28/m. For 2weeks I have a had a history of vague abdominal pain and cramping. I've had a loss of appetite, and have lost some weight (around 7 pounds; I am normally ~150).
At the onset of the pain, I was having diarrhea following a night of moderate consumption of alcohol. This is not uncommon--however, the abdominal pain continued. It feels a bit dull, like a gnawing pain most of the time, and occasionally feels sharper and more urgent--like the pain you get before an imminent diarrhea attack.
1 year ago I had an upper endo done for dysphasia. Result was positive for hiatal hernia, and suggestive of eosinophilic esophagitis. Biopsy of E-G junction noted cardiac type gastric mucosa showing lymphoplasmic infiltrate in the lamina propria."
-Two months ago I had pinworms, treated with a course of Albenza.
-Last week I had 2 CBC studies done. 1. Normal counts, with the exception of a note of "burr cells." 2. Normal counts, with the exception of slightly elevated eosinophils (8%)
-Normal pancreatic enzymes
-Normal CRP of 0.8
-Complete abdominal ultrasound - normal and unremarkable.
My particular concern is small bowel cancer. I understand the relative rarity of this malignancy generally, and in particular in my age group. However, it is still a chief concern.
My particular questions are as follows:
1. Is the lymphoplasmic infiltrate something I should be alarmed about? The biopsy report did not attribute it to any particular pathology, and specifically noted "Plasma cells predominate in the more superficial aspect of the lamina propria. No significant neutrophilic activity is identified. No definite intestinal metaplasia is seen. No dysplasia is seen [. . .] The negative staining confirms the absence of intestinal metaplasia."
2. Any significance to the plasmacytoid cells found on the CBC? Should I be concerned?
3. Are any of these lab or clinical findings suggestive of small bowel cancer or lymphoma?
I can appreciate your concerns. A lymphoplasmic infiltarate at the esophagus and esophageal-cardiac junction is seen due to reflux gastritis. The degree of infiltrate correlates with the degree of reflux. Since there is no metaplasia or dysplasia (which signify a trend towards cancerous change), there is no evident cancer as of now. However yes, Barrett’s esophagus is more prone to cancer than normal esophagus.
No, your reports are not suggestive of cancer/lymphoma. The slightly elevated eosinophils are due to worm infection. Plasmacytoid cells are basically reactive lymphocytes, seen after recent infection and inflammation. Burr cells appear due to uremia caused by mild hemolysis of red blood cells as seen in hemolytic anemia, hypomagnesemia, hypophosphatemia, and pyruvate kinase deficiency. Please discuss this aspect with your doctor. However, burr cells often disappear without treatment if the hemolysis was self limiting.
I sincerely hope you will find this information useful in your journey towards better health.
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