GPR: 2020 - Week 02

From MGH Learn Pathology

Clinical history

59 year-old-man


GPR19-35 -Nodular Lymphoid Hyperplasia .JPG


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GPR19-35 -Nodular Lymphoid Hyperplasia .JPG

 
Nodular Lymphoid Hyperplasia
(Terminal Ileum)

- Granular, round-shaped nodules normally between 2 and 10 mm in diameter, distributed along the GI tract

- More common in children than in adults

- Benign but associated with immunodeficiency (CVID, IgA deficiency) and infection (HIV, Giardia, H. Pylori)
 

GPR19-35 -Tubulo Villous Adenoma Cropped .JPG

 

Adenoma

-Can be pedunculated, sessile, flat or depressed

-Firmness, ulceration or depression suggest progression/invasion

-More common in colon than in the small intestine
 

GPR19-35 -Pseudopolyps Cropped.JPG

 

Pseudopolyps

- Inflamed projections of regenerative mucosa; may impart cobblestone appearance

- Arise in a background of repeated inflammation/ulceration; inflammatory bowel disease

- Presence of pseudopolyps does not increase risk of colorectal neoplasia
 

GPR19-35 -Lymphoma Small Bowel.JPG

 

Intestinal Lymphoma (DLBCL)

(Diffuse Large B-Cell Lymphoma)

- Large, solitary, transmurally invasive mass with hemorrhage/ulceration/necrosis; fleshy, tan appearance ("fish flesh")

- GI tract most common extranodal site of DLBCL

- Predominantly disease of older adults
 
Deshpande, Vikram, M.D. Zhang,Mingjuan Lisa, M.D.
Lin R, Lu H, Zhou G, Wei Q, Liu Z. Clinicopathological and Ileocolonoscopic Characteristics in Patients with Nodular Lymphoid Hyperplasia in the Terminal Ileum. Int J Med Sci. 2017;14(8):750–757. Published 2017 Jul 18. doi:10.7150/ijms.19480

Albuquerque A. Nodular lymphoid hyperplasia in the gastrointestinal tract in adult patients: A review. World J Gastrointest Endosc. 2014;6(11):534–540. doi:10.4253/wjge.v6.i11.534

ExpertPath: Adenoma, Colon (Alexandros D. Polydorides, MD, PhD); Colon Adenoma (Joel K. Greenson, MD; Alexandros D. Polydorides, MD, PhD); Ulcerative Colitis, Colon (Scott R. Owens, MD); Diffuse Large B-Cell Lymphoma (Rhonda K. Yantiss, MD; Scott A. Ely, MD, MPH); Diffuse Large B-Cell Lymphoma, Not Otherwise Specified (L. Jeffrey Medeiros, MD; Francisco Vega, MD, PhD; Roberto N. Miranda, MD)

Mahmoud R, Shah SC, Ten Hove JR et al (2018) No association between pseudopolyps and colorectal neoplasia in patients with inflammatory bowel diseases. Gastroenterology. https://doi.org/10.1053/j.gastro.2018.11.067

This week's Gross Pathology Roundup was presented by Jakob Moran, MD on Mon, Jan 06, 2020.