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Presented by Pedram Argani, M.D. and prepared by Hillary Ross, M.D.
Case 5: This is an 8 year old male with diarrhea.
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1. Question
Week 435: Case 5
This is an 8 year old male with diarrhea.images/1alex/05102010case5image1.jpg
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images/1alex/05102010case5image3.jpgCorrect
Answer: Pneumatosis cystoides intestinalis
Histology: Within the wall of the colon there are large cystic spaces. No epithelial lining is identified, but focally one can identify multinucleate giant cells. This represents a foreign body type giant cell reaction to air which has penetrated into the wall of the bowel.
Discussion: Pseudolipomatosis results from excessive insufflations of air into the bowel during colonoscopy. One does not see a giant cell reaction in response to the air. Adenomatoid tumors may be cystic, but should be lined by mesothelial cells. Lymphangioma would be lined by endothelial cells.
Pneumatosis cystoides intestinalis may present in a fulminant fashion, typically in patients with bowel necrosis which permits gas forming bacteria to grow within the dead bowel, or in benign fashion, typically associated with areas of ulceration.
Incorrect
Answer: Pneumatosis cystoides intestinalis
Histology: Within the wall of the colon there are large cystic spaces. No epithelial lining is identified, but focally one can identify multinucleate giant cells. This represents a foreign body type giant cell reaction to air which has penetrated into the wall of the bowel.
Discussion: Pseudolipomatosis results from excessive insufflations of air into the bowel during colonoscopy. One does not see a giant cell reaction in response to the air. Adenomatoid tumors may be cystic, but should be lined by mesothelial cells. Lymphangioma would be lined by endothelial cells.
Pneumatosis cystoides intestinalis may present in a fulminant fashion, typically in patients with bowel necrosis which permits gas forming bacteria to grow within the dead bowel, or in benign fashion, typically associated with areas of ulceration.
