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Cytomegalovirus-associated intussusception with florid vascular proliferation in an infant.

Park H, Park S, Hong YJ, Lee SW, Cho MS - J Pathol Transl Med (2015)

View Article: PubMed Central - PubMed

Affiliation: Department of Pathology, National Health Insurance Service Ilsan Hospital, Goyang, Korea.

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Intussusception is usually idiopathic, with no pathologic lead point except for the presence of reactive lymphoid hyperplasia, which is probably associated with gastrointestinal infection or a reaction to newly introduced food proteins... Her body temperature was 37.2°C... The results of the laboratory examination were unremarkable... Ultrasonography (US) on admission showed ileocolic intussusception at the hepatic flexure of the colon, which was successfully reduced by US-guided saline reduction... However, vomiting continued, although at a reduced rate, and bloody diarrhea developed intermittently... Gastrointestinal CMV infection presenting as a polyp is unusual, and only a few cases have been reported... Therefore, based on the dominant histologic pattern in the biopsy, CMV-associated polyps could be variably diagnosed as inflammatory fibroid polyps, inflamed hyperplastic polyps, inflammatory myofibroblastic tumors or even vascular tumors, etc.... In our case, the polyp had histologic features reminiscent of a juvenile polyp... However, glandular change and the preserved plicae circulares structure did not fit the diagnosis of a juvenile polyp... Recurrent intussusception produces variable nonspecific histologic changes, including disorganization of the muscularis propria, fusion of the muscularis mucosae with the muscularis propria, focal submucosal fibrosis, telangiectasia, fibrous serosal adhesion, localized mucosal hyperplasia, etc.... In addition, florid small vascular proliferation has been reported, which may be so pronounced as to raise the possibility of primary vascular neoplasm... Although the mechanisms underlying the development of such vascular lesions are difficult to ascertain, repeated mechanical forces applied to the bowel wall during long-term mucosal prolapse associated with intussusception trigger angiogenesis, resulting in an exuberant form of highly vascularized granulation tissue... In summary, it is considered that CMV-induced mucosal inflammation acted as a lead point of intussusception, and persistent prolonged intussusception caused nodular florid vascular proliferation of deeper layers, in this case with unique microscopic and gross findings.

No MeSH data available.


Related in: MedlinePlus

(A) Longitudinal ultrasonography of the lower abdomen with a Doppler study shows an ovoid mass with alternating thick hypoechoic and thin hyperechoic layers, indicating ileoileal intussusception and Doppler flow signals at the intussusceptum. A round hypoechoic lesion (arrow) indicating a lead point of intussusception is identified. (B) The ileum reveals a 4×2×1 cm, roughly ovoid, sessile, polypoid mass with a conglomerated nodular or nodule-aggregating appearance. (C) The cut surface shows thickened mucosa and multiple round solid nodules with focal hemorrhages at deeper layers. (D) The polyp is composed of enlarged plicae circulares having dilated and distorted crypt glands with expanded lamina propria.
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f1-jptm-49-3-270: (A) Longitudinal ultrasonography of the lower abdomen with a Doppler study shows an ovoid mass with alternating thick hypoechoic and thin hyperechoic layers, indicating ileoileal intussusception and Doppler flow signals at the intussusceptum. A round hypoechoic lesion (arrow) indicating a lead point of intussusception is identified. (B) The ileum reveals a 4×2×1 cm, roughly ovoid, sessile, polypoid mass with a conglomerated nodular or nodule-aggregating appearance. (C) The cut surface shows thickened mucosa and multiple round solid nodules with focal hemorrhages at deeper layers. (D) The polyp is composed of enlarged plicae circulares having dilated and distorted crypt glands with expanded lamina propria.

Mentions: An 8-week-old healthy female infant was admitted to the hospital following 10 episodes of repeated vomiting and poor oral intake for one day. She was born by normal vaginal delivery at 40 weeks without any perinatal problems and with a birth weight of 3.98 kg. At admission, her height was 63.1 cm and her body weight was 6 kg, which was 89.4% of her ideal body weight. Her body temperature was 37.2°C. The results of the laboratory examination were unremarkable. Ultrasonography (US) on admission showed ileocolic intussusception at the hepatic flexure of the colon, which was successfully reduced by US-guided saline reduction. However, vomiting continued, although at a reduced rate, and bloody diarrhea developed intermittently. Follow-up US the next day revealed a newly developed ileoileal intussusception, which persisted until additional follow-up US (Fig. 1A). Five days after symptoms developed, an exploratory laparotomy and segmental resection of the ileum was performed.


Cytomegalovirus-associated intussusception with florid vascular proliferation in an infant.

Park H, Park S, Hong YJ, Lee SW, Cho MS - J Pathol Transl Med (2015)

(A) Longitudinal ultrasonography of the lower abdomen with a Doppler study shows an ovoid mass with alternating thick hypoechoic and thin hyperechoic layers, indicating ileoileal intussusception and Doppler flow signals at the intussusceptum. A round hypoechoic lesion (arrow) indicating a lead point of intussusception is identified. (B) The ileum reveals a 4×2×1 cm, roughly ovoid, sessile, polypoid mass with a conglomerated nodular or nodule-aggregating appearance. (C) The cut surface shows thickened mucosa and multiple round solid nodules with focal hemorrhages at deeper layers. (D) The polyp is composed of enlarged plicae circulares having dilated and distorted crypt glands with expanded lamina propria.
© Copyright Policy
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4440941&req=5

f1-jptm-49-3-270: (A) Longitudinal ultrasonography of the lower abdomen with a Doppler study shows an ovoid mass with alternating thick hypoechoic and thin hyperechoic layers, indicating ileoileal intussusception and Doppler flow signals at the intussusceptum. A round hypoechoic lesion (arrow) indicating a lead point of intussusception is identified. (B) The ileum reveals a 4×2×1 cm, roughly ovoid, sessile, polypoid mass with a conglomerated nodular or nodule-aggregating appearance. (C) The cut surface shows thickened mucosa and multiple round solid nodules with focal hemorrhages at deeper layers. (D) The polyp is composed of enlarged plicae circulares having dilated and distorted crypt glands with expanded lamina propria.
Mentions: An 8-week-old healthy female infant was admitted to the hospital following 10 episodes of repeated vomiting and poor oral intake for one day. She was born by normal vaginal delivery at 40 weeks without any perinatal problems and with a birth weight of 3.98 kg. At admission, her height was 63.1 cm and her body weight was 6 kg, which was 89.4% of her ideal body weight. Her body temperature was 37.2°C. The results of the laboratory examination were unremarkable. Ultrasonography (US) on admission showed ileocolic intussusception at the hepatic flexure of the colon, which was successfully reduced by US-guided saline reduction. However, vomiting continued, although at a reduced rate, and bloody diarrhea developed intermittently. Follow-up US the next day revealed a newly developed ileoileal intussusception, which persisted until additional follow-up US (Fig. 1A). Five days after symptoms developed, an exploratory laparotomy and segmental resection of the ileum was performed.

View Article: PubMed Central - PubMed

Affiliation: Department of Pathology, National Health Insurance Service Ilsan Hospital, Goyang, Korea.

AUTOMATICALLY GENERATED EXCERPT
Please rate it.

Intussusception is usually idiopathic, with no pathologic lead point except for the presence of reactive lymphoid hyperplasia, which is probably associated with gastrointestinal infection or a reaction to newly introduced food proteins... Her body temperature was 37.2°C... The results of the laboratory examination were unremarkable... Ultrasonography (US) on admission showed ileocolic intussusception at the hepatic flexure of the colon, which was successfully reduced by US-guided saline reduction... However, vomiting continued, although at a reduced rate, and bloody diarrhea developed intermittently... Gastrointestinal CMV infection presenting as a polyp is unusual, and only a few cases have been reported... Therefore, based on the dominant histologic pattern in the biopsy, CMV-associated polyps could be variably diagnosed as inflammatory fibroid polyps, inflamed hyperplastic polyps, inflammatory myofibroblastic tumors or even vascular tumors, etc.... In our case, the polyp had histologic features reminiscent of a juvenile polyp... However, glandular change and the preserved plicae circulares structure did not fit the diagnosis of a juvenile polyp... Recurrent intussusception produces variable nonspecific histologic changes, including disorganization of the muscularis propria, fusion of the muscularis mucosae with the muscularis propria, focal submucosal fibrosis, telangiectasia, fibrous serosal adhesion, localized mucosal hyperplasia, etc.... In addition, florid small vascular proliferation has been reported, which may be so pronounced as to raise the possibility of primary vascular neoplasm... Although the mechanisms underlying the development of such vascular lesions are difficult to ascertain, repeated mechanical forces applied to the bowel wall during long-term mucosal prolapse associated with intussusception trigger angiogenesis, resulting in an exuberant form of highly vascularized granulation tissue... In summary, it is considered that CMV-induced mucosal inflammation acted as a lead point of intussusception, and persistent prolonged intussusception caused nodular florid vascular proliferation of deeper layers, in this case with unique microscopic and gross findings.

No MeSH data available.


Related in: MedlinePlus