Biomedical subjects
Publications and source records attributed to G Franzin.
Fifteen cases of squamous papilloma of the esophagus were found in 20,000 upper gastrointestinal endoscopies. Squamous papillomas are usually incidental findings; symptoms are related to associated esophageal or gastrointestinal lesions. Chronic irritation from gastric acid reflux may play an etiological role.
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Changes in mucin secretion and increase in height of the colonic mucosa adjacent to colorectal carcinoma (transitional mucosa) have been considered pre-malignant. In this study similar changes (both morphological and histochemical) have been found in some cases of ulcerative colitis and ischaemic colitis, as well as in juvenile, inflammatory and hyperplastic (metaplastic) polyps. 'Transitional' patterns of mucin secretion also occur in some other cases of ulcerative colitis, colostomies and Crohn's disease of the colon in which the mucosa has a normal height, suggesting the changes in mucin secretion are independent of mucosal morphology. In all these pathological conditions, hyperplastic (metaplastic) mucosa also coexisted. These findings seem to suggest that: (1) 'transitional' changes more likely represent a secondary regenerative phenomenon rather than a premalignant one; (2) the pattern of mucin secretion is not selective enough to serve as a premalignant marker; therefore is not a valid prognostic indicator in colonic biopsies; (3) hyperplastic (metaplastic) changes might derive from 'transitional' mucosa as a result of a more mature phase of this exaggerated regenerative phenomenon. However, in some patients longstanding 'transitional' mucosa may lead to dysplasia under the influence of environmental and genetic factors.
A light microscopy and histochemical study of 24 juvenile and 27 inflammatory polyps showed that both may derive from inflammatory processes. Granulation tissue, secondary to spontaneous local inflammation or due to surgical procedures may subsequently be covered by regenerating epithelium which lines haemorrhagic cavities and mucus lakes to form irregular, elongated and cystic glands, which are characteristic of juvenile polyps. Both juvenile and inflammatory polyps showed cystic, metaplastic and 'transitional-type' glands. The mucin distribution was identical in both types of polyps. All these findings suggest a common origin of the polyps. The presence of 'transitional-type' glands seems to confirm these as a secondary regenerative phenomenon rather than pre-neoplastic, although dysplastic changes in juvenile polyps have been described. It is suggested that both the juvenile and inflammatory polyps may undergo dysplasia only in genetically predisposed subjects. However, this event seems to be very rare.
A case of adenocarcinoma occurring in a hyperplastic (metaplastic) polyp of the colon is presented. The polyp, two cm in diameter, was located in the transverse colon of a 45-year-old male patient, and was removed endoscopically. From the periphery to the centre, the polyp showed epithelial changes progressing from hyperplastic to severely dysplastic, terminating in a central focus of invasive adenocarcinoma. It is suggested that the considerable number of absorptive cells in large hyperplastic polyps may occasionally result in an excessive absorption of carcinogen thus leading to dysplastic changes.
A follow-up study of fourteen out of twenty-seven cases of solitary ulcer syndrome of the rectum was performed at one year's interval from the previous endoscopic and histologic examination. Most of the lesions consistently changed their aspect, resulting in incomplete irregular narrowings, polypoid protrusions or linear ulcers. The symptoms remained unchanged or slightly diminished. A striking difference was found in the histological pattern of the "evolved" ulcer in comparison to the active one, the former showing features of hyperplastic (metaplastic) colonic polyps as well as of the so called "transitional mucosa". It is suggested that chronic ischemia occurring in solitary ulcer of the rectum leads to "transitional mucosa" as an exaggerated regenerative phenomenon, hyperplastic (metaplastic) mucosa representing a later maturative phase. Possibly "transitional" mucosa may undergo dysplastic changes under the influence of environmental factors.
Twenty cases of heterotopic fundic mucosa in the duodenum are reported. The patients had several small polyps ranging from one to three mm tightly grouped to form a plaque in a limited zone of the duodenal bulb. In some cases the polyps were separated from one another. They were round or conical and manifested a frosted-glass appearance with a pale-pink or redded coloration. In two cases a whitish solitary polyp of five mm was located in the 2nd part of the duodenum. Biopsies obtained from the polyps revealed them to be composed of fundal mucosa, thus representing a particular form of heterotopia, other then the steroid-induced type, and that of patients undergoing regular dialysis for uraemia. The different clinical and morphological data in the various forms of fundal heterotopia are discussed.
Fourteen polps with the gross appearance of small hyperplastic (metaplastic) polyps, not exceeding five mm in diameter, were removed from the rectum and the sigmoid colon of patients during colonscopy, and from surgical specimens. At light microscopy they were seen to be composed of apparently normal mucosa. In most cases some hyperplastic (metaplastic) and adenomatous polyps were also present. HID-AB stain revealed the polyps to be composed of "transitional" mucosa containing almost exclusively sialomucins, in contrast to normal mucosa, in which sulphomucins predominate. It is suggested that these "transitional" polyps may represent a reservoir of hyperplastic (metaplastic) and adenomatous polps, the different fate depending on different environmental situations.
An endoscopic and biopsy study of the upper gastrointestinal tract in 102 patients receiving regular dialysis treatment (RDT) for chronic renal failure, showed prominent hypertrophic folds and a peculiar pale-grey or pale-pink colour of the gastric mucosa in most cases. Gastric erosions occurred in 11 cases and gastric ulcer in two. Duodenal erosions were found in 13 cases, eight of which were associated with hyperplasia of Brunner's glands. Duodenal ulcer occurred in one case. The histological findings were compared with those in 100 subjects with an endoscopically normal gastro-duodenal tract. In most cases of the RDT group the fundal area was enlarged at the expense of the antrum, fundal glands and/or isolated parietal cells often spreading within the duodenal mucosa. In most cases the duodenal bulb showed hyperplasia of Brunner's glands and heterotopic gastric surface epithelium. The frequency of the mucosal changes differs significantly in the two groups of subjects. Gastric hyperplastic changes in RDT are probably due to the trophic action of hypergastrinemia which is of common occurrence in such a condition, and can account for gastric acid hypersecretion. Acid hypersecretion, in turn, can account for the duodenal changes and gastroduodenal lesions.
Upper gastrointestinal endoscopic examination of 40 patients on immunosuppressive therapy after successful kidney transplantation revealed a duodenal ulcer in four cases and duodenal erosions in six. Between four and six biopsies were collected from the antral and the fundal mucosa in each case and from the duodenal mucosa in 29. Antral superficial gastritis was found in 13 cases and fundal superficial gastritis in three. In the fundus, heterotopic calcifications were seen in eight cases and cytomegalovirus inclusion bodies in two. Parietal cells were increased in number and reached the pyloric zone in 34 cases, whilst they spread within the duodenal mucosa in 12. Multinucleate parietal cells were of common occurrence and in some cases showed mitotic figures. Duodenitis was found in 16 cases and in duodenal mucosal cells cytomegalovirus inclusion bodies were seen in nine cases. Biopsy evidence of hyperplasia of Brunner's glands was encountered in 26 cases. Of 20 patients tested for gastric acid secretion, hypersecretion occurred in 14 and normal secretion in six. Endoscopic and histological changes relate to the secretory pattern. Cytomegalovirus inclusion bodies relate to immunosuppressive therapy. An inverse temporal relationship exists between heterotopic calcification and the duration of renal transplant. Steroids seem to be responsible for gastroduodenal changes in transplanted patients.
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Non-polypoid hyperplastic mucosa similar to that adjacent to colorectal carcinomas and adenomas, the so-called "transitional mucosa" (TM), was found in 16 out of 27 cases of solitary ulcer syndrome of the rectum. In 18 cases fully developed hyperplastic (metaplastic) mucosa was also found. It is suggested that chronic ischaemia which takes place in the solitary ulcer syndrome leads to TM as an exaggerated regenerative phenomenon. Later maturation of TM could lead to hyperplastic (metaplastic) changes.
Fourteen cases of gastritis cystica polyposa, four gastric adenomas and 25 "mature" erosions removed by diathermy at endoscopy were studied by light microscopy. Twenty surgical resections from gastric cancer patients and 18 gastric resections from gastroenterostomy patients previously operated upon for benign lesions were also studied. The mucosa showed consistent changes which were grouped as "gastritis cystica superficialis". Most surgical specimens, three out of 25 "mature" erosions, the four adenomas, and eight cases of gastritis cystica polyposa showed cystic gastric glands within the submucosa closely resembling the changes seen in colitis cystica profunda. Thus the term "gastritis cystica profunda" is proposed. It is suggested that ischaemia and chronic inflammation as well as the effects of surgery and presence of suture material have a role in the pathogenesis of gastritis cystica profunda. A correlation seems to exist between gastritis cystica profunda and gastric ulcer.
Biopsies collected from gastroduodenal mucosa during endoscopic examination of 20 patients having undergone renal transplantation and subsequent immunosuppressive therapy showed cytomegalovirus (CMV) inclusion bodies in nine cases. CMV antibody titres were tested in all patients before and after the transplant procedure. Not all patients exhibited viraemia-related symptoms at the time of endoscopy. No correlation was found between the presence of CMV-type cells within the gastroduodenal mucosa, endoscopic and histological findings, the duration of the transplant, and the dosage of immunosuppressive drugs. The duodenum seems to be the elective site of CMV. The involvement of gastric mucosa seems to represents a worsening of the illness. Eight of nine patients with positive biopsies for CMV inclusion had negative pretransplant antibody titres to CMV. All nine patients were seropositive after transplantation and showed seroconversion. Five of 11 recipients with negative biopsies for CMV inclusion bodies, were seronegative before transplantation. Seroconversion occurred in five patients after the transplant; the other six had no rise in antibody titres. The lack of pre-transplant CMV antibody titre and its subsequent increase after transplantation identifies a greater risk of developing post-transplant CMV infection.
Endoscopic examination of the upper gastrointestinal tract was performed in 12 patients after renal transplantation and immunosuppressive therapy. Histological examination of the specimens obtained from the duodenal bulb revealed the presence of cytomegalovirus (CMV)-type cells in four cases. In one of these patients several CMV-type cells were scattered in the duodenal mucosa and also affected the antral mucosa. In the other three cases just one or two cells with prominent intranuclear inclusions (CMV) were present in only a few of the multiple sections. No correlation of CMV inclusion with symptoms and with the morphological appearance of the upper gastrointestinal tract has been found. CMV infection seems to be correlated with immunosuppressive therapy.
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Explore the source record for details and available documents.