Frequency and significance of granulomas in a cohort of incident cases of Crohn's disease.

BACKGROUND AND AIMS: Epithelioid granulomas is one of the best histological criterion for distinguishing Crohn's disease (CD) from other inflammatory bowel diseases. Few data are available on the time of occurrence of epithelioid granulomas, and the value of epithelioid granulomas in predicting outcome has been determined only in cohorts of prevalent CD cases. Our objective was to evaluate epithelioid granuloma occurrence in incident CD cases and to examine the associations between epithelioid granulomas and outcome. PATIENTS AND METHODS: We reviewed the histological reports of endoscopic and surgical specimens in a cohort of 188 consecutive incident CD cases seen in 1994 and 1995, and recorded the occurrence of epithelioid granulomas, isolated giant cells, and microgranulomas. Kaplan-Meier curves were plotted for time from CD diagnosis to immunosuppressive treatment or surgery, and associations between epithelioid granulomas and outcome were evaluated in a multivariate analysis. Follow up was at least five years. RESULTS: Granulomas were found in 69 (37%) patients, including 46 (25%) at presentation. Median time from CD diagnosis to epithelioid granuloma detection was 0.16 (0-63) months overall, and 9.59 (0.1-63) months in 23 patients who became epithelioid granuloma positive during follow up. Isolated giant cells were found in 6% of patients and microgranulomas in 12%. Epithelioid granuloma detection increased with the number of endoscopic sampling procedures; sampling site had no influence. By multivariate analysis, epithelioid granulomas were associated with surgical resection but not immunosuppressive therapy. CONCLUSIONS: Epithelioid granulomas may separate CD into two pathological subsets and may indicate aggressive disease.

[Liver mesenchymal hamartoma in adulthood. Report of a new case]. / Hamartome mésenchymateux du foie de l'adulte. A propos d'un nouveau cas.

A case of hepatic mesenchymal hamartoma, found after sudden onset clinical and biological cholestasis, is reported in a 18-year-old man. Abdominal ultrasound examination and computed tomography showed a intrahepatic cystic tumor. The diagnosis of hepatic mesenchymal hamartoma was made by the pathological examination of the resected specimen. This rare tumor is found in most cases in children less than 2 years old. Thirteen cases in adulthood were already reported, five of them in Japanese patients. Our case is peculiar because no hepatic tumor was shown by ultrasound examination, 2 years before, the large size of cysts and presence of smooth muscle fibers in the wall.

[Do the eosinophilic granulomas observed in Brittany represent a form of anisakiasis? The larvae of Thynnascaris aduncum do not produce these granulomas experimentally]. / Les granulomes eosinophiles signalés en bretagne representent-ils une forme d'Anisakiase? Les larves de Thynnascaris aduncum ne permettent par d'obtenir experimentalement ces granulomes

To explain the enigmatical origin of gastric eosinophilic granulomas prevailing among patients in Brittany (France), we have tried to experiment with the larvae of Thynnascaris (Thynnascaris aduncum (Rud.)), a Nematode found in the sardine (Sardina pilchardus (Walbaum)), a fish sometimes eaten raw in our country. In a preliminary experiment, larvae of Thynnascaris were observed to penetrate the mucosa of the rabbit stomach in vitro at room temperature. But in vivo, whatever the means, the ways and the experimented mammals of our study, we have failed to experimentally reproduce such tumours. We think that this result belongs to the fact that the larvae of Thynnascaris in the conditions of our experimentation could not perform an evolution in homeothermal animals.