Clinical Significance of Granuloma in Crohn's Disease

Abstract

Crohn's disease (CD) is diagnosed from information obtained clinically, pathologically, and radiologically. One important pathologic finding is a granuloma, which is helpful when a positive diagnosis of CD will affect treatment. Whether the presence of a granuloma has any clinical implication is not clear. We conducted a retrospective study to determine whether a granuloma found on a biopsy sample is associated with disease severity, fistulizing or perianal disease, frequent relapses, and extraintestinal manifestations. Eighty-two patients were identified who had a biopsy or bowel resection for CD between 1990 and 1994 at a tertiary referral center; 21 (25.6%) had a granuloma. This group was compared with a group of 61 patients without a granuloma. Forty-five percent were male (n = 37), mean age at diagnosis was 42.6 years (median, 39.5 years), mean disease duration at presentation was 8.8 years (median, 4.8 years), and mean follow-up duration was 2 years (range, 1 day to 10.2 years). No significant differences were demonstrated between the two groups by the Fisher exact test with regard to fistulizing or perianal disease, oral aphthous ulcers, disease severity, axial or peripheral arthralgia, episcleritis, anterior uveitis, erythema nodosum, or pyoderma gangrenosum.

High-dose immune suppression and autologous hematopoietic stem cell transplantation in refractory Crohn disease

“…9 Failure to induce disease by immunization with intestinal autoantigens and murine models of cytokine gene knock-out dsyregulation suggests that CD is a T H 1 immune-mediated imbalance perhaps caused by a delayed-type hypersensitivity against intestinal flora. High-dose immune ablative therapy and HSCT may reset the immune balance resulting in regeneration of a normal phenotype and prolonged disease remission.…”

Frequency and significance of granulomas in a cohort of incident cases of Crohn's disease

“…In an early paediatric cohort, 18 including 56 CD patients, presence of epithelioid granulomas (33% of patients) was associated with a greater likelihood of ileal involvement, perineal disease, and surgery for CD. A more recent study 66 of 82 prevalent CD cases found no difference between patients with (26%) and without epithelioid granulomas regarding the number of patients with extraintestinal CD manifestations, perineal disease, and/or fistulas; among 82 patients, 42 were followed up for longer than one year, and neither the number nor the severity of CD flares during the period differed between the two groups. Finally, two studies evaluated the significance of histological findings as predictors of CD outcome; one sought to identify histological features distinguishing patients with penetrating or stricturing CD lesions from those without complications 67 and another looked for histological patterns predicting relapse of ulcerative colitis.…”

Presence of Granulomas in Mesenteric Lymph Nodes Is Associated with Postoperative Recurrence in Crohnʼs Disease

“…23 The granuloma has long been considered as a histologic hallmark for CD, which is identified between 9% and 60% of patients with CD. [24][25][26][27][28] The prognostic significance of the granuloma remains unknown although many investigators have attempted to link the presence of granulomas with postoperative recurrence 29 and disease severity. 27,28 However, the association between the presence of granulomas and the recurrence of CD remains controversial.…”

“…[24][25][26][27][28] The prognostic significance of the granuloma remains unknown although many investigators have attempted to link the presence of granulomas with postoperative recurrence 29 and disease severity. 27,28 However, the association between the presence of granulomas and the recurrence of CD remains controversial. [29][30][31][32][33] The association between surgical pathology markers and postoperative recurrence in CD has been investigated.…”