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Pathologist Report - Help Needed!


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#1 Sarahsmile416

 
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Posted 19 January 2013 - 08:54 AM

Want to clarify - diagnosed myself a month ago after negative blood tests and negative biopsy as NCGI and have been gluten free since late December.

Went to the doctor two days ago and was pleasantly surprised. Apparently it is just her nurse who is a moron...I did find it funny that the nurse wanted as little to do with me as possible after I excoriated her on the phone.

The doctor on the other hand, when I told her I was still having problems she said that I might easily be gluten intolerant (which, duh, but from what I have read on here, she seems to be one of the few doctors who acknowledge it!) and given the amount of inflammation I showed I should give up dairy for awhile. I was just very happy to hear my doctor parrot what I have been reading on here! I have also been doing my food diary all wrong - only recording major reactions and not minor ones, whoops!

Anyway, I asked her for the pathologist's report and she gave it to me. Shorter than I expected (2 pages), but shockingly some things were done that I did not expect (they DID test for eosinophils, which were not present).

Here it is, in most of its entirety:
Clinical impression: Abnormal mucosa in duodenum; normal mucosa entire stomach; erythematous esophagus.

Gross description: Received in zinc-formalin are six fragments of red-tan soft tissue measuring 0.9 cm x 0.6 cm x 0.2 cm in aggregate.
Received in zinc-formalin are two fragments of red-tan soft tissue measuring 0.4 cm x 0.3 cm x 0.2 cm in aggregate.
Received in formalin are two fragments of soft tissue measuring 0.3 cm x 0.3 cm x 0.1 cm in aggregate.

Miscroscopic description:
Small bowel mucosa with foveolar metaplasia and Brunner gland hyperplasia. Giardia and other parasites not identified.
Foveolar cell hyperplasia, edema of lamina propria and minimal inflammation. No evidence of intestinal metaplasia, malignancy or dysplasia. H.pylori not present.
Esophageal mucosa with basal layer hyperplasia and elongation of esophageal papillae. Eosinophils are not present. There is no columnar mucosa present.

Final diagnosis;
Duodenum, Biopsy with Cold Forceps:
Chronic duodenitis with focal foveolar metaplasia and Brunner gland hyperplasia.
No evidence of celiac sprue.
Giardia not identified.

Stomach, biopsy with cold forceps:
Reactive (erosive) gastropathy
Silver stain negative for H.pylori

Distal esophagus, Biopsy with cold forceps
Hyperplastic squamous mucosa most consistent with chronic reflux esophagitis.
There are no eosinophils present.
No evidence of Barrett's esophagus; no glandular mucosa present.

Phew!! Anyone able to decipher the medical speak for me?
Thanks!
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#2 Opa3

 
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Posted 19 January 2013 - 01:17 PM

Here it is, in most of its entirety:
Clinical impression: Abnormal mucosa in duodenum; normal mucosa entire stomach; erythematous esophagus.

Gross description: Received in zinc-formalin...............................

..................... able to decipher the medical speak for me?

Firstly, you have irritation of the duodenum and esophagus. What did the Doc Rx'ed? Avoid foods that cause these issues.
Secondly, zinc- formalin (ie: formaldhyde) is a perservative. 10 biopsies taken at various places. Size of each tissue sample, so indicated.
Hope this helps for starters.
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#3 Sarahsmile416

 
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Posted 19 January 2013 - 03:09 PM

Firstly, you have irritation of the duodenum and esophagus. What did the Doc Rx'ed? Avoid foods that cause these issues.
Secondly, zinc- formalin (ie: formaldhyde) is a perservative. 10 biopsies taken at various places. Size of each tissue sample, so indicated.
Hope this helps for starters.


Thanks, Opa. Formally, I was diagnosed with gastritis, esophagitis, and duodenitis...so I knew about the inflammation in all of those places.

What I really wanted more information about were the words mucosa, hyperplasia and those types of medical lingo. Since I am not a doctor I don't know what those things mean in the context of my esophagus, duodenum and stomach.

Additionally, I wasn't sure if the sizes of the biopsies taken were important or just something usually noted during the biopsy.
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#4 mushroom

 
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Posted 19 January 2013 - 03:27 PM

The proper way for a pathologist to start his report is to describe the samples he received, as in the number, their size, their color, their appearance, and where they were labelled as being taken from.

He then details what he sees (or doesn't see) under the microscope.

If you see words you don't understand it often helps to google into an online dictionary to find out what they mean. For example, I googled mucosa, hyperplasia and metaplasia for you, with these results:

"Mucosa:

A mucous tissue lining various tubular structures consisting of epithelium, lamina propria, and, in the digestive tract, a layer of smooth muscle (muscularis mucosae).

hyperplasia - abnormal increase in number of cells

metaplasia - Abnormal transformation of an adult, fully differentiated tissue of one kind into a differentiated tissue of another kind; an acquired condition, in contrast to heteroplasia."


Even the answers may pose more questions than they answer for you. :)
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#5 GFinDC

 
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Posted 19 January 2013 - 03:56 PM

sounds like the Brunner's gland thing is not normally any problem. This linked case is an unusual one, but the article does describe the Brunner's Gland hyperplasisa.

http://www.ncbi.nlm....les/PMC2526515/
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Job 30:27 My bowels boiled, and rested not: the days of affliction prevented me.
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#6 Sarahsmile416

 
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Posted 19 January 2013 - 04:44 PM

sounds liek the Brunner's gland thing is not normally any problem. This linked case is an unusual one, bt the article does describe the Brunner's gland hyperplasisa.

http://www.ncbi.nlm....les/PMC2526515/


Yes, the Brunner's gland hyperplasia was the most glaring thing I saw. I looked it up and saw it was a benign tumor in the duodenum - which didn't really worry me just confused me that my doctor wouldn't tell me that.

And yes, mushroom, I agree, the definitions of those words do tend to lead to more questions than answers, haha.
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