Pathology Inc. Consensus Conference
June 20th, 2006

Diagnostic Nuances

Citing the current article by Dr. Goldstein, we discussed the diagnostic significance of an isolated erosion in the ileum with clinically normal endoscopic findings. All of the patients had complaints of looser than normal stools and increased defecation. Celiac disease-related serum antibody titers were within the normal range for all patients. Four patients were ingesting NSAIDs. In this prospective study, 28 patients with this pathologic finding were followed for a mean of 5.8 years. During this follow-up, the following outcomes were noted:

The abnormal biopsies exhibited the following histopathology:

Patchy lymphoplasmacytic inflammation
Edema
Villous shape irregularities
Crypt disarray in association with active inflammation

In contrast, in 11% of the normal ileal mucosa control sections, there were isolated foci of minimal active inflammation in the lamina propria that did not form crypt abscesses. None of these control cases exhibited the pathologic associations noted above. It was noted the distal ileal mucosa may be prone to mild mechanical injury and ischemia and this may result in these non-specific inflammatory changes.

Dr. Goldstein suggests that if this change is noted in the ileum, to use the diagnosis of "isolated ileal erosion" and add a comment stating "this lesion is idiopathic in most patients; however, in approximately one third, the disease will eventuate into typical Crohn's disease, often after a prolonged interval."

Update on Conferences

Dr. Alessandro DeVito reported on his two week rotation with Dr. Jonathan Epstein at Johns Hopkins University. He was enthusiastic about the experience revealing that Dr. Epstein reviews about 80 prostate consultations a day and has 3 fellows working with him. Each day, Dr. DeVito was given 10 cases to review and then presented the findings to Dr. Epstein who would make the final diagnosis. Handout material from his rotation will be distributed to all of us.

Journal Articles Reviewed:

Current prostate biopsy interpretation: criteria for cancer, atypical small acinar proliferation, high-grade prostatic intraepithelial neoplasia, and use of immunostains. Iczkowski KA. Arch Pathol Lab Med. 2006 Jun;130(6):835-43.

Isolated ileal erosions in patients with mildly altered bowel habits. A follow-up study of 28 patients. Goldstein NS. Am J Clin Pathol. 2006 Jun;125(6):838-46.

The Doctor's Doctor-Crohn's Disease

The Doctor's Doctor-Prostate Cancer Histopathology