1/6. Necrotizing and giant cell granulomatous phlebitis of caecum and ascending colon.A distinctive form of necrotizing and granulomatous phlebitis of a segment of large intestine is described in a previously healthy 36-year-old woman who presented with sudden severe abdominal pain and diarrhoea. At operation the caecum and ascending colon were oedematous and inflamed and right hemicolectomy was performed. Microscopically there was striking involvement of veins in all coats of the bowel ranging from recent fibrinoid necrosis of the whole vessel wall in the case of the caecum, to more chronic giant cell granulomas in parts of the vessel wall with partial or complete occlusion of the lumen in ascending colon. arteries and lymphatics were entirely spared of these changes. The aitiology of this condition has not been elucidated but the histological appearances and site of involvement suggest an immunological reaction to material absorbed from the bowel. No evidence of food or other allergies or of infection has been obtained. The patient remains symptom free after 18 months. This form of phlebitis does not appear to have been previously described.- - - - - - - - - - ranking = 1keywords = giant (Clic here for more details about this article) |
2/6. Giant-cell vasculitides.Although many of the vasculitides within the classification of the American College of rheumatology can have a component of granulomatous inflammation with giant cells, two (ie, giant-cell [temporal] arteritis and takayasu arteritis) are characterized by infiltrates that are dominated by granulomatous and/or giant-cell-containing inflammation. Furthermore, granulomatous and/or giant-cell dominant infiltrates can characterize disseminated giant-cell arteritis, granulomatous vasculitis of the central nervous system, localized giant-cell arteritis, mesenteric inflammatory veno-occlusive disease, primary cutaneous phlebitis, and giant-cell phlebitis of mesenteric veins and/or omentum. Like the other systemic vasculitides, there is considerable clinicopathologic overlap between these giant-cell vasculitides. Indeed, they are likely closely related, but how they specifically relate to each other is not clear. Their accurate diagnosis is important; because serious morbidity and even death may occur, if proper treatment is delayed or if excessive immunotherapy is given.- - - - - - - - - - ranking = 1.6keywords = giant (Clic here for more details about this article) |
3/6. A case of gastric adenocarcinoma associated with giant-cell phlebitis.A 60-year-old male patient with advanced gastric adenocarcinoma was treated by subtotal gastrectomy with dissection of the regional lymph nodes. Microscopic examination of the tumour revealed tubular adenocarcinoma which invaded the muscularis propria. There was no evidence of metastatic carcinoma in the dissected lymph nodes (pT2N0Mx). Granulomatous reaction comprising epithelioid cells and giant cells involved subserosal muscular veins, adjacent to the carcinoma tissue. Fibrinoid necrosis, with or without infiltration of eosinophils, was noted within the lumen of some veins. The acid-fast and fungal stains were negative. Remnants of parasites were not identified in serial sections of the paraffin blocks. No pulmonary disease was evident on radiographic or pulmonary examination. The presence of granulomatous destruction of muscular veins with sparing of arteries suggested the diagnosis of giant-cell phlebitis. To our knowledge, there have been no previous reports regarding an association between giant-cell phlebitis and advanced gastric adenocarcinoma.- - - - - - - - - - ranking = 1.4keywords = giant (Clic here for more details about this article) |
4/6. Primary granulomatous giant cell polyphlebitis of visceral veins.A case of granulomatous giant cell phlebitis occurred in the mesenteric veins of a 38-year-old man, resulting in segmental infarction of the ileum. Multiple epithelioid granulomas with giant cells of the Langhans type were situated in media/adventitia of small and middle-sized mesenteric veins with subsequent thrombotic venous occlusions. No involvement of arterial vessels could be detected. The aetiology of the disease remains unknown. Known types of vasculitis were excluded. It was assumed that this is an example of in immunological vasculopathy but this could not be proved.- - - - - - - - - - ranking = 1.2keywords = giant (Clic here for more details about this article) |
5/6. Nodular granulomatous phlebitis of the skin: a fourth type of tuberculid.We present five cases of granulomatous phlebitis of the skin and compare them with a case of miliary tuberculosis with granulomatous phlebitis. All five patients were hypersensitive to purified protein derivative, but without active tuberculosis. Although anti-tuberculous drugs were effective, no tubercle bacilli were isolated from the skin. Clinically, subcutaneous nodules were felt along the course of the leg vein. Histologically, epithelioid cell granulomas with Langhans' giant cells were observed within the walls of the cutaneous veins. In a later stage, granulomatous panniculitis was often associated. Using the polymerase chain reaction method. mycobacterium tuberculosis dna was detected in four of the five cases of granulomatous phlebitis of the skin. Granulomatous phlebitis of the skin seems to represent a relatively early phase of delayed-type hypersensitivity reactions to mycobacterium tuberculosis and may represent a distinct entity different from other types of tuberculid-a new tuberculid. Nevertheless, before making the diagnosis, the possibility of true tuberculosis must always be excluded. Nodular granulomatous phlebitis of the skin would be an appropriate name for the newly described condition.- - - - - - - - - - ranking = 0.2keywords = giant (Clic here for more details about this article) |
6/6. Giant cell phlebitis as a cause of large intestinal stricture.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.- - - - - - - - - - ranking = 0.4keywords = giant (Clic here for more details about this article) |