Publication: Pyloric and foveolar type metaplasia are important diagnostic features in Crohn’s disease that are frequently missed in routine pathology
Authors
Meditskou, Soultana ; Grekou, Alexandra ; Toskas, Alexandros ; Papamitsou, Theodora ; Miliaras, Dimosthenis
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Publisher
Universidad de Murcia, Departamento de Biologia Celular e Histiologia
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DOI
https://10.14670/HH-18-167
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info:eu-repo/semantics/article
Description
Abstract
Pyloric type metaplasia (PYME) as evidence
of chronic mucosal damage, is one of the main
histopathological findings for diagnosing Crohn’s
Disease (CD) in terminal ileum biopsies, according to
the latest guidelines but still frequently underdiagnosed
in routine pathology. Foveolar metaplasia (FOME)
changes in mucosa, another aspect of the chronic post -
inflammatory Ulcer Associated Cell Lineage (UACL),
have only been reported in a few cases. However, their
clinical significance has not been investigated in depth
except in pouchitis. The aim of this study was to
investigate the importance of meticulous study of
terminal ileum biopsies for the recognition of
PYME/FOME as an adjunct finding helpful for the
diagnosis of CD. In the present study, two experienced
gastrointestinal pathologists, have reviewed 105 terminal
ileum biopsies from 105 patients with CD, using a
protocol of 15 sections on average per biopsy. In 21%
(22/105) of cases PYME was recognized and in 4%
(4/105) FOME was also present. PYME/FOME had not
been detected in 83% of these cases in the original
reports. FOME was also identified in terminal ileum
biopsies, a feature not reported previously in CD.
Conclusively, PYME/FOME can be easily missed in
terminal ileum biopsies from patients with suspected or
known CD unless a meticulous study of the histologic
material is carried out combined with awareness of the
pathologist about its importance.
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Citation
Histology and Histopathology Vol. 35, nº6 (2020)
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