Lymphoid follicles with red ring signs as first manifestation of early Crohn’s disease

[kiny]

Lymphoid follicles with red ring signs as first manifestation of early Crohn’s disease

Full:http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3396064/

Characterization of lymphoid follicles with red ring signs as first manifestation of early Crohn’s disease by conventional histopathology and confocal laser endomicroscopy

Department of Medicine 1, University of Erlangen-Nuremberg, Germany

Ekaterina Krauss,1, Abbas Agaimy,2, Helmut Neumann,1 Ulrike Schulz,Hermann Kessler,Arndt Hartmann,Markus F Neurath,Martin Raithel, and Jonas Mudter

2012

Introduction

LFs have always been thought to be the main portal of entry for potential pathogens, and it has been suggested that aphthous ulceration in Crohn disease (CD) originates in FAE over the LFs [4,10,11]. The pathogenesis of the ulcerating lesions in IBD was the subject of several studies, trying to provide a better insight into the pathogenesis of the disease [6,12,13].

The aim of this study was the analysis of LFs with irregular vessel and epithelial pattern, comparing the morphology of LFs in IBD and control patients using confocal laser endomicroscopy (CLE) in correlation to histological results of targeted LFs biopsies, immunological findings and medical history.

Background and aims

Clinical observations suggest that the lymphoid follicles (LFs) may play a crucial role in the pathogenesis of inflammatory bowel disease (IBD), especially in Crohn’s disease (CD) as the site of initial mucosal inflammation. The aim of this study was to compare the morphology of LFs in CD, ulcerative colitis (UC) and control patients using confocal laser endomicroscopy (CLE) in correlation to histological and immunohistochemical findings of biopsies.

Methods

79 patients with IBD (46 with CD, 32 with UC and 1 patient with indeterminate colitis) and 67 controls patients were enrolled prospectively in this study. Median age was 32.5 years (range 19-65) and 37.4 years (range 20-65 years) respectively. To analyze the LFs, standardized images from the terminal ileum and the colon were taken using white-light video endoscopes. Additionally, CLE was performed to analyze subsurface structure of LFs. Targeted biopsies of LFs were analyzed using haematoxylin and eosin stain and immunohistochemistry.

Results

LFs were seen in all parts of the lower GI tract, but mostly in the terminal ileum and cecum. Endoscopy in 15 out of 17 patients with the first manifestation of CD showed LFs surrounded by red ring (so-called red ring sign, RRS). Histologically, LFs with RRS showed hypervascularization at the base of the LFs associated with numerous CD15-positive granulocytes. Similar features were not seen in LFs without RRS and in the control group. In some LFs with RRS early aphthous ulcers were seen. Using CLE, RRS showed abolished normal crypt architecture, crypt distortion, increased cellular infiltrate within the lamina propria, and dilated vessels.

Conclusion

LFs with RRS probably represent an early sign of aphthous ulcers in early CD and, thus, may be considered as early markers of first manifestation and flares in CD.

 

[Mark in Seattle]

Thanks for bringing this up kiny. The lymphatic system seems like a hugely under-studied area.

http://www.i-md.com/docsearch/doc/793aa471-51e3-495e-9303-44b2c363645b

Role of the lymphatic system in the pathogenesis of Crohn's disease.

von der Weid, Pierre-Yves/PY; Rehal, Sonia/S; Ferraz, José Gp/JG; Inflammation Research Network and Smooth Muscle Research Group, Snyder Institute of Infection, Immunity and Inflammation, Department of Physiology & Pharmacology, Faculty of Medicine, University of Calgary, Calgary, Alberta, Canada. Current opinion in gastroenterology.2011 Jul;27(4): 335-41 Crohn Disease/immunology*; Humans; Lymphangiogenesis/physiology; Lymphangitis/complications*; Lymphatic System/immunology/microbiology/physiopathology*; Intestinal lymph containing interstitial fluid, proteins, immune cells, and digested lipids is actively transported back to the blood stream thanks to rhythmical contractions of the mesenteric lymphatic vessels. During this process, lymph flows through several lymph nodes, allowing antigens to be sampled by the immune system. Abnormalities in lymphatic drainage have been noted in the original descriptions of Crohn's disease, but essentially ignored since. The lymphatic system is re-emerging as a critical player in inflammatory and immune processes and the purpose of this review is to present and discuss new concepts related to the involvement of the lymphatic system in the development of inflammatory bowel diseases IBDs and more specifically Crohn's disease. Recent studies reporting lymphangitis, lymphangiogenesis, bacterial infiltration and lymph node infection, immune cell trafficking, and fat-wrapping in Crohn's disease suggest altered lymph drainage and lymphatic pumping, implicating the lymphatic system as a likely player in inflammatory disorders and IBDs. Improved knowledge and appreciation of the roles that the lymphatic system plays in immune cell trafficking, infection, fat transport, distribution and metabolism and, of course, edema resolution is necessary to better understand the pathogenesis of chronic inflammatory conditions such as Crohn's disease and may provide the basis for new therapeutic strategies.

 

[kiny]

Thanks for bringing this up kiny. The lymphatic system seems like a hugely under-studied area.

I try to find new studies regarding the lymphatic system whenever I can. Transmural disease, inflammation is deep.