Carcinoma, villous atrophy, and steatorrhoea.

Abstract

EDITORIAL SYNOPSIS There appears to be an increased incidence of carcinoma of the fore and mid gut in patients with villous atrophy of the small intestine.Intestinal reticulosis may arise as a complication of idiopathic steatorrhoea (Gough, Read, and Naish, 1962). Creamer (1964) has suggested that malignancy anywhere in the body may be accompanied by villous atrophy of the small intestinal mucosa. In this paper, seven patients with steatorrhoea and accompanying carcinoma are presented and the possible reasons for this association are discussed.CASE REPORTS CASE 1 A man aged 50 years was in good health until April 1961, when he complained of pain in the right buttock and was treated with phenylbutazone. He afterwards developed watery diarrhoea, passing six to 10 motions daily, which lasted a fortnight. Subsequently his bowels opened four times a day and the stools weie clay coloured and offensive. His appetite was good. Apart from pallor, physical examination was normal.Investigations showed that haemoglobin was 47 % with evidence of iron deficiency. A small intestinal barium meal showed the features of steatorrhoea. Faecal fat was 90 g. in three days. Xylose absorption was normal. A glucose tolerance test (50 g.) produced a rise of 40 mg./100 ml. The patient refused to have a jejunal biopsy.He was followed up in the Out-patient Department and the iron-deficiency anaemia was treated with oral and parenteral iron. When a gluten-free diet was prescribed his weight increased by 8 lb. and a subsequent three-day faecal fat estimation was 26 g. As anaemia persisted in spite of treatment, he was admitted for transfusion during the summer of 1962. A 51Cr-labelled red cell study was carried out and showed an average daily blood loss of 39 4 ml. Faecal fat was 23-9 g. in three days.In December 1962 he was admitted as an emergency because of upper abdominal pain, and after a blood transfusion a laparotomy was carried out, at which an ulcerated annular tumour was found 10 cm. below the duodeno-jejunal flexure. The tumour and 15 cm. of jejunum were resected. Histological examination showed the tumour to be an adenocarcinoma with no lymph node metastases. The jejunum showed partial villous atrophy.He has been in good health since the operation with bowels opening once a day. Haemoglobin has risen to 97%.CASE 2 A man, aged 70 years at the time of death, had had attacks of diarrhoea and lower abdominal pain since 1946. Idiopathic steatorrhoea and megaloblastic anaemia were diagnosed in 1954. He was treated with a gluten-free diet and improved. He was admitted again in 1960 because of diarrhoea and weight loss. On examination he was small, wasted, and pale. Clubbing was present as were abdominal distension and dorsal kyphosis.Investigations revealed 36 g. of fat in a 24-hour stool collection and only 1-7 g. of 25 g. of d-xylose was excreted in the urine in five hours. A glucose tolerance test revealed a maximum rise of 10 mg./100 ml. A jejunal biopsy showed subtotal villous atrophy. Serum albumin was 2-2 g./100 ml. and serum y gl...

Coeliac disease and small bowel carcinoma

“…In other reports the duration of malabsorption before the diagnosis of the carcinoma is too short to warrant a diagnosis of preceding coeliac disease, despite some supporting evidence. These reports include one of the patients of Girdwood, Delamore & Williams (1961) and case number 1 of Brzechwa-Ajdukiewicz et al (1966). Hennessy & Ralston (1969) report a patient in whom the initial diagnosis was coeliac disease with some response to a gluten-free diet and an intestinal biopsy showed total villous atrophy.…”

“…Harris et al (1967) in describing thirty-four malignancies in over 200 cases of coeliac disease and idiopathic steatorrhoea, also report a number of instances of the occurrence of carcinoma elsewhere in the alimentary tract, but they found no small bowel carcinomas, and only four reports in the literature. Brzechwa-Ajdukiewicz et al (1966) reviewed five case reports and added a further three reports of small bowel carcinomas occurring in patients suffering from steatorrhoea and another earlier report has been found in the French literature (Kissel et al, 1965). In some of these reports the evidence for a diagnosis of a coeliac syndrome preceding the carcinoma is inconclusive.…”

Ostatnie fastrygi. Irit Amiel w rozmowie z Agnieszką Piśkiewicz-Bornstein

“…A Żuraw i czapla? "Przykro było żurawiowi, że samotnie ryby łowi, patrzy, czapla na wysepce wdzięcznie z błota wodę chłepce" 69 … Tego nie znam całego na pamięć… Albo Chrząszcz -to tylko Polacy mogą powiedzieć: "W Szczebrzeszynie chrząszcz brzmi w trzcinie i Szczebrzeszyn z tego słynie…" 70 . Czy to nie jest piękny język?…”

Coeliac disease and malignancies

“…Later the term malignant histiocytosis of the intestine (MHI) was used, but current evidence suggests that the tumour is a T-cell lymphoma (4) and the name "enteropathy-associated T-cell lymphoma" (EATCL) will be used in this paper. An apparent excess of non-lymphomatous malignancies in coeliacs was also recognized in the 1960s (5). Apart from lymphoma, patients with C D are at increased risk of developing esophageal and pharyngeal squamous carcinomas and small intestinal adenocarcinomas, as discussed below.…”