Tuesday, March 30, 2010
Mesenteric lymph nodes
Female patient, 23 years old, C/O vague abdominal pain -on and off- for long duration, not relieved by medical treatment. Abdominal exploration was done (photo intra-operative), showing multiple lesions in the ileum, separated by normal looking areas, enlarged mesenteric lymph nodes (biopsy), reddish peritoneal fluid (12 ml), and appendicectomy was done. Microscopically: multiple epithelioid granulomas with focal minimal caseation in lymph nodes. Fluid cytology; transudate with very few lymphocytes. Appendix: unremarkable.
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T.B or Crohn's? Difficult to say in 100%. The ileal lesions are not reachable by endoscopy. The PCR for TB is too much expensive for the patient.
ReplyDeleteWhat are your suggestions?
The histopathological features are more suggestive of TB But you can exclude Crohns disease by correlation with the radiological findings and the serological findings especially ASCA (Anti-Saccharomyces cerevisiae antibodies) which are found to be associated with the disease severity.Also histopathological examnation of the regional lymph nodes could be helpful if they show tuberculous lymphadenitis. Maha Akl
ReplyDeleteThank you Dr. Maha for your valuable suggestions. This biopsy is already from regional (mesenteric) lymph nodes. We have no biopsy material from the bowel lesion itself.
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