A Novel Cause of Bowel Obstruction in a Patient with Long-Standing Crohn's Disease.

IF 0.7 Q4 PATHOLOGY Case Reports in Pathology Pub Date : 2021-10-18 eCollection Date: 2021-01-01 DOI:10.1155/2021/3278392
Satya V Vedula, T Paul Nickerson, Douglas J Grider
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Abstract

Solitary fibrous tumors are rare tumors of mesenchymal origin. Although most often observed in the lung pleura, they have been reported in varied extrapleural sites. A 70-year-old male with complicated Crohn's disease presented with 3 days of nausea, emesis, constipation, and abdominal pain. Computed Tomography (CT) demonstrated mucosal thickening of the middescending colon, consistent with fibrosing stricture. Surgical excision revealed an unusual, 5 cm mass originating in the subserosa. Histopathology of the lesion was notable for a proliferation of cells with spindle and stellate-shaped nuclei and no appreciable mitotic figures, which extended into the muscularis and submucosa. Immunohistochemistry was STAT6 nuclear positive and cytoplasmic CD34 positive, diagnostic for solitary fibrous tumor (SFT). In this case, the SFT infiltrating into the muscularis propria and subserosa caused the stricture and bowel obstruction. This illustrates that while fibrosing strictures are usually the etiology of bowel obstruction in the setting of Crohn's disease, other rare possible causes should be considered.

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长期克罗恩病患者肠梗阻的新原因。
孤立性纤维瘤是间充质来源的罕见肿瘤。尽管最常在肺胸膜中观察到,但据报道,它们出现在不同的胸膜外部位。一名70岁男性,患有复杂的克罗恩病,出现恶心、呕吐、便秘和腹痛3天。计算机断层扫描(CT)显示降结肠中段粘膜增厚,与纤维化狭窄一致。手术切除显示异常,5 cm质量,起源于浆膜下。病变的组织病理学表现为细胞增殖,细胞核呈梭形和星状,没有明显的有丝分裂影,延伸到肌层和粘膜下层。免疫组织化学染色STAT6核阳性,CD34胞浆阳性,诊断为孤立性纤维瘤(SFT)。在这种情况下,SFT浸润到固有肌层和浆膜下引起狭窄和肠梗阻。这表明,虽然纤维狭窄通常是克罗恩病中肠梗阻的病因,但应考虑其他罕见的可能原因。
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审稿时长
12 weeks
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