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Fibroelastotic changes (FEC) and especially elastotic polyps of the gastrointestinal (GI) tract are considered rare benign lesions. They consist of accumulations of elastic fibers within the mucosal, submucosal, or muscular layer, occurring in all parts of the GI tract and often appearing as polyps, but also as diffuse non-polyp-forming deposits. They have been the subject of only a few studies. To explore the clinical and histopathological features of FEC in the GI tract, a series of 162 elastotic lesions was collected within a 2-year period. The clinical data and endoscopic findings were correlated. FEC appeared as polyp-forming lesions of the large intestine in 23 samples (14 %), all other samples concerning histological findings without an identifiable gross mass. Frequently related findings were postinterventional status (9 %), previous irradiation (7 %), and history of GI lymphoma (4 %). Eight samples (5 %) presented endoscopically with lesions justifying surgical intervention. We identified three different histological patterns of FEC, which we have called fibroelastosis, angioelastosis, and elastofibroma. Consistent with previous studies, CD34 immunohistochemical staining (performed on 38 polypoid FEC specimens) showed an increase of CD34-positive mesenchymal cells in 95 % of immunostained samples, suggesting a potential role for CD34-positive mesenchymal cells in the accumulation of elastic fibers. In conclusion, FEC are more common in the GI tract than previously recognized. They often present as a benign polyp. Many accompany other diseases like ulcers and atrophic gastritis or represent a residual finding after an intervention.

Blood protoporphyrin (PROTO) concentration in man and animals has been studied as a possible means of assessing the relationship between iron supply and marrow requirements. There appear to be two fractions of PROTO: one at a level of about 30 µg/ 100 ml unrelated to either iron supply or cell age, and a second fraction that appears when iron supply is limited and that has an elution T½ of 2-4 wk. Animal studies have demonstrated that increased erythropoiesis and reticulocytosis per se do not change PROTO, providing that there is an adequate (increased) plasma iron level. In phlebotomized man, within 1 or 2 wk following a decrease in plasma iron saturation to less than 15%, the PROTO levels become significantly elevated. In more chronic disease states associated with near normal rates of erythropoiesis, a transferrin saturation less than 15% is usually associated with increased PROTO. In patients with hemolytic anemia, the PROTO level rises even though plasma iron and per cent saturation values are higher. Evidence is presented suggesting that both the extent of marrow proliferation and erythropoietin stimulation may affect the PROTO response. The red cell PROTO concentration is an important parameter for assessing iron-deficient erythropoiesis, either relative or absolute. The usefulness of this parameter is compared with red cell indices, plasma iron, and transferrin saturation data.