Pediatric gastrointestinal pathology

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This article deals with pediatric gastrointestinal pathology. An introduction to pediatric pathology is in the pediatric pathology article.

An overview of (adult) gastrointestinal pathology is in the gastrointestinal pathology article.

Birth defects

Omphalocele

General

Usually genetic (unlike gastroschisis) - associated with:[1]

Presentation:

  • Increased AFP.

Gross

  • Bowel outside of abdomen - covered by membrane/in a sac.

Image:

Gastroschisis

General

  • Defect considered to be more severe than omphalocele.
  • Usually sporadic.

Gross

  • Bowel outside of abdomen - individual loops of bowel are seen.

Image:

Luminal pathology

Abetalipoproteinemia

  • AKA Bassen-Kornzweig syndrome.

General

Microscopic

Features:

  • Enterocytes have clear cytoplasm (due to lipid accumulation).

Notes:

  • Have abnormal erythrocytes with a spiculated cell membranes acanthocyte - seen on blood films.

Microvillous inclusion disease

  • AKA Davidson disease.

General

  • Autosomal recessive inherited condition - due to mutation in MYO5B.[4]

Microscopic

Features:

  • Flat mucosa; no villi.

Notes:

  • Appearance similar to celiac sprue; however, usually lacks the intraepithelial lymphocytic infiltration characteristic of celiac sprue.

Images:

IHC

  • Carcinoembryonic antigen (CEA) +ve.[5]

EM

Images:

Cystic fibrosis

Main article: Cystic fibrosis

General

Microscopic

Features - large bowel:[7]

  • Crypt enlargement.

Notes:

  • Not intracellular and extracellular accumulation of mucus. (?)

Aganglionosis

  • AKA Hirschsprung disease.

General

  • Congenital.
  • Fixed by surgery.

Pathology:

  • Parasympathetic ganglion cells in intramural and submucosal plexuses - not present.[8]

Notes:

  • Most common reason for litigation in paediatric pathology.[9]

Microscopic

Features:[8]

  • Ganglion cells missing in submucosal plexus and myenteric plexus.
  • +/-Submucosal fibrosis.

Stains

  • Acetylcholinesterase: abundant, disorganized, nerve fibers.
  • CD117. (???)

Images:

Meconium ileus

General

Gross

Features:

  • Thick.
    • High viscosity.
  • Green.

Image:

Microscopic

Features:

  • Meconium-laden macrophages. (???)

Meconium peritonitis

General

Microscopic

Features:

  • Brown granular material - key feature.
  • +/-Multinucleated giant cells.
  • Inflammatory infiltrate (PMNs, lymphocytes, plasma cells).

Image:

Necrotizing enterocolitis

  • Abbreviated NEC.

General

  • Disease primarily of premature babies.
  • Diagnosed by imaging.

Note:

  • Enterocolitis = inflammation of small bowel and colon.[12]
    • Necrotizing enteritis = small bowel only.

Microscopic

Features:

  • Large spaces.

Images:

Autoimmune enteropathy

Main article: Autoimmune enteropathy

Pancreas

Main article: Pancreas

Pancreatic islet cell hyperplasia

General

Microscopic

Features:

  • Marked size variation of pancreatic islets.
    • Normal islets ~ 150 micrometers (diameter). Hyperplastic islets - up to ~500 micrometers (diameter).

Image:

Liver

Main article: Liver pathology

Giant cell hepatitis

  • AKA neonatal giant cell hepatitis, abbreviated NGCH.

General

  • Rare.

Etiology:

  • Unknown - possibly viral, autoimmune and/or drugs.[14]
  • One large series suggests that, in the neonatal population, with follow-up the causes are:
    • ~49% idiopathic.
    • ~16% pan-hypopituitarism.
    • ~8% biliary atresia.
    • ~6% Alagille syndrome
    • ~6% bile salt defects.

Notes:

Microscopic

Features:[17]

  • Giant hepatocytes with multiple nuclei - key feature.
    • Typically ~35% of hepatocytes affected.
  • Minimal or absent inflammation portal and lobular inflammation.
  • Lobular cholestasis.

Images:

Biliary atresia

General

  • 1/3 of neonatal cholestasis.[19]
  • Etiology - various.
    • Viral - possibly rotavirus.[20]
    • Genetic/syndromic - several.[21]

Microscopic

Features:[19]

  • Bile duct proliferation.
  • Portal tract edema.
  • Portal tract fibrosis.

Image:

See also

References

  1. ↑ Frolov, P.; Alali, J.; Klein, MD. (Dec 2010). "Clinical risk factors for gastroschisis and omphalocele in humans: a review of the literature.". Pediatr Surg Int 26 (12): 1135-48. doi:10.1007/s00383-010-2701-7. PMID 20809116.
  2. ↑ URL: http://www.ncbi.nlm.nih.gov/omim/200100. Accessed on: 6 April 2011.
  3. ↑ Bassen FA, Kornzweig AL (April 1950). "Malformation of the erythrocytes in a case of atypical retinitis pigmentosa". Blood 5 (4): 381–87. PMID 15411425.
  4. ↑ Müller T, Hess MW, Schiefermeier N, et al. (October 2008). "MYO5B mutations cause microvillus inclusion disease and disrupt epithelial cell polarity". Nat. Genet. 40 (10): 1163–5. doi:10.1038/ng.225. PMID 18724368.
  5. ↑ Mills, Stacey E; Carter, Darryl; Greenson, Joel K; Oberman, Harold A; Reuter, Victor E (2004). Sternberg's Diagnostic Surgical Pathology (4th ed.). Lippincott Williams & Wilkins. ISBN 978-0781740517.
  6. ↑ Kennea N, Norbury R, Anderson G, Tekay A (2001). "Congenital microvillous inclusion disease presenting as antenatal bowel obstruction". Ultrasound Obstet Gynecol 17 (2): 172–4. doi:10.1046/j.1469-0705.2001.00211.x. PMID 11251929.
  7. ↑ Neutra MR, Trier JS (October 1978). "Rectal mucosa in cystic fibrosis. Morphological features before and after short term organ culture". Gastroenterology 75 (4): 701–10. PMID 710839.
  8. ↑ 8.0 8.1 URL: [[1] [2]]. Accessed on: 11 January 2011.
  9. ↑ GT. 19 January 2011.
  10. ↑ URL: http://pathology.mc.duke.edu/research/PTH225.html. Accessed on: 11 January 2011.
  11. ↑ URL: http://library.med.utah.edu/WebPath/EXAM/IMGQUIZ/pdfrm.html. Accessed on: 3 December 2011.
  12. ↑ URL: http://medical-dictionary.thefreedictionary.com/enterocolitis. Accessed on: 10 October 2011.
  13. ↑ URL: http://cueflash.com/decks/Pathology_Pediatrics. Accessed on: 11 January 2011.
  14. ↑ Hartl, J.; Buettner, R.; Rockmann, F.; Farkas, S.; Holstege, A.; Vogel, C.; Schnitzbauer, A.; Schlitt, HJ. et al. (Nov 2010). "Giant cell hepatitis: an unusual cause of fulminant liver failure.". Z Gastroenterol 48 (11): 1293-6. doi:10.1055/s-0029-1245476. PMID 21043007.
  15. ↑ Hayashi, H.; Narita, R.; Hiura, M.; Abe, S.; Tabaru, A.; Tanimoto, A.; Sasaguri, Y.; Harada, M. (2011). "A case of adult autoimmune hepatitis with histological features of giant cell hepatitis.". Intern Med 50 (4): 315-9. PMID 21325763.
  16. ↑ Guddat, SS.; Ehrlich, E.; Martin, H.; Tsokos, M. (Sep 2011). "Fatal spontaneous subdural bleeding due to neonatal giant cell hepatitis: a rare differential diagnosis of shaken baby syndrome.". Forensic Sci Med Pathol 7 (3): 294-7. doi:10.1007/s12024-011-9227-8. PMID 21331818.
  17. ↑ Torbenson, M.; Hart, J.; Westerhoff, M.; Azzam, RK.; Elgendi, A.; Mziray-Andrew, HC.; Kim, GE.; Scheimann, A. (Oct 2010). "Neonatal giant cell hepatitis: histological and etiological findings.". Am J Surg Pathol 34 (10): 1498-503. doi:10.1097/PAS.0b013e3181f069ab. PMID 20871223.
  18. ↑ URL: http://www.ikp.unibe.ch/lab2/labdk.htm. Accessed on: 27 December 2011.
  19. ↑ 19.0 19.1 Mitchell, Richard; Kumar, Vinay; Fausto, Nelson; Abbas, Abul K.; Aster, Jon (2011). Pocket Companion to Robbins & Cotran Pathologic Basis of Disease (8th ed.). Elsevier Saunders. pp. 464. ISBN 978-1416054542.
  20. ↑ Hertel, PM.; Estes, MK. (Jan 2012). "Rotavirus and biliary atresia: can causation be proven?". Curr Opin Gastroenterol 28 (1): 10-7. doi:10.1097/MOG.0b013e32834c7ae4. PMID 22123643.
  21. ↑ Santos, JL.; Choquette, M.; Bezerra, JA. (Feb 2010). "Cholestatic liver disease in children.". Curr Gastroenterol Rep 12 (1): 30-9. doi:10.1007/s11894-009-0081-8. PMID 20425482.
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