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Year : 2021  |  Volume : 64  |  Issue : 5  |  Page : 102-103
Uncommon pathological presentation of colonic biopsy in a patient with inferior mesenteric venous thrombosis

Department of Pathology, School of Medicine, College of Medicine; Department of Pathology and Laboratory Medicine, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan

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Date of Submission22-Jan-2020
Date of Decision01-Feb-2020
Date of Acceptance19-Feb-2020
Date of Web Publication7-Jun-2021

How to cite this article:
Chang IW. Uncommon pathological presentation of colonic biopsy in a patient with inferior mesenteric venous thrombosis. Indian J Pathol Microbiol 2021;64, Suppl S1:102-3

How to cite this URL:
Chang IW. Uncommon pathological presentation of colonic biopsy in a patient with inferior mesenteric venous thrombosis. Indian J Pathol Microbiol [serial online] 2021 [cited 2022 Aug 16];64, Suppl S1:102-3. Available from: https://www.ijpmonline.org/text.asp?2021/64/5/102/317913

Dear Editor,

Mesenteric venous thrombosis is uncommon, in which, inferior mesenteric venous thrombosis is much rarer. The histopathological findings of involved intestine were seldom reported in the literature. Herein, we reported the uncommon histopathological presentation in a case with inferior mesenteric venous thrombosis.

A 70-year-old man presented to our hospital with general weakness and bloody stool for 2 days. Other accompanying symptoms included poor appetite and abdominal pain. He had underlying diseases of type 2 diabetes mellitus (DM), hypertension, and old stroke. He visited our emergency room and received colonoscopy, which revealed swelling of rectum and sigmoid colon [Figure 1]. The histopathological examination of biopsy specimen demonstrated fibrinoid necrosis and congestion of the vasculature and acute and chronic inflammation in the lamina propria [Figure 2]a and [Figure 2]b. Direct immunofluorescence (DIF) assay demonstrated no immunoglobulins (IgG, IgM, IgA), complements (C3, C4), or fibrin deposition in the vessel walls.
Figure 1: The colonoscopy revealed swelling of the rectum and sigmoid colon

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Figure 2: The histopathological examination showed fibrinoid necrosis and congestion of the capillaries, as well as acute and chronic inflammatory cell infiltration in the lamina propria. (a: H and E, 100×; b: H and E, 400×)

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After admission, abdominal computed tomography revealed inferior mesenteric vein (IMV) thrombosis and colonic wall thickening over descending colon to rectum [Figure 3]a and [Figure 3]b. The laboratory data revealed normal complete blood count (CBC) and differential count, prothrombin time (PT) and activated partial thromboplastin time (aPTT), as well as homocysteine within normal range in serum. Anticoagulant was administered. Unfortunately, nosocomial pneumonia developed during hospitalization. Finally, the patient died of septic shock.
Figure 3: The subsequent abdominal computed tomography revealed inferior mesenteric vein (IMV) thrombosis and colonic wall thickening over descending colon to the rectum. (a: axial view; b: coronal view)

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Mesenteric venous thrombosis (MVT) is an uncommon clinical condition, occurs in about 2.0–2.7 per 100,000 person-years.[1] MVT usually occurs in the distal small intestine due to occlusion of the superior mesenteric vein (SMV) and rarely happens to IMV, which involves the colon.[2] MVT may cause profound bowel-wall edema, submucosal hemorrhage, and even bowel infarction. There are many predisposing factors to MVT identified, including prothrombotic state, hematological malignancy, and local abdominal inflammatory conditions.[3],[4] Over the last decade, JAK-2 (Janus kinase 2) mutation has emerged as an accurate biomarker for diagnosis of myeloproliferative neoplasm, an important cause for mesenteric venous thrombosis. For the current case, hypertension and type 2 DM were possibly predisposed to MVT. Both hypertension and type 2 DM would cause atherosclerosis and increase the risk of thromboembolism. Fibrinoid necrosis of the vessels is a specific type of necrosis, where proteinaceous material deposits on the vessel wall. Fibrinoid necrosis is usually associated with immune vasculitis and malignant hypertension.[5] In this case, IMV thrombosis may cause regional bowel hypertension and subsequently led to fibrinoid necrosis of the vessels. To the best of our knowledge, the present case is the first to report fibrinoid necrosis in the bowel before radiological diagnosis. The pathological finding is informative for an accurate diagnosis.

Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.

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Conflicts of interest

There are no conflicts of interest.

   References Top

Acosta S, Alhadad A, Svensson P, Ekberg O. Epidemiology, risk and prognostic factors in mesenteric venous thrombosis. Br J Surg 2008;95:1245-51.  Back to cited text no. 1
Clavien PA, Dürig M, Harder F. Venous mesenteric infarction: A particular entity. Br J Surg 1988;75:252-5.  Back to cited text no. 2
Singal AK, Kamath PS, Tefferi A. Mesenteric venous thrombosis. Mayo Clin Proc 2013;88:285-94.  Back to cited text no. 3
Jagtap SV, Nikumbh DB, Kshirsagar AY, Bohra A, Khatib W. Malignant gastrointestinal stromal tumor of the sigmoid colon with perforation and peritonitis-an unusual presentation. Int J Health Sci Res 2012;2:104-9.  Back to cited text no. 4
Kitiyakara C, Guzman NJ. Malignant hypertension and hypertensive emergencies. J Am Soc Nephrol 1998;9:133-42.  Back to cited text no. 5

Correspondence Address:
I-Wei Chang
Department of Pathology, Taipei Medical University, 250 Wu-Hsing Street, Taipei City
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/IJPM.IJPM_46_20

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  [Figure 1], [Figure 2], [Figure 3]


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