Effects of Tumor Necrosis Factor Alpha Inhibitors on Lymph Node and Ileocecal Mucosa-Associated Lymphoid Tissue Architecture in Patients With Inflammatory Bowel Disease

2019 ◽  
Vol 23 (2) ◽  
pp. 115-120
Author(s):  
Virginia E Duncan ◽  
Karen M Chisholm ◽  
M Cristina Pacheco

Background Antitumor necrosis alpha (TNFα) therapy is often used in the management of patients with inflammatory bowel disease (IBD) and may have effects on lymphoid tissue architecture and function. The goal of our study was to characterize the effects of TNFα inhibitors on mesenteric lymph node and mucosa-associated lymphoid tissue in patients with IBD. Methods We examined lymphoid tissue morphology in IBD patients treated with TNFα inhibitors compared to untreated controls. Intestinal resections from 19 patients (10 anti-TNFα treated and 9 controls) were reviewed. Immunohistochemistry for CD21, CD20, and CD3 was performed on ileocecal valve lymphoid tissue and mesenteric lymph nodes from the resection specimens to assess follicular architecture. Results Relative to control groups, TNFα-treated groups showed less preserved germinal center architecture, evidenced by lower overall semiquantitative scores for follicular architecture. Likewise, the percentage of secondary follicles to total follicles was decreased in patients treated with TNFα blockade. Conclusions Our results suggest that TNFα inhibitors may play a role in disruption of lymphoid germinal center architecture in patients with IBD. Awareness of this disrupted lymphoid morphology when examining histologic sections from patients with IBD treated with TNFα inhibitors may prevent unnecessary studies to exclude a lymphoproliferative disorder.

2006 ◽  
Vol 131 (6) ◽  
pp. 1812-1825 ◽  
Author(s):  
Guillaume Dalmasso ◽  
Françoise Cottrez ◽  
Véronique Imbert ◽  
Patricia Lagadec ◽  
Jean-François Peyron ◽  
...  

2019 ◽  
Vol 2019 ◽  
pp. 1-21
Author(s):  
Shou-jiang Tang ◽  
Ruonan Wu

For gastrointestinal endoscopists, the ileocecum is the finishing line during colonoscopy and it is identified by three endoscopic landmarks: terminal ileum, ileocecal valve, and the appendiceal orifice. Although ileal intubation is recommended during routine screening colonoscopy, it is not required in most cases of screening colonoscopy. Ileal intubation is indicated in certain circumstances such as suspected inflammatory bowel disease and GI bleeding. There is much pathology that can be observed within the ileocecum. Careful and systematic examination should be stressed during GI endoscopic training and practice. In this review, the authors demonstrate its anatomy, endoscopic findings, and pathologies.


2020 ◽  
Vol 154 (Supplement_1) ◽  
pp. S108-S108
Author(s):  
W Huang ◽  
M G Bayerl

Abstract Introduction/Objective Indeterminate dendritic cell tumor (IDCT) is an extremely rare neoplasm, most frequently presenting in skin with cells resembling precursors to Langerhans cells. We report an exceptional case of IDCT occurring in GI tract, spleen, and lymph nodes of a 66-year-old lady, mimicking inflammatory bowel disease (IBD). Methods Four years prior to the diagnosis of IDCT, she was diagnosed with ulcerative colitis (UC) based on bloody diarrhea and pan-colitis. Her colitis became refractory to medical treatments and she developed pancytopenia, splenomegaly and abdominal lymphadenopathy. A FNA of abdominal lymph node and a colonoscopic biopsy both showed non-necrotizing granulomas, which along with her multiple oral ulcers suggested Crohn’s disease. Due to failure to medical treatments, she underwent proctocolectomy and ileostomy, followed later by subtotal colectomy with excision of a splenule and lymph nodes. Results All specimens from the final operation showed involvement by IDCT characterized by polygonal cells with abundant eosinophilic cytoplasm, oval nuclei with occasional nuclear grooves, open chromatin and eosinophilic nucleoli. By immunohistochemistry, the tumor cells expressed S100, CD1a, cyclin D1, BRAFV600E. Langerin staining was observed in <5% of cells, suggesting partial differentiation of tumor cells (frequently seen in IDCT) vs. reactive Langerhans cells. No overt cytological atypia and no necrosis were observed. Eosinophils, neutrophils, lymphocytes and plasma cells were sparse. There was no emperioloperesis. The colon showed multifocal active and chronic inflammation and ulcerations associated with the IDCT infiltrate. These specimens were diagnostic of IDCT. Conclusion Absence Langerin in the majority of cells excluded the possibility of Langerhans cell histiocytosis. The presence of CD1a and absence of bone involvement excluded the possibility of Erdheim-Chester disease. Retrospectively, it appears that the patient’s symptoms were due to IDCT rather than IBD. The clinical course of IDCT is highly variable, but the BRAF mutation offers a promising new therapeutic target for this patient.


Gut ◽  
2011 ◽  
Vol 61 (7) ◽  
pp. 1016-1027 ◽  
Author(s):  
Lael Werner ◽  
Uta Berndt ◽  
Daniela Paclik ◽  
Silvio Danese ◽  
Anja Schirbel ◽  
...  

2019 ◽  
Vol 10 ◽  
Author(s):  
Chathyan Pararasa ◽  
Na Zhang ◽  
Thomas J. Tull ◽  
Ming H. A. Chong ◽  
Jacqueline H. Y. Siu ◽  
...  

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