Pathologica 4-07.pdf - Pacini Editore

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negativi per HP, privi di sintomi da reflusso e di mucosa colonnare
in esofago all’endoscopia. Su tutti i campioni è stato
effettuato l’esame immunoistochimico con Citocheratina
(CK) 7, CK 20, CDX2 e p53.
Risultati. I campioni al di sopra della GGE dei gruppi EB e
CLO mostravano una notevole somiglianza per quanto concerne
la positività di CK7 e p53 mentre i controlli erano sempre
negativi. In alcuni casi di CLO, la CK7 era presente soltanto
nelle cellule basali della componente ghiandolare. Nelle
CLO è stata evidenziata la presenza di p53 e displasia lieve
in 7 di 22 (32%) biopsie alla prima osservazione ed in 8 di
22 (36%) biopsie effettuate dopo 2 anni di follow-up.
Conclusioni. L’espressione di CK7, sia nel EB che nel CLO,
ma assente nei controlli, potrebbe essere una espressione immunofenotipica
aberrante verosimilmente correlata alla reale
natura patologica, legata al reflusso della CLO. La precoce
espressione di CK7 nelle cellule basali dell’epitelio ghiandolare,
suggerisce che queste probabilmente sono più suscettibili
ai cambiamenti immunofenotipici indotti dal reflusso a
causa della loro multipotenzialità. La presenza di p53 e displasia
lieve in alcuni casi di CLO sia alla prima osservazione
che nel follow-up suggerisce infine che la CLO può rappresentare
uno stadio precoce del processo “multi-step” che
porta all’EB.
Adult celiac disease: correlation among
serology, clinical data and histological
subtipes
P. Ceriolo * , P. Cognein, E. Giannini ** , G. Pesce ** , M. Bagnasco
** , V. Savarino ** , R. Fiocca * , M.C. Parodi, P. Ceppa
*
Department of Histopathology, * Gastroenterology and ** Digestive
Endoscopy Unit, Department of Internal Medicine,
“San Martino” University Hospital, Genova, Italy
Background and aim. Epidemiological studies showed that
celiac disease (CD) is more common than previously believed
(0.5-1% prevalence). Various histopathological patterns
have been associated with CD. Villous atrophy (VA) of
the small bowel mucosa combined with an increased number
of intraepithelial lymphocytes (IEL) represents the most
widely accepted diagnostic pattern. Conversely, the clinical
meaning of an increased number of IEL without VA has not
yet been fully elucidated. Aim of the present study was to
evaluate the correlations among histology, serology and clinical
features in patients with non-atrophic changes.
Methods. We retrospectively reviewed a continuous series of
125 cases with either atrophic or non-atrophic lesions (79 females
and 46 males, mean age 40 yrs); histological lesions
were classified according to Marsh mod. Oberhuber (M 1-2
= non-atrophic lesions; M 3 = atrophic lesions). Only cases
with available anti-endomysial and/or anti-transglutaminase
antibody tests were included. We also reviewed the corresponding
clinical data and recorded the prominent symptoms.
Results. Atrophic lesions were found in 83 cases (66%),
whilst non-atrophic changes were observed in 42 (34%). Positive
serology was found in 78 out of 83 atrophic cases (94%)
and in 11/42 (26%) non-atrophic cases (p < 0.0001). Among
the 5 serology-negative atrophic cases, one was affected by
immunodeficiency and 4 showed only mild atrophy. Typical
CD clinical features, i.e. malabsorption, diarrhoea and weight
POSTERS
loss were more frequent in atrophic (23%, 27% * and 15%, respectively)
than in non-atrophic cases (12%, 13% * and 7%,
respectively) ( * p < 0.05). On the other hand, the prevalence of
malabsorption (27%), diarrhoea (36%) and weight loss (18%)
in non-atrophic patients with positive serology was similar to
the percentages in atrophic cases. In contrast, non-specific
symptoms (i.e. dyspepsia, vomiting, epigastric pain) more frequently
affected non-atrophic patients than atrophic ones
(47% vs. 17%; p < 0.0003).
Conclusions. Our data confirm the high prevalence of positive
serology in VA. In contrast more than 70% of non-VA
patients show negative serology and non specific symptoms.
Although the clinical meaning of non atrophic lesions remains
uncertain, they could represent the earliest presentation
of CD: patients with such lesions and negative serology
should be followed up.
Reduced expression of synaptophysin in the
dilated ileum of an adult patient with
primitive lymphangiectasia
P. Braidotti * , S. Ferrero * , G. Basilisco ** , V. Fabbris * , G.
Iasi * , G. Coggi *
* ** Università degli Studi di Milano, Fondazione Ospedale
Maggiore Policlinico, Mangiagalli e Regina Elena, Milano,
Italia; * Dipartimento di Medicina, Chirurgia e Odontoiatria,
e A.O. San Paolo; ** Dipartimento di Scienze Mediche, Unità
di Gastroenterologia, Padiglione Granelli
A 48 years old man suffering for diarrhea, abdominal distention,
lower extremities edema and body weight loss, underwent
surgical 25 cm ileal resection with latero-lateral anastomosis.
The surgical specimen was characterized by ileal dilatation
(maximum circumference 17 cm) and increased
bowel wall thickness (14 mm). Histologic sections revealed
thinning of longitudinal smooth muscle layer together with
marked lymphangiectasia which caused distortion of the
bowel wall. Intestinal lymphangiectasia is a rare disease
characterized by dilatation of intestinal lymphatics and abnormalities
in the lymphatic circulation with consequent protein
loss in intestinal lumen. In order to investigate the putative
causes of the segmental small bowel dilatation in absence
of obstruction, the integrity and the distribution of interstitial
cells of Cajal and intramural neural structures were
evaluated with ultrastructural and immunohistochemical
studies. Histologic sections from the case under study and
control normal ileum were incubated with anti c-kit, S100,
PGP 9.5, BCL2, NSE, Neurofilaments, and Synaptophysin
antibodies.
Morphologic light and electron microscopy studies revealed
the presence of normal interstitial cells of Cajal, neuronal
structures and nerve endings. Interstitial cells of Cajal were
intensely immunostained with anti c-kit antibody; neuronal
structures and nerve endings were strongly immunoreactive
with anti S100, PGP 9.5, BCL2, NSE and Neurofilaments antibodies,
both in the case and control samples. In the case under
study, synaptophysin antibody weakly stained neuronal
structures and was unreactive on nerve endings but strongly
immunoreactive on neuro endocrine cells in mucosa glands
providing internal controls. Therefore the altered expression
of synaptophysin in the submucosa suggests that abnormalities
in neurotransmission may play a role in the still unclear
pathophysiology of gut dilatation in absence of obstruction.