Vascular Ectasia/Congestion as an Early Manifestation of Gastrointestinal Histopathology in Behcet's Disease: A Study of 184 Biopsies from 24 Patients
Meghna Alimchandani, Preet Bagi, Theo Heller, Cailin H Sibley, Martha M Quezado. National Institutes of Health, Bethesda, MD
Background: Behcet's disease is a rare disease, more common in people with ethnic backgrounds from the Middle East and far East. It is characterized by systemic inflammatory lesions and vasculitis of unclear pathogenesis. There is significant morbidity associated with gastrointestinal (GI) manifestations of this disease. The histopathology of the gastrointestinal manifestations in this disease is not well characterized.
Design: We analyzed samples from the gastrointestinal tract of 24 patients diagnosed with Behcet's disease. The biopsies were collected at the National Institutes of Health (NIH) from 2009 - 2012. We reviewed 184 samples: 6 esophageal, 45 gastric, 25 duodenal, 17 terminal ileal, and 91 colonic biopsies. In our evaluation, special attention was paid to the following parameters: vascular changes, inflammation, polyps, dysplasia.
Results: In our cohort, there were a total of 24 Behcet's patients, mostly females (22 females and 2 males), ranging in age from 15 to 57 years (mean age 36 years) with vague to symptomatic clinical presentation. We find vascular changes in majority of biopsies (138/184; 75%), regardless of the site in the gastrointestinal tract. The vascular changes range from mild vascular congestion/ectasia to ischemic-like colitis in 2 cases. Additionally, vascular thrombi are identified in 2 cases. We did not encounter vasculitis with fibrinoid necrosis in any of our cases. There was evidence of chronic or acute inflammation in 21 cases (11%), most often in gastric biopsies. Nine polyps were identified – six fundic gland polyps from gastric biopsies, one hyperplastic polyp and one serrated adenoma from the colonic biopsies.
Conclusions: Though the gastrointestinal pathology encountered in Behcet's disease is largely non-specific, we find a high incidence of vascular changes that range from vascular ectasia to thrombi and ischemic-like colitis. There was prominent vascular congestion/ectasia throughout the GI tract, not associated with inflammation, that may represent an early GI manifestation of this disease. Inflammation was most often encountered in biopsies from the stomach. When reviewing gastrointestinal biopsies from a Behcet's patient, the pathologist needs to have a high index of suspicion for these vascular changes.
Tuesday, March 5, 2013 1:00 PM
Poster Session IV # 118, Tuesday Afternoon