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Features of gastric and colonic mucosa in congenital enteropathies: a study in histology and immunohistochemistry.

先天性肠病中胃和结肠粘膜的特征:一项组织学和免疫组化研究

Treetipsatit J,Hazard FK

Abstract

Congenital enteropathies comprise a constellation of rare clinicopathologic diagnoses characterized by intractable watery diarrhea and failure to thrive in infants. These diagnoses include, but are not limited to, tufting enteropathy (TE), microvillous inclusion disease (MID), and enteroendocrine cell dysgenesis (EED). Commonly, the diagnosis is based on identification of their characteristic histologic and/or ultrastructural features in small intestinal mucosa. In cases in which the changes in the small intestine are inconclusive or a small intestine biopsy is not performed, the diagnosis can be hampered or significantly delayed. We describe the histologic features and immunohistochemical staining patterns of gastric and colonic mucosa in patients with confirmed TE (3), MID (2), and EED (1). Specifically, focal epithelial tufts were found in the gastric mucosa of one TE patient and multifocally in the colonic mucosa of another. All TE patients showed complete loss of membranous epithelial EpCAM expression in gastric and colonic mucosa, characteristic of the diagnosis. Gastric biopsies were available in 1 patient with MID; this showed focal disruption of the gastric glandular architecture. Three colon biopsies and 1 resection from 2 patients with MID showed characteristic cytoplasmic vacuoles and periodic acid-Schiff/villin-positive cytoplasmic inclusions. Chromogranin stains showed complete absence of enteroendocrine cells within the colon and a normal distribution in the gastric mucosa of the EED patient. On the basis of our findings, we conclude that the characteristic histologic and immunohistochemical features associated with the small intestine can be confirmed within the gastric and/or colonic mucosa by careful histologic examination and immunohistochemistry.

摘要

先天性肠病包括一大组罕见的临床病理实体,特征性地表现为顽固性的水样腹泻和婴儿不能茁壮生长。这些包括、但是不局限于绒毛状肠病(TE),微绒毛包涵体病(MID)和肠内分泌细胞发育不全(EED)。一般来说,这类诊断是基于小肠粘膜的组织学和/或超微结构特征而做出。在小肠改变不明确或者没有进行小肠活检的情况下,则可能妨碍或明显延迟诊断。我们描述了确诊的绒毛状肠病(3),微绒毛包涵体病(2)和肠内分泌细胞发育不全(1)的胃和结肠粘膜组织学特征和免疫组化染色模式。特异性的是,一例绒毛状肠病的病人的胃粘膜中发现局灶的上皮绒毛,另一例则是结肠粘膜多灶性上皮绒毛。所有的绒毛状肠病病人显示膜上皮EpCAM在胃粘膜和结肠粘膜的表达彻底丢失,这是诊断特征。在一例微绒毛包涵体病的病人中进行了胃活检;显示了胃腺体结构的局灶性紊乱。2例微绒毛包涵体病的病人中进行了三次结肠活检和一次切除活检,显示特征性的胞浆空泡和PAS染色/绒毛蛋白染色阳性的胞浆包涵体。在肠内分泌细胞发育不全的病人中,其结肠嗜铬素染色显示肠内分泌细胞完全消失,而其胃粘膜则显示正常的分布。基于我们的发现,我们认为通过胃和/或结肠粘膜仔细的组织学和免疫组化检查可以证实小肠相关组织学特点和免疫组化特征。

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