Match each patient's specific clinical presentation with the most likely corresponding gastrointestinal histologic finding observed on biopsy.
- A 45-year-old man presents with chronic watery diarrhea, migratory arthralgias, and cognitive decline. On examination, he exhibits a continuous, rhythmic convergence of the eyes combined with synchronous chewing movements.Lamina propria distended by massive numbers of large macrophages containing periodic acid-Schiff (PAS)-positive, diastase-resistant inclusion granules.
- A 32-year-old woman presents with weight loss, chronic non-bloody diarrhea, and intensely pruritic vesicular eruptions symmetrically distributed on her elbows and knees.Prominent intraepithelial lymphocytosis, crypt hyperplasia, and marked villous blunting that predominantly affects the duodenal mucosa.
- A 24-year-old man presents with steatorrhea, progressive ataxia, and night blindness. Laboratory evaluation shows an absence of apolipoprotein B-48 and B-100, and his peripheral smear reveals prominent spiculated red blood cells.Intestinal enterocytes displaying a clear, vacuolated cytoplasm due to massive intracellular accumulation of unsecreted chylomicrons and VLDL particles.
- A 38-year-old man who recently moved from Puerto Rico to the United States presents with fatigue, sore tongue, and chronic diarrhea. Laboratory studies demonstrate macrocytic anemia and combined deficiencies of folate and vitamin B12.Villous blunting and increased intraepithelial lymphocytes that involve the entire small intestine but are characteristically most prominent in the jejunum and ileum.
- A 65-year-old woman presents with persistent, high-volume watery diarrhea. She recently started taking lansoprazole and naproxen for dyspepsia and osteoarthritis. Colonoscopy reveals grossly normal-appearing colonic mucosa.Thickened subepithelial collagen band measuring in depth, accompanied by increased intraepithelial lymphocytes but normal crypt architecture.
Cevap
The presentations map to Whipple disease (PAS-positive macrophages), Celiac disease (duodenal-predominant villous blunting), Abetalipoproteinemia (lipid-vacuolated enterocytes), Tropical sprue (jejunoileal-predominant villous blunting), and Collagenous colitis (thickened subepithelial collagen band).
Each clinical presentation contains pathognomonic or highly specific clues that perfectly align with a single distinct biopsy finding. Oculomasticatory myorhythmia is unique to Whipple disease (PAS-positive macrophages). Dermatitis herpetiformis confirms celiac disease (duodenal villous atrophy). Absence of ApoB leads to abetalipoproteinemia (enterocytes packed with untransported lipids). Tropical sprue presents with megaloblastic anemia due to terminal ileum involvement (distal villous blunting). Finally, secretagogue-induced watery diarrhea with a normal colonoscopy is classic for microscopic colitis, specifically the collagenous variant featuring a thickened collagen band.
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Anahtar Kavram
Histological differentiation of malabsorption and chronic diarrhea syndromes