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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5 comments:

  1. Dr. Tarek AboushoushaMarch 30, 2010 at 11:21 AM

    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.
    What are your suggestions?

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  2. AnonymousMarch 31, 2010 at 12:01 AM

    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

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  3. Dr. Tarek AboushoushaMarch 31, 2010 at 9:30 AM

    Thank 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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