Pathology report question

[Tisha208]

I am 30 year old female. 2 years ago I was diagnosed with lupus for which I take prednisone 15mg, and plaquinel 4oomg daily. I also have had alot of trouble with my GI system which includes, surgery for fissures and a sphincterotmy, fissurectomy. I have daily cramping and loose watery diarrhea, mouth ulcers, joint aches, fevers, and elevated sed rate. Recently I have had bleeding with bm's as well, not very much though. I ended up with a colonoscopy and here are my results:

Ileum: ileal mucosa with prominent lymphoid aggregates and single calcified nodule withing lamina propria. see comment.
*comment:  Single calcified nodule surrounded by histiocytes within the laminent propria. lesion is most likely an old, non-caseating granuloma. other granulomas are not identified in any of the other biopsies. There is not evidence of ileitis or colitis. Clinical correlation is recommended.

Distal Colon: Fragments of mildly hyperplastic colonic mucosa.

My question is does this old granuloma indicate crohns disease? and does the hyperplastic mucosa indicate a threat for future cancer? and could I actually have negative biopsies and have crohns as it skips areas, leaving spots of healthy tissue between inflammed areas?

Thank you so much for comments.

Tisha

[Kevin Pho, MD]

A definition of a granuloma is as follows:
"Imprecise term applied to small nodular delimited aggregation of mononuclear inflammatory cells, or collection of modified macrophages resembling epithelial cells (epithelioid cells), usually surrounded by a rim of lymphocytes, often with multinucleated giant cells. Some granulomas contain eosinophils and plasma cells, and fibrosis is commonly seen around the lesion. Granuloma formation represents a chronic inflammatory response initiated by various infectious and noninfectious agents."
http://www.google.com/search?q=define+granuloma&sourceid=mozilla-search&start=0&start=0&ie=utf-8&oe=utf-8&client=firefox-a&rls=org.mozilla:en-US:official

Thus, this can be a non-specific finding.  I am not aware of an old granuloma being associated with Crohn's disease.

Hyperplastic mucosa is the abnormal multiplication in the number of cells in the mucosa (lining) of the colon.  It may be suggestive of Crohn's disease.  It is possible that there is an association between this and cancer.  

You are correct in that Crohn's skips areas and there may negative biopsies - however, on visual exam, an endoscopist may be able to see these "skip lesions".

Followup with your personal physician is essential.

This answer is not intended as and does not substitute for medical advice - the information presented is for patient education only. Please see your personal physician for further evaluation of your individual case.

Kevin, M.D.
http://www.straightfromthedoc.com

[Sarah Connors]

After reading your post I think & feel that you could be suffering from both SLE & Crohns simultaneously.
• The granulomata could be indicative of Crohns.
• Hyper plastic mucosa does occur in Inf. Bowel disease, known as pseudo polyps I don’t feel it’s a threat but just for your own peace of mind, a biopsy won’t be a bad idea.
• You definitively can have negative biopsies cause of skip lesions.
• Do have any other symptoms like erythema nodosum, hepatobiliary symptoms?

[Tisha208]

I'm not sure what erthymema nodosum is, I have had occasional rashes, that I have just chalked up to lupus.  I have continuous right sided pain under my ribs, sometimes like a knife into my back. I had it worked up two years ago, and nothing was found. So I just ignore it. I guess my labs are ok.

BTW, my internist is positive I have IBD, from my symptoms so he did send me to the GI doctor. I haven't heard back from my GI doctor yet, still just waiting to talk to him.
One other thing I forgot to mention is that my tongue has also changed dramatically. This sounds funny but it looks flattened and pale with a prominent curvy ridge on the edge. It used to be pink and healthy looking and now it looks like it got run over by a truck. My internist took a look at it and thinks it definantly is abdnormal. But I'm not sure what is causing that.

Thanks!
Tisha

[Sarah Connors]

•EN are red painful raised nodular areas on the skin, present mostly on the shins though may occur on other body parts. They can be associated with fever & pain.
•Angular Stomatitis, Apthous Ulceration, Glossitis are all very common in Inf. Bowel Disease, occurring due to various deficiencies.
•The way you described your tongue is typical of conditions that cause iron / vitamin deficiency & the tongue to appear like that. It can even get very sore, sensitive.
•To sum it up I feel that you do have inf. Bowel. Disease.