Kenneth W. Barwick

Filiform polyposis: an unusual complication of inflammatory bowel disease

Filiform polyposis is an unusual form of inflammatory polyposis which complicates inflammatory bowel disease. Recognition of this variant is important in that its radiographic and endoscopic picture may mimic villous adenoma or adenocarcinoma. Filiform polyposis may precipitate obstruction by stricture formation or give rise to major hemorrhage. We report five patients with inflammatory bowel disease complicated by asymptomatic filiform polyposis to emphasize the pathology of this lesion. We also review the literature regarding this topic.

Obesity in Celiac Sprue

Celiac sprue usually results in biochemical and clinical signs of malabsorption, nutrient loss, and resulting growth failure. We report a child with celiac sprue diagnosed at 1 year of age who was initially cachectic but who eventually developed obesity while taking a gluten-containing diet.

Cholangitis glandularis proliferans: a histologic variant of primary sclerosing cholangitis with distinctive clinical and pathological features

This is the first report in the American literature of a recently described histologic variant of primary sclerosing cholangitis (PSC). Only six examples of this unique entity, called cholangitis glandularis proliferans (CGP), or proliferative cholangitis, have previously been reported. This disorder typically presents as painless jaundice but differs clinically from PSC by occurring predominantly in females and lacking an association with inflammatory bowel disease. The unique histological features are characterized by florid intramural proliferation of glandular elements in addition to an intense inflammatory component. Anatomically, the lesion is confined to the extrahepatic biliary tree, which enables its successful surgical extirpation since it does not appear to be progressive.

The histopathologic and clinical indicators of prognosis in hepatoma.

Two histopathologic subtypes of hepatoma, clear cell type and fibrolamellar type, have been reported to indicate a longer survival. Although data on the prognostic value of clear cell histology is equivocal, evidence for prolonged survival (mean survival: 32-68 months) for patients with fibrolamellar type is impressive. Aggressive surgical intervention, including resection of metastases, appears indicated in fibrolamellar hepatocellular carcinoma. Bilirubin determination may be a reliable indicator of survival, but conflicting results are reported for most reputed clinical prognostic markers. Discrepancies may reflect regional and ethnic differences in the pathogenesis of hepatoma. We present an illustrative case of fibrolamellar hepatoma discovered in a 24-year-old woman with migratory thrombophlebitis. The patient successfully underwent an extended right hepatic lobectomy and is currently free of disease. We review the histopathologic and clinical prognostic features of fibrolamellar carcinoma and hepatoma.

Gastrointestinal manifestations of multiple endocrine neoplasia, type IIB.

Multiple endocrine neoplasia, type IIB (MEN 2b), is comprised of medullary carcinoma of the thyroid, pheochromocytoma, diffuse ganglioneuromatosis of the gastrointestinal tract, and skeletal abnormalities. Alimentary tract manifestations, especially enlargement of the lips and tongue by proliferative neural tissue, are often the earliest clues to the presence of the syndrome. A patient is presented here who illustrates the chronicity and diversity of symptoms characteristic of MEN 2b. It is important to recognize the typical oral manifestations of this syndrome so that the thyroid gland can be evaluated before the development of disseminated medullary carcinoma.

Diagnostic pathology of the intestinal mucosa : an atlas and review of biopsy interpretation

1 Processing of Biopsy Specimens for Light and Electron Microscopy.- Sampling.- Orienting the Sample.- Processing Specimens for Light Microscopy.- Processing Specimens for Electron Microscopy.- 2 Biopsy Interpretation-Light Microscopy.- Normal Villous Architecture.- Normal Epithelium.- Normal Lamina Propria.- Normal Muscularis Mucosae.- 3 Biopsy Interpretation-Electron Microscopy.- Intestinal Epithelial Cells.- Intraepithelial Lymphocytes and Immune Cells of the Lamina Propria.- Other Cells of the Lamina Propria.- Metaplasia.- 4 Immunoperoxidase Techniques: Light and Electron Microscopy Applications.- Materials and Methods: Light Microscopy.- Materials and Methods: Electron Microscopy.- 5 The Abnormal Biopsy.- Recognizing Artifacts.- Interpreting the Abnormal Biopsy.

Juvenile polyps and ulcerative colitis

Four children with ulcerative colitis, three of whom were in clinical remission of their disease, experienced rectal bleeding due to solitary juvenile polyps. Only one of the four polyps was detected radiologically. Two children passed their polyps spontaneously, one was identified at colonoscopy, and the fourth caused colocolic intussusception and was removed during surgery.