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Metastatic Crohn's disease. Report of 3 cases with special reference to histopathologic findings
M Hackzell-Bradley1, M A Hedblad, E A Stephansson
1Department of Dermatology, Karolinska Hospital, Karolinska Institute, Stockholm, Sweden.
Background:
Metastatic Crohn's disease is a rare, often unrecognized cutaneous disorder lacking definite histopathologic criteria. The purpose of this study was to document clinicopathologic and immunologic findings in 3 patients with metastatic Crohn's disease. The histopathologic findings are evaluated in correlation to those reported in the literature in an attempt to better define the histopathologic features.
Observations:
None of the patients showed signs of depressed cell-mediated immune response as evaluated with skin tests and T-cell subtyping of blood samples. One of the patients had antineutrophil cytoplasmic antibodies. Polymerase chain reaction, a highly efficient method of amplifying low levels of specific DNA sequences, did not show mycobacterial DNA in the samples studied. Granulomas of the sarcoid type with numerous foreign body and Langhans giant cells were the dominating features. In accordance with previous results, we found vascular involvement in 2 cases, manifested as granulomatous perivasculitis in both. We also found necrobiotic areas in all 3 cases.
Conclusions:
We propose that both necrobiosis and granulomatous perivasculitis be added to the histopathologic characteristics of metastatic Crohn's disease. Patients may even have a positive antineutrophil cytoplasmic antibody test result.