RESUMO
Radiographic findings of 113 submucosally invasive colorectal cancers (CRCs) Assuntos
Neoplasias Colorretais/diagnóstico por imagem
, Sulfato de Bário
, Colonoscopia
, Neoplasias Colorretais/patologia
, Meios de Contraste
, Enema/métodos
, Humanos
, Invasividade Neoplásica
, Variações Dependentes do Observador
, Valor Preditivo dos Testes
, Radiografia
, Estudos Retrospectivos
RESUMO
In Crohn's disease (CD), aphthous lesions are regarded as possible precursors of typical intestinal involvement. To determine the natural course of intestinal lesions in CD of aphthous type, the clinical course of 10 patients was retrospectively investigated during a period ranging from 6 to 16 years after diagnosis. The criterion for inclusion was confirmed aphthous lesions within the gastrointestinal tract with histologically verified epithelioid granuloma. The degrees of aphthous lesions in the small intestine and the colon were graded by small bowel radiography, barium enema examination and colonoscopy. Five patients developed typical CD during a period ranging from 0.8-3.3 years. The site of involvement was the ileum in three patients, the colon in one patient and both the ileum and the colon in one patient. Typical small intestinal CD occurred in four of seven patients with marked aphthous lesions of the small intestine, whereas colonic CD occurred in two of eight patients with such aphthous lesions of the colon. These findings suggest that CD of aphthous type is not necessarily a precursor of clinically overt disease. This may especially be the case for colonic aphthous lesions.
Assuntos
Doença de Crohn/patologia , Adolescente , Adulto , Sulfato de Bário , Colite/diagnóstico por imagem , Colite/patologia , Colonoscopia/métodos , Doença de Crohn/diagnóstico por imagem , Enema/métodos , Células Epitelioides/patologia , Feminino , Humanos , Ileíte/diagnóstico por imagem , Ileíte/patologia , Masculino , Radiografia , Estudos RetrospectivosRESUMO
PURPOSE: To clarify the radiographic appearance of the initial change an dprogression in Crohn disease. MATERIALS AND METHODS: Between 1984 and 1992, nine patients (seven men and two women, aged 16-34 years; mean, 20 years) with Crohn disease, who had evidence of only aphthous erosions or ulcers at the initial examination, underwent repeated radiography for up to 7 years 11 months (median, 4 years). RESULTS: In all patients, the stomach, duodenum, small intestine, and colorectum were involved, and the esophagus was affected in three patients. Subsequently, four of the nine patients had lesions that progressed from aphthous lesions to overt Crohn disease, including ileitis in two patients, colitis in one, and ileocolitis in one. Time intervals between the first visit and the progression varied from 9 months to 3 years 6 months. In all eight patients who underwent nutritional treatment, regression of the lesions was recognized, but three of the lesions progressed during interruption of the nutritional diet. CONCLUSION: Crohn disease may initially appear as diffuse aphthous lesions in the gastrointestinal mucosa.
Assuntos
Doença de Crohn/diagnóstico por imagem , Adolescente , Adulto , Sulfato de Bário , Colo/diagnóstico por imagem , Colo/patologia , Sistema Digestório/diagnóstico por imagem , Sistema Digestório/patologia , Enema , Feminino , Seguimentos , Humanos , Masculino , Radiografia , Úlcera/diagnóstico por imagem , Úlcera/patologiaRESUMO
Four patients with an established diagnosis of Cowden's disease underwent barium meal study, upper gastrointestinal endoscopy, barium enema examination, and colonoscopy. In three, the esophagus was affected by small protrusions, which were diagnosed as glycogenic acanthosis. Numerous hyperplastic polyps were found in the stomach in three patients, and in one an inflammatory fibroid polyp was also detected. Either lymphangiectasia or lymphoid polyps were found in the duodenum in two patients. In all patients, the colon showed polyps that varied in histology and included adenoma, hamartomatous polyp, and ganglioneurofibroma. In addition, jejunal lymphangiomas were found in one of the three patients in whom the small intestine could be precisely evaluated. These findings suggest that the gastrointestinal involvement in Cowden's disease is characterized by various benign lesions, especially esophageal glycogenic acanthosis, numerous gastric hyperplastic polyps, and multiple hamartomatous polyps in the rectosigmoid colon. Detection of these gastrointestinal manifestations may lead to early diagnosis of this potentially malignant disease.