. [PMID: 22859384 DOI: 10.1136/bcr-2012-006914] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
An 83-year-old woman presented to us with a 4-week history of general malaise, subjective fever and lower abdominal pain. Despite the intravenous infusion of antibiotics, her blood results and physical condition worsened, resulting in her sudden death. Autopsy study revealed that the medium-sized veins of the mesentery were infiltrated by eosinophil granulocytes, lymphocytes, macrophages and multinucleated giant cells; however, the arteries were not involved. Microscopically, venous giant cell infiltration was observed in the gastrointestinal tract, bladder, retroperitoneal tissues and myocardium. The final diagnosis was giant cell phlebitis, a rare disease of unknown aetiology. This case demonstrates for the first time that giant cell phlebitis involving extra-abdominal organs, including hearts, can cause serious morbidity.
Collapse
|
10
|
Kim M, Lee HJ, Yeo MK, Lee YS, Moon HS, Lee SI, Cho JS, Song KS. Lymphocytic Phlebitis of the Stomach - A Case Report with Literature Review -. KOREAN JOURNAL OF PATHOLOGY 2011. [DOI: 10.4132/koreanjpathol.2011.45.6.654] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
- Meeran Kim
- Department of Pathology, Chungnam National University School of Medicine, Daejeon, Korea
| | - Hyun-Jung Lee
- Department of Pathology, Chungnam National University School of Medicine, Daejeon, Korea
| | - Min-Kyung Yeo
- Department of Pathology, Chungnam National University School of Medicine, Daejeon, Korea
| | - Young-Suk Lee
- Department of Pathology, Chungnam National University School of Medicine, Daejeon, Korea
| | - Hee Seok Moon
- Department of Internal Medicine, Chungnam National University School of Medicine, Daejeon, Korea
| | - Sang-Il Lee
- Department of Surgery, Chungnam National University School of Medicine, Daejeon, Korea
| | - June-Sik Cho
- Department of Radiology, Chungnam National University School of Medicine, Daejeon, Korea
| | - Kyu-Sang Song
- Department of Pathology, Chungnam National University School of Medicine, Daejeon, Korea
| |
Collapse
|
11
|
|
12
|
Ngo N, Chang F. Enterocolic Lymphocytic Phlebitis: Clinicopathologic Features and Review of the Literature. Arch Pathol Lab Med 2007; 131:1130-4. [PMID: 17617004 DOI: 10.5858/2007-131-1130-elpcfa] [Citation(s) in RCA: 62] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/21/2006] [Indexed: 11/06/2022]
Abstract
Abstract
Enterocolic lymphocytic phlebitis (ELP) is a recently described entity and is of unknown etiology and pathogenesis. It is characterized by phlebitis of the bowel wall and mesentery, without arterial involvement or evidence of systemic vasculitis. The clinical presentation of ELP is varied, but it most commonly manifests with signs of an acute abdomen. Clinical, radiologic, and endoscopic findings are often conflicting and misdiagnosis is common as venous thrombosis is not suspected. The diagnosis of ELP is obtained histologically. There is a spectrum of histologic features associated with ELP, which includes lymphocytic phlebitis, necrotizing phlebitis, granulomatous phlebitis, and myointimal hyperplasia. Other features include venous thrombi and acute ischemic changes of the intestine. Surgical resection of the affected bowel is usually curative and recurrences are rare. The clinical and histopathologic features of ELP are reviewed.
Collapse
Affiliation(s)
- Nyethane Ngo
- Department of Histopathology, Guy's & St Thomas' NHS Foundation Trust, London SE1 7EH, United Kingdom
| | | |
Collapse
|
13
|
Hu JCC, Forshaw MJ, Thebe P, Stewart M. Mesenteric Inflammatory Veno-occlusive Disease as a Cause of Acute Abdomen: Report of Five Cases. Surg Today 2005; 35:961-4. [PMID: 16249852 DOI: 10.1007/s00595-004-3036-6] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2004] [Accepted: 11/16/2004] [Indexed: 11/25/2022]
Abstract
Mesenteric inflammatory veno-occlusive disease (MIVOD) is a rare but increasingly recognized cause of intestinal ischemia. It can be defined as phlebitis or venulitis affecting either the bowel or mesentery, without any evidence of coexisting arterial inflammatory involvement or an obvious predisposing cause. We report the clinicopathological characteristics of five patients who, after presenting with an acute abdomen, underwent exploratory laparotomy and resection of ischemic bowel. The distinctive histopathological characteristics of MIVOD were identified in all five patients. We review the literature on this under-reported condition.
Collapse
Affiliation(s)
- Jennifer C C Hu
- Department of Surgery, Darent Valley Hospital, Dartford, Kent, UK
| | | | | | | |
Collapse
|
14
|
Abraham SC, Solem CA, Hauser SC, Smyrk TC. Chronic Antral Ulcer Associated With Gastroduodenal Lymphocytic Phlebitis. Am J Surg Pathol 2004; 28:1659-63. [PMID: 15577689 DOI: 10.1097/00000478-200412000-00018] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Enterocolic lymphocytic phlebitis (ELP) is a rare cause of gastrointestinal ischemia. Unlike most vasculitic diseases affecting the gastrointestinal tract, ELP involves only the mural and mesenteric veins, which are surrounded by a lymphocytic and sometimes granulomatous infiltrate. The mesenteric arterial system and the systemic vasculature are characteristically spared. Most patients with ELP present with an acute abdomen that resolves following surgical resection of the involved bowel. ELP has been reported to involve the small bowel, colon, or both, but involvement of the upper gastrointestinal tract has not been previously described. Here we report a case of lymphocytic phlebitis that affected only the stomach and duodenum. The patient, a 68-year-old man, had a nonhealing gastric antral ulcer and underwent hemigastrectomy with vagotomy and Billroth II reconstruction. Both the resected stomach and duodenum showed characteristic lymphocytic and granulomatous infiltrates that involved the submucosal and mural veins, with associated obliteration of vascular lumina; the adjacent arteries were completely spared. The patient developed late postoperative complications including bile reflux gastritis and erosive esophagitis, but he had no recurrence of gastrointestinal ulceration or ischemia over a 2-year follow-up. We hypothesize that there may be more cases of upper gastrointestinal ELP than are diagnosed as such, in part because the diagnosis can be made only on surgical resections specimens.
Collapse
Affiliation(s)
- Susan C Abraham
- Department of Pathology and Laboratory Medicine, Mayo Clinic, Rochester, MN 55905, USA.
| | | | | | | |
Collapse
|
15
|
Arain FA, Willey J, Richter J, Senagore A, Petras R. An unusual presentation of enterocolic lymphocytic phlebitis. J Clin Gastroenterol 2002; 34:252-4. [PMID: 11873107 DOI: 10.1097/00004836-200203000-00012] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Enterocolic lymphocytic phlebitis (ELP) is a recently described disease characterized by phlebitis in the wall and mesentery of the colon and small bowel. Unlike other systemic or localized vasculitic diseases that can have similar gastrointestinal manifestations, there is no involvement of the arterial system or evidence of systemic vasculitis. The lymphocytic phlebitis affects not only the grossly involved intestinal segment but also the apparently healthy bowel. The diagnosis of ELP is histologic, and other systemic vasculitis must be ruled out. Surgical resection of the bowel not only provides the diagnostic tissue but also leads to resolution of the symptoms. In the literature, ELP has most commonly been reported to present as an acute abdomen. We describe a case of ELP presenting as a large abdominal mass, without evidence of an acute abdomen. This mass was actually diffusely thickened colonic serosa, caused by extensive organizing fat necrosis and marked edema of the serosa and bowel wall.
Collapse
Affiliation(s)
- Faisal A Arain
- Internal Medicine Residency Program, Cleveland Clinic Foundation, Cleveland, Ohio 44195, USA.
| | | | | | | | | |
Collapse
|
16
|
Martinet O, Reis ED, Joseph JM, Saraga E, Gillet TM. Isolated granulomatous phlebitis: rare cause of ischemic necrosis of the colon: report of a case. Dis Colon Rectum 2000; 43:1601-3. [PMID: 11089601 DOI: 10.1007/bf02236749] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
Isolated phlebitis of the gastrointestinal tract is rare and potentially life threatening. We report on a patient who developed peritonitis, requiring emergency laparotomy, total colectomy, and ileostomy because of colon necrosis. The specimen displayed multiple ulcerations and erosions. Histology showed a predominantly lymphocytic infiltrate of small-sized and middle-sized veins in the submucosa and subserosa, associated with granulomas and foci of vein wall necrosis. Arteries were spared. No local recurrence or systemic vasculitis developed during a follow-up period of two years. Isolated granulomatous phlebitis seems to be self-limited, and its cause is unknown. Surgical resection of the diseased intestine is usually curative.
Collapse
Affiliation(s)
- O Martinet
- Department of Surgery and lnstitute of Pathology, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland
| | | | | | | | | |
Collapse
|
17
|
Tuppy H, Haidenthaler A, Schandalik R, Oberhuber G. Idiopathic enterocolic lymphocytic phlebitis: a rare cause of ischemic colitis. Mod Pathol 2000; 13:897-9. [PMID: 10955457 DOI: 10.1038/modpathol.3880160] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
We report on a 74-year-old female patient who was admitted to the hospital because of abdominal pain. She underwent a colonoscopy and a stenosing mass was found in the cecum. Histologic findings in the biopsy specimens were consistent with ischemic colitis. Due to clinical symptoms and the endoscopic and radiologic findings that roused the suspicion that the patient was suffering from a malignant tumor, a right hemicolectomy was performed. Histology of the resection specimen disclosed an inflammation of the veins. It was characterized by a predominantly lymphocytic infiltration of the vessels affecting the veins of the colonic wall and the mesentery. Furthermore, secondary thrombosis with focal venous occlusion was observed. The colon showed extensive ischemic colitis with focal transmural coagulation necrosis. The disease was considered to be idiopathic lymphocytic phlebitis, which is a rare disease of unknown origin. Our patient is well and alive after more than 1 year, supporting the notion that the disease shows a benign course after surgery.
Collapse
Affiliation(s)
- H Tuppy
- Department of Pathology, Krankenhaus Wels, University of Vienna, Austria
| | | | | | | |
Collapse
|
18
|
Saraga E, Bouzourenne H. Enterocolic (lymphocytic) phlebitis: a rare cause of intestinal ischemic necrosis: a series of six patients and review of the literature. Am J Surg Pathol 2000; 24:824-9. [PMID: 10843284 DOI: 10.1097/00000478-200006000-00007] [Citation(s) in RCA: 50] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Vasculitis of the gastrointestinal tract is known to occur as part of a systemic process but also may be present in a localized form involving only the digestive tract. We report the clinical and pathologic findings of six patients with intestinal ischemia and necrosis resulting from localized phlebitis associated with fresh and/or organized thrombosis of intramural mesenteric veins. None of the patients showed clinical or laboratory evidence of systemic vasculitis. In all cases the arteries were not involved in the inflammatory process. Follow up ranged between 2 and 15 years without recurrence necessitating reoperation. This form of intestinal phlebitis is described in the literature under different terms but lymphocytic phlebitis, granulomatous phlebitis, necrotizing phlebitis, and myointimal venous hyperplasia are probably morphologic variants of the same entity. We propose to unify the nomenclature and to use for this unusual clinicopathologic entity only the generic term of enterocolic (lymphocytic) phlebitis.
Collapse
Affiliation(s)
- E Saraga
- Institute of Pathology, CHUV, Lausanne, Switzerland.
| | | |
Collapse
|
19
|
Sharma MC, Deshpande V, Sharma R, Pal S, Sahni P. Giant cell phlebitis as a cause of large intestinal stricture. J Clin Gastroenterol 1998; 27:79-81. [PMID: 9706778 DOI: 10.1097/00004836-199807000-00018] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/09/2022]
Abstract
Although arteritis of the gastrointestinal tract is well known, an isolated phlebitis without associated arteritis of the colon and cecum is rare. We describe a distinct form of giant cell phlebitis in a 16-year-old girl causing ischemic stricture of the large intestine. She presented with subacute intestinal obstruction and was suspected of suffering from tuberculosis. However, histopathologic examination showed giant cell phlebitis, the arterioles and arteries being spared. Although this is an extremely rare form of nonprogressive vasculitis, it should be considered in the differential diagnosis of strictures in the large intestine, especially in the young.
Collapse
Affiliation(s)
- M C Sharma
- Department of Pathology, All India Institute of Medical Sciences, New Delhi.
| | | | | | | | | |
Collapse
|
20
|
Abu-Alfa AK, Ayer U, West AB. Mucosal biopsy findings and venous abnormalities in idiopathic myointimal hyperplasia of the mesenteric veins. Am J Surg Pathol 1996; 20:1271-8. [PMID: 8827035 DOI: 10.1097/00000478-199610000-00014] [Citation(s) in RCA: 43] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Idiopathic myointimal hyperplasia of the mesenteric veins (IMHMV) is a rare cause of intestinal ischemia secondary to venous compromise. A patient with this condition who presented with crampy abdominal pain, diarrhea, and rectal bleeding initially attributed to inflammatory bowel disease had several colonoscopies and ultimately a sigmoid colectomy. The colonic mucosa in biopsies performed at initial presentation and subsequently and in the resection specimen contained numerous hyperplastic, thick-walled, hyalinized vessels in the lamina propria, which have not been described in this entity previously. Examination of the mucosa in 27 resection specimens of ischemic enterocolitis of various etiologies, in five resections of prolapsed rectum, and in seven colostomy specimens revealed no instance in which there were similar histologic abnormalities. When seen on biopsy, therefore, these features should lead to inclusion of IMHMV in the differential diagnosis. Furthermore, the characteristic lesions of the submucosal and extramural veins in IMHMV were compared with those of 14 examples, from several organs, of veins subjected to arterial pressure and 21 cases of venous hypertension. The marked similarity of the arterialized veins to the mural veins of IMHMV suggests a role for arteriovenous fistulization in the pathogenesis of IMHMV, and a mechanism by which this might occur is proposed.
Collapse
Affiliation(s)
- A K Abu-Alfa
- Department of Pathology, Yale University, New Haven, Connecticut, USA
| | | | | |
Collapse
|