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Crohn's Disease Forum » Parents of Kids with IBD » Finally got a copy of the biopsy report


06-07-2013, 07:50 AM   #1
Sascot
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Finally got a copy of the biopsy report

The GI finally got round to sending me a copy of the biopsy report - not without a little note saying it was very unusual to get a copy and only a medical professional can possibly understand it.
I will give a brief summary - for those of you good at these kinds of things, I would be interested to know if it sounds about "normal" for mild Crohn's.

Clinical History - ?Crohn's disease. Scattered apthous ulscers and erythema in duodenum. Scattered apthous ulscers at pylorus. Limited view of TI. Apthous ulcers and erythema on right of colon.
Some of the underlined areas include:
TI - 2 foci of inflammation with one characterised by neutrophilic cryptitis and in the other an increase in lymphohistiocytic inflammation ass with crypt destruction.
Caecum - sections show colonic mucosa with mild with goblet cell depletion. Reactive lymphoid hyperplasia. Increase in chronic inflammatory cell numbers. Patchy neutrophilic cryptitis with incipient crypt abscess formation.
AC - mild to moderate increase in chronic inflammatory cell numbers. Also patchy netropholic cryptitis and crypt abscess formation.
TC - mild chronic inflammation. Single focus of lymphohistiocytic crypt destructive inflammation. Eosinophils are prominent.

End comment - The appearances in this biopsy series are those of a patchy, active colitis together with a focally accentuated chronic gastritis. Despite the absence of well formed epithelioid granulomas, the pattern of pathology and distribution of inflammation, with distal sparing, are in keeping with Crohn's disease. There is mild activity in the stomach, caecum, ascending colon and transverse colon.
06-07-2013, 08:39 AM   #2
Tesscorm
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How annoying that they had to include that 'note'!

I can't help much with the results... I'd have to look up most words!

Do you know how it compares to any past scopes/biopsies?
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06-07-2013, 09:26 AM   #3
Sascot
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Nope, it was his one and only scope.
06-07-2013, 09:58 AM   #4
Jmrogers4
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Not much help, but limited view of TI because of inflammation? Sounds like quite a few ulcerations as well but I would have to look up quite a few words as well.
No need for the note whether you can understand or not doesn't mean that you don't know someone that can understand (like quite a few fabulous people on here)
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06-07-2013, 10:10 AM   #5
Johnnysmom
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I wish I understood more about the disease process to be able to help you. It seems to be in the mild category at present. What I have been trying to figure out is if there are any indicators for future severity/prognosis.

The report sounds similar to my son's. I am not sure if having granulomas or diffuse disease is an indicator for how long the disease has been present and or the severity.

I know there are some people around able to answer your question! Looking forward to learning more about it.
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06-07-2013, 11:20 AM   #6
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Wish I could help but I'm like Tess I have to look up most of the words!! I agree with Jmrogers4 on TI inflammation but honestly not speaking medical jargon I could be way off base! Sending HUGS!!
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06-07-2013, 01:14 PM   #7
Dexky
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I'm afraid I'm just taking up space too Sascot! I'm sure Dusty or MLP can shed some light. I'd expect MLP will have something to say about those prominent eosinophils.
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06-07-2013, 01:22 PM   #8
Farmwife
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I just want to type on here so I can be part of the group.
Sorry the only word I recognize is eosinophilia.

HUGS


Sending out the bat signal to MLP and Dusty.
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06-07-2013, 02:51 PM   #9
Mehita
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No advice either, Sascot. I just want to subscribe to the discussion.
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Last edited by Mehita; 06-07-2013 at 04:31 PM.
06-07-2013, 03:47 PM   #10
Mylittlesunshine
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No advice here either sascot
Hopefully MLP or dusty will be able to
Give u some idea
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06-07-2013, 08:57 PM   #11
DustyKat
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Hey Sascot,

I will tag Aussie into this as he will be able to answer your question far more eloquently and knowledgeably than I!

But I will put my two cents worth in and say that I imagine the diagnosis of mild, moderate or severe disease would depend on the extent of penetration into the underlying layers and the extent of changes present, i.e. stricturing, fissures etc.

The anatomical features they are describing are what you expect to see with Crohn's and it would seem that they are essentially superficial, hence the term mild. Don't hold me to that though!

Dusty. xxx
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06-09-2013, 10:44 PM   #12
Aussie
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Hi Sascot and Dusty. Probably the easiest way to look at this report is to divide it into sections. Firstly, what areas were involved, then what was the phenotype (inflammatory, stricturing or fistulising), what did it look like macroscopically (ie. how severe was it to the naked eye) and then histologically (ie. microscopically).

When talking about severity, the more severe disease usually has more bowel involved, the phenotype is worse (stricturing or fistulising), it looks worse macroscopically and microscopically. Then you have to add clinical symptoms and a faecal calprotectin is a great way to quantify the inflammatory burden.

So, in this report - there is upper GI, TI and colonic involvement. Will need imaging of the small bowel (MRE) to quantify how much small bowel is involved. Usually the upper GI involvement will settle in adulthood. It sounds like macroscopically it's not too severe with only erythema and scattered apthous ulcers (the tiny ulcers you get occasionally in your mouth). Also, microscopically it sounds mild (the more severe the inflammation, the more neutrophils in the mucosa).

So, reasonably extensive bowel involvement (will need MRE) although that involvement is mild.

Best wishes.
06-10-2013, 05:21 AM   #13
Dexky
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Usually the upper GI involvement will settle in adulthood.
I've never heard this mentioned. Is there a known reason for this?
06-11-2013, 05:30 PM   #14
Aussie
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Hi Dexky,not sure why upper GI involvement is more prevalent in children and not in adults, although it is a marker for worse prognosis so treatment should be more aggressive earlier on.

Best wishes.
06-12-2013, 03:01 PM   #15
Dexky
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Thanks Aussie! That would tend to justify our GI's aggressiveness.
06-12-2013, 03:20 PM   #16
dodie74
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Sascot, was it from yorkhill itself you got the biopsy report or did you have to through your gp first. Im asking as i would also like to go through Kians report too. xx
06-12-2013, 03:51 PM   #17
Sascot
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I asked Dr Russell when we had an IBD clinic earlier in the year. Don't think he was too keen, but I persevered! It did take him 3 months to send it though
06-12-2013, 04:12 PM   #18
my little penguin
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Three months
I will not complain about medical records again.
They may give you too many forms but we get all paperwork reports in a day or two
Cd images of mri , ct etc... within a week or less.
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06-13-2013, 01:23 PM   #19
araceli
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I am lucky to be in a part of the woods where I am able to just ask for copies of everything. And I get them right away. I think granulomas are present in Crohn's and not on Colitis, so probably that's why they put... Despite the abscence of granulomas.... My son's biopsies show problems in the same places as your biopsies, pictures show only mild inflammation, with the words, mild,chronic, but with granulomas. Doctor told me is first stage crohn's. (he does not have usual" symptoms) biopsies and pictures for my daughter were terrible, with the words, severe, cronic, in terminal ileum. no blood, diarrhea only three times a day but severe weight loss. Hers was Severe Crohns.
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Crohn's Disease Forum » Parents of Kids with IBD » Finally got a copy of the biopsy report
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