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Presented by Peter Illei, M.D. and prepared by Zarir E. Karanjawala, M.D., Ph.D.
Case 5: This 46-year-old Caucasian female had a 20-year past medical history of Crohn’s disease treated with ileocolectomy.
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1. Question
Week 318: Case 5
This 46-year-old Caucasian female had a 20-year past medical history of Crohn’s disease treated with ileocolectomy followed by multiple incisional hernias and colostomy site revisions. Within the last year, the patient developed hypothyroidism, hypertension, hypertriglyceridemia and hypercholesterolemia. She now presented with excessive and sometimes bloody discharge from her diverted portion of sigmoid and rectum (not exposed to feces) for which a procto-sigmoidectomy was performed. Images shown are sections of the blind ended portion of the specimen.images/illei071607_5A.jpg
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images/illei071607_5e.jpgCorrect
Answer: Diversion colitis with endometriosis
Histology: The sigmoid and rectal mucosa shows an increased number of prominent lymphoid aggregates with minimal architectural distortion and an increased number of plasma cells in the lamina propria.
Discussion: No acute inflammation, cryptitis, crypt abscess or granulomata are identified. The blind end of the specimen shows variably sized endometrial glands with variable amount of surrounding endometrial stroma in all layers of the mucosa. Focally, the endometrial glands show direct communication with the colonic lumen.
Incorrect
Answer: Diversion colitis with endometriosis
Histology: The sigmoid and rectal mucosa shows an increased number of prominent lymphoid aggregates with minimal architectural distortion and an increased number of plasma cells in the lamina propria.
Discussion: No acute inflammation, cryptitis, crypt abscess or granulomata are identified. The blind end of the specimen shows variably sized endometrial glands with variable amount of surrounding endometrial stroma in all layers of the mucosa. Focally, the endometrial glands show direct communication with the colonic lumen.
