结肠 肉芽肿？讨论病例【IBD病理群病例40】

小王

肖书渊
41-year old female, had total abdominal colectomy when she was 33 years old, for ulcerative pan-colitis, with J-pouch ，under went poucheoscopy, revealing erosions, erythema, and granularity in the J-pouch and a suspected rectal cuff proximal to the anal verge ，the following are the pouch biopsy




what should be done further in the evaluation.

刘秀丽
Remicade can cause granuloamatous inflammation or sarcoidosis like changes. The granulomatous inflammation is almost too good to be Crohn.  

黄艳
软斑病？好像看到GM小体了



肖书渊
@［小片-刘秀丽 UF Florida］ Would you please elaborate on the "too good to be Crohn" comment?  So you have never seen these type of granulomas in resected CD specimen?It is understandable that patients treated with remicade or other TNF-antagonists are prone to infections, including those that may manifest as granulomatous infection, such as mycobacterial, fungal, etc.  But I am not aware of a situation that remicade causes the development of florid epithelioid granulomas.  Please share with us a publication on this topic (ie.  non-infectious granulomas).  Thanks.Please keep in mind that whatever reports are there, they have to be on UC patients, in which there shouldn't be large granulomas originally and any large granulomas developed can be blamed on the drug.

刘秀丽
@肖书渊 芝加哥大学 病理 in completion   Proctectomy specimen and pouch resected specimen, I never saw this type of diffuse granulomatous inflammation.  Also, in resected Crohn's disease specimen I could not recall seeing this type of diffuse granulomatous inflammation.I do see cases of extensive granuloma inflammation in the colon and liver in non IBD patients treated with Remicade.  The granulomatous inflammation is too diffuse and not that epithelioid.  That is the reason I suspect this case is related to medication or infection.  Of course, this is your case, you make the final call.  The USCAP last year has a series of anti TNF agent induced GI tract change and granuloma is a common finding in that abstract.  I do not know if that has been published or not.You are expert, you may have more experience.I just voice my concern.

肖书渊
Thank you for the suggestions.  The case in which your saw extensive granulomas in colon from non-IBD patients who were treated with remicade, did you work up for infection? What was the reason for colectomy?  @［小片-刘秀丽 UF Florida］