1/12. Granulomatous osteonecrosis in Crohn's disease.A 25-year-old white woman was diagnosed with Crohn's disease involving the small and large intestines. She had a complex clinical course that required treatment with multiple pharmacological agents, including intravenous, oral and rectal corticosteroids. She also received parenteral nutrition with lipid emulsions. Finally, repeated intestinal resections and drainage of perianal abscesses were required. Her disease was complicated by gallstones, urolithiasis and hip pain. After osteonecrosis was diagnosed, joint replacements were performed. review of the pathological sections from the resected hip, however, resulted in detection of granulomatous inflammation with multinucleated giant cells - the histological 'footprint' of Crohn's disease in the gastrointestinal tract. Because prior specialized perfusion fixation pathological studies of the intestine in Crohn's disease have shown that granulomas are located in the walls of blood vessels, a possible mechanism for the pathogenesis of osteonecrosis in Crohn's disease is chronic microvascular ischemia of bone.- - - - - - - - - - ranking = 1keywords = giant (Clic here for more details about this article) |
2/12. Granulomatous colitis associated with botryomycosis of propionibacterium acnes.propionibacterium acnes, an anaerobic, non-spore-forming, gram-positive bacillus, is a common inhabitant of the skin, and its virulence is considered to be low in humans. This report describes an unusual case of granulomatous colitis associated with P acnes infection in a 46-year-old woman. The affected cecum exhibited a tumor histologically characterized by massive transmural infiltrates of small lymphocytes and noncaseating epithelioid granulomas with multinucleated giant cells. Botryomycotic granules were also found in the muscular layer and paracolic connective tissues and consisted of gram-positive bacilli with filamentous growth. polymerase chain reaction confirmed the presence of P acnes 16S ribosomal dna in the surgical specimen of the colon. The patient developed a postoperative P acnes-induced peritonitis, which subsided with treatment with antibiotics and surgical drainage. The present case indicates that P acnes is one of the possible pathogens for granulomatous colitis.- - - - - - - - - - ranking = 1keywords = giant (Clic here for more details about this article) |
3/12. Microscopic colitis with giant cells.AIMS: Collagenous colitis and lymphocytic colitis are the two types of microscopic colitis with specific morphological features. In this report we describe a new histopathological subtype of microscopic colitis. methods AND RESULTS: colonoscopy in four patients with chronic watery diarrhoea showed no macroscopic abnormalities. The random biopsies from the colon showed subepithelial multinucleated giant cells in combination with the features of collagenous colitis in three patients and lymphocytic colitis in one patient. These multinucleated giant cells were positive for CD68. The density of macrophages was highest in the most superficial part of the lamina propria. In one patient, a previous biopsy showed features consistent with collagenous colitis without multinucleated giant cells. Treatment with budesonide led to the disappearance of diarrhoea in all four patients. CONCLUSIONS: The clinical and histopathological features of the four presented patients indicate that there exists a histopathological subtype of microscopic colitis characterized by the presence of subepithelial multinucleated giant cells, which probably arise from fusion of subepithelial macrophages. Analysis of more patients with this histopathological subtype of microscopic colitis is necessary to determine whether they also form a clinically distinct group.- - - - - - - - - - ranking = 8keywords = giant (Clic here for more details about this article) |
4/12. Giant inflammatory polyposis of the descending colon associated with a Crohn's disease-like colitis.A case of giant inflammatory polyposis associated with a localized inflammatory bowel disease of the descending colon in a 49-year-old man is presented. Lower abdominal distension rapidly appeared without any previous history of gastrointestinal disease. Two months later, he underwent a left hemicolectomy. Postoperative recovery was complete and he remains in good health more than 2 years later. The resected colon showed a giant and bizarre polyposis measuring up to 12 cm in length and 2 cm in height and covering the entire circumference of the colon. The polyposis consisted of narrow worm- or noodle-like polyps that bridged over the irregularly shaped ulcers, which sometimes extended into muscularis propria. Although longitudinal ulcers or scars, stricture, and a cobble-stone appearance were not observed, transmural inflammation and deep fissures were found in the interpolypoid area. From these findings, this case seems to be more similar to Crohn's disease than other inflammatory bowel diseases.- - - - - - - - - - ranking = 2keywords = giant (Clic here for more details about this article) |
5/12. Microscopic colitis with giant cells: a rare new histopathologic subtype?Collagenous and lymphocytic colitis might be part of the same disease spectrum. In this report, we present a histopathologic subtype of microscopic colitis characterized by the presence of subepithelial multinucleated giant cells. This reaction is very unusual and not explicable by any underlying disease process or previous treatment. Among 490 cases of microscopic colitis (MC) diagnosed between 1992 and 2002, we found 2 cases with macrophages and giant cells (0.4%). One case of lymphocytic colitis (LC) and 1 case of collagenous colitis (CC) presented aggregates of macrophages and giant cells located in the superficial part of the lamina propria. Infectious or non-infectious colonic granulomatous diseases were excluded on histologic, clinical, and biological grounds. The recognition of this feature in an MC is important to avoid the diagnosis of granulomatous infectious or idiopathic colitis such as Crohn's disease. Even if very unusual, this subtype of MC evolves favorably since the 2 patients responded well to corticosteroid treatment.- - - - - - - - - - ranking = 7keywords = giant (Clic here for more details about this article) |
6/12. Giant and symptomatic inflammatory polyps of the colon in idiopathic inflammatory bowel disease.Four cases of giant inflammatory polyps were found in a series of 86 consecutive colectomies for inflammatory bowel disease. Two presented a distinctive clinical syndrome of abdominal pain and chronic iron-deficiency anemia due to blood loss. Secondary ulceration of the heads of the polyps accounted for the bleeding and anemia, and the size of the polyps accounted for the abdominal pain. In both cases unusually long portions of colon were involved by the giant polyps. The third and fourth cases had rare complications--reactivation of an enterocutaneous fistula and perforation of an acquired diverticulum. These cases demonstrate that giant inflammatory polyps may produce symptoms independently of the underlying inflammatory bowel disease. In reported cases of giant inflammatory polyps, approximately two-thirds had Crohn's disease and one-third had ulcerative colitis. The transverse colon was the commonest location, pain was the commonest symptom, and the polyps were localized to a short segment of colon in the majority of cases. More than 50% of cases mimicked neoplasm on barium enema. Giant inflammatory polyps may produce a variety of distinctive signs and symptoms and deserve independent recognition.- - - - - - - - - - ranking = 4keywords = giant (Clic here for more details about this article) |
7/12. Localized giant pseudopolyposis of the colon in granulomatous colitis: a case report and review of the literature.A case of localized giant pseudopolyposis of the colon is presented. The case was proven histologically to be granulomatous colitis. This unusual manifestation of granulomatous colitis may mimic a large bowel carcinoma or less frequently villous adenoma. This is the first proven reported case of granulomatous colitis presenting in this manner.- - - - - - - - - - ranking = 5keywords = giant (Clic here for more details about this article) |
8/12. Localized giant pseudopolyposis of the colon.Localized giant pseudopolyposis is a rare complication in patients with inflammatory diseases of the colon which produces a huge intraluminal polypoid mass. Examples are described in a child with chronic ulcerative colitis in whom the lesion filled the rectum and in an adult with recurrent granulomatous ileocolitis in whom the mass was present in the transverse colon adjacent to a stenotic anastomosis. The clinical presentation, radiologic features and pathologic findings of this unusual sequela to inflammation are reviewed.- - - - - - - - - - ranking = 5keywords = giant (Clic here for more details about this article) |
9/12. Localized giant pseudopolyposis of the colon in ulcerative and granulomatous colitis.The occurrence of localized large clusters of colonic pseudopolyps in 4 patients is described. The underlying disease was chronic ulcerative colitis in 2 cases and granulomatous colitis in 2 others. Each lesion presented as a bulky polypoid mass causing partial or total occlusion of the transverse segment or splenic flexure of the colon. The radiographic and pathologic features of this rare entity are illustrated, and the previously reported 10 cases are briefly reviewed.- - - - - - - - - - ranking = 4keywords = giant (Clic here for more details about this article) |
10/12. Obstructing giant pseudopolyps in granulomatous colitis.Two cases of giant pseudopolyps occurring in Crohn's disease of the colon are presented. In both there was obstruction to retrograde flow of barium, and in one the patient presented with acute obstruction.- - - - - - - - - - ranking = 5keywords = giant (Clic here for more details about this article) |
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