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Category Archives: Small Intestine
Small Intestine Carcinoid Tumors
Small Intestine Carcinoid Tumors
Clinical: associations MEN, ZES, sporadic
- associated carcinoid syndrome if liver metastases present
Treatment: surgical excision of tumor and regional lymph nodes, excise solitary liver metastases
5 year survival: 50-65% (85% if confined to bowel wall vs. 5% if serosal invasion)
Gross: submucosal, can ulcerate
- bright yellow after formalin fixation
Histology:
- architecture: insular (nests), acinar, trabecular
duodenum jejuno-ileal
<2cm >2cm
indolent aggressive
muc/submucosa muc/submucosa
somatostatinomas (peri-ampullary with psammoma bodies) serotonin-prod
gastrinoma gastrinoma
Location: ileum > jejunum > duodenum
Posted in Small Intestine
Tagged carcinoid, Carcinoid tumor, Carcinoid Tumors, Carcinoid tumour, Carcinoid tumours, Small Intestine, Small Intestine Carcinoid Tumors
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Duodenum Peptic Ulcer
Duodenum Peptic Ulcer
Clinical presentation: H.pylori, ZES, smoking
Pathophysiology: gastric acid hypersecretion (balance between aggressive factors and defensive factors?see stomach)
Gross:
- punched out lesion (well defined margins)
- multiple lesions?think ZES
Histology
- abrupt lesions with normal adjacent mucosa
- gastric metaplasia
- chronic duodenitis
- Brunner’s gland hyperplasia
- Helicobacter pylori often present
Posted in Small Intestine
Tagged duodenal peptic ulcer, helicobacter pylori, peptic ulcer, Peptic ulcer disease, ulcer
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Tuberculosis Small Intestine Infection
Tuberculosis Small Intestine Infection
- associated with HIV
Location: ileocecal
Histology
- caseating or noncaseating granulomas, ulceration and desmoplasia
Positive stains: FAFB, ZN
Posted in Small Intestine
Tagged Small Intestine, Small intestine infection, tb, Tuberculosis
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Mycobacterium Avium Intracellulare
Mycobacterium Avium Intracellulare
- associated HIV
Location
- small bowel unremarkable grossly
Histology
- macrophages and cytoplasmic rods in lamina propria
- minimal inflammation
Differential diagnosis
- Whipple’s disease but without fat vacuoles
Positive stains: FAFB, ZN
Posted in Small Intestine
Tagged AIDS, autoimmune disease, HIV, Mycobacteria, Mycobacterium, Mycobacterium avium, Mycobacterium Avium Intracellulare, ZN stain
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Microsporidia
Microsporidia
Clinical presentation
- associated immunosuppression, HIV
Diagnosis: stool examination, PCR
Histology
- minimal or no changes in mucosa
Spores: 1.5 mm dots in enterocytes; may be surrounded by halos
Nucleated sporont: 3-5 micron, rounded, basophilic structure often surrounded by a halo
Positive stains: Giemsa
Electron microscopy
- helpful in diagnosis
Cryptosporidiosis
Cryptosporidiosis
Cryptosporidium enteritis
Clinical presentation: severe, watery diarrhea resistant to most therapy
Diagnosis: acid-fast infective oocyst in stool
Histology
- 2-5 micron basophilic spherical structures attached to microvillus surface of epithelium
- variable villus changes, eosinophils
Positive stains: Giemsa, silver stains, PAS
Differential diagnosis
- mucin, cellular debris
Posted in Small Intestine
Tagged Cryptosporidiosis, Cryptosporidium, Cryptosporidium enteritis, Small intestine infection
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Giardia
Giardia
Giardia Lamblia
Clinical presentation
- malabsorption, chronic diarrhea
Diagnosis
- detect cysts, trophozoites or antigens in stool
Histology
- variable villous blunting, increased chronic inflammation
- Giardia: pear shaped with 2 nuclei, in lumen
Positive stains: Giemsa stain
Posted in Small Intestine
Tagged Giardia, Giardia Lamblia, Giardiasis, Infection of the small intestine, Small intestine infection
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Whipple Disease
Whipple Disease
Etiology: Tropheryma whipplei
Gross appearance: shaggy, edematous
Histology
- mild blunted villi
- fat globules (actually distended lacteal)
- foamy histocytes
Special stains
- PAS-D + intracellular granules
Immunohistochemistry
- antibody anti-Whipple, PCR
Differential diagnosis
- MAI, malakoplakia, muciphages (macrophages containing mucin), mineral oil ingestion
Tropical Sprue
Tropical Sprue
- post-infectious sprue
Symptoms: malabsorption within weeks of acute diarrheal enteric infection
Treatment: broad-spectrum antibiotics
Histology
- variable villous atrophy (none, partial, total); injury to entire small bowel (not proximal as in celiac sprue), inflammatory infiltrate, crypt hyperplasia