Multinucleated Stromal Giant Cells of the Colonic Lamina Propria in Ulcerative Colitis M a Pitt, W F Knox, N Y Haboubi on October 1, 2021 by Guest

874 Bashir, Abbott

Retractile mesenteritis, characterised by The clinical course of mesenteric lipodys- shortening of the mesentery with fibrosis and trophy is usually benign with a favourable lymphocyte infiltration, has been suggested as outcome; no treatment is necessary.4 In the

a condition similar to mesenteric lipodystro- mesocolon the disease is clinicopathologically J Clin Pathol: first published as 10.1136/jcp.46.9.874 on 1 September 1993. Downloaded from phy, and some authors would regard it as an more advanced and progressive and may end stage of mesenteric lipodystrophy.9 An require surgical treatment, including a colec- association between mesenteric lipodystrophy tomy.6 and retroperitoneal fibrosis has also been sug- It is important for pathologists and their gested and obstruction of the vena cava due clinical colleagues to be aware of mesenteric to retroperitoneal extension of mesenteric lipodystrophy as a cause of a mass in the lipodystrophy has been reported.410 abdomen when symptoms of anorexia, nau- In pelvic lipomatosis there is a gross sea, vomiting, diarrhoea and constipation are increase in perivesical and perirectal adipose present. tissue but there is no foamy macrophage infil- 1 Durst AL, Freund H, Rosenmann E, Birnbaum D. tration and the process does not extend above Mesenteric panniculitis: Review of the literature and the pelvic brim. Although there may be presentation of cases. Surgery 1977;81:203-1 1. 2 Crane JT, Aguilare MJ, Grimes OF. Isolated lipodys- inflammatory changes in the serosa in trophy, a form of mesenteric tumour. Am Jf Surg 1955; Whipple's disease, the mesenteric nodules 90:169-79. 3 Ogden WW, Bradburn DM, Rives JD. Mesenteric panni- represent enlarged lymph nodes which con- culitis. Ann Surg 1965;161:864-73. tain numerous periodic acid Schiff positive 4 Kipfer RE, Moertel CG, Dahlim D. Mesenteric lipodystrophy. Ann Intern Med 1974;80:582-8. macrophages and bacilli and there is no sign 5 Shah AN, You CH. Mesenteric lipodystrophy presenting of fat necrosis. as an acute abdomen. Southern MedJ 1982;75:1025-26. 6 Adachi Y, Mori M, Enjoji M, Ueo H, Sugimachi KI. The three cases that we have presented Mesenteric panniculitis of the colon. Dis Colon Rectum demonstrate the clinical spectrum of mesen- 1987;30:962-6. 7 Simpson RD, Harrison EG, Mayo CW. Mesenteric fibro- teric lipodystrophy. Case 1 presented with an matosis in familial polyposis. Cancer 1964;17:526-34. acute abdomen and in cases 2 and 3, despite 8 Campbell JS, Ewing JB, Grice HC. Abdominal and pelvic paraffinomatosis: peritoneal and retro-peritoneal. Can J7 extensive investigations, the diagnosis was Surg 1958;1:131-41. made at necropsy. Only histological examina- 9 Soergel KH, Hensley GT. Fatal mesenteric panniculitis. Gastroenterology 1966;51:529-36. tion of the mesenteric masses indicated the 10 Handelsman JC, Shelley WM. Mesenteric panniculitis. diagnosis. Arch Surg 1965;91:842-50.

J Clin Pathol 1993;46:874-875 Multinucleated stromal giant cells of the colonic lamina propria in ulcerative colitis http://jcp.bmj.com/ M A Pitt, W F Knox, N Y Haboubi on October 1, 2021 by guest. Protected copyright. Abstract So-called (atypical) multinucleated stromal Multinucleated stromal giant cells were giant cells have been described in a variety of seen in the colonic mucosa in biopsy sites including the lower female genital tract, specimens from two patients with long- bladder, anus, skin, breast and nose.lA When standing quiescent ulcerative colitis. numerous they have been confused with a Similar cells have been described at diagnosis of sarcoma or pseudosarcomatous other sites associated with chronic carcinoma. Their association with polyps, inflammation, including the lower chronic inflammation and changes after radi- female genital tract, bladder and anus. ation has suggested that these are reactive The immunophenotype of the cells in the cells and studies suggest an origin from the colonic mucosa suggested that they had indigenous stromal cells.l4 An interaction originated from fibroblasts rather than between stromal cells and mast cells has been histiocytes, in common with cells seen at suggested as being crucial to the induction of other sites ofinflammation. this morphological change.' Department of These examples lend support to the Histopathology, concept of there being a reactive mor- Case reports Withington Hospital, 1 Manchester M20 8LR phological change possibly related to CASE M A Pitt interaction with mast cells. These multi- A 62 year old woman with an 18 year history W F Knox nucleated giant cells are distinct from of ulcerative proctitis that had been con- N Y Haboubi histiocytic giant cells and should not be trolled by salazopyrine had a review Correspondence to: Dr M A Pitt confused with them. colonoscopy at which the mucosa looked nor- Accepted for publication mal. Biopsy specimens were taken to assess 22 April 1993 (3 Clin Pathol 1993;46:874-875) disease activity and exclude dysplasia. Multinucleated stromal giant cells of the colonic lamina propia in ukerative colitis 875

CASE 2 Discussion A 72 year old woman with a 20 year history Multinucleated giant cells may be seen in of ulcerative colitis affecting the rectum and colonic mucosa in association with granulo- sigmoid colon that had been controlled with mata or in isolation in Crohn's disease, infec- J Clin Pathol: first published as 10.1136/jcp.46.9.874 on 1 September 1993. Downloaded from salazopyrine had a review colonoscopy at tious colitis, ruptured crypt abscesses and which the mucosa was described as normal. foreign body reactions.5 These are epithelioid Biopsy specimens were taken to exclude in appearance with abundant eosinophilic dysplasia. cytoplasm and are CD68 positive, indicating a histiocytic origin. Bizarre vimentin positive stromal cells, some of which are multinucle- Pathological findings ated, have also been reported in the colon in In both cases the biopsy specimens showed association with ulcers and inflammatory large bowel mucosa with a mild increase in polyps.6 The cells seen in the mucosal tissue chronic inflammatory cells but minimal glan- in the two cases reported here have an irregu- dular distortion and no mucus depletion, lar or stellate outline with nuclei arranged in a ulceration, polyps or dysplasia. In both cases rosette or grape-like manner and have rela- low power examination showed small num- tively little cytoplasm. They are not associ- bers of bizarre multinucleated cells scattered ated with granulomata, foreign body material, throughout the lamina propria (fig lA). The infection, crypt, abscesses, ulceration or cells were irregular or stellate in outline and inflammatory polyps. They are vimentin posi- contained between three and 15 round, uni- tive but CD68 negative, suggesting a mes- form nuclei arranged in a rosette or grape-like enchymal rather than histiocytic origin. manner (figs 1B and 1C). There was no evi- Morphologically and immunophenotypi- dence of associated foreign material, crypt cally similar giant cells have been described at absesses, - or granulomata. Toluidine blue other sites in association with a variety of staining showed large numbers of mast cells reactive conditions.4 We believe the colonic in the lamina propria in both cases. Sufficient giant cells described here are of this type and material was available from case 2 to perform are linked to the underlying chronic inflam- immunohistochemical staining which showed matory process, particularly the presence of these cells to be vimentin positive but CAM increased numbers of mast cells, a phenome- 5-2, a-smooth muscle actin, desmin, CD68 (a non which has been reported in association macrophage marker), leucocyte common with ulcerative colitis.7 Increased numbers of antigen, S 100 and factor VIII negative. mast cells have been noted in association with stromal giant cells from other sites.' These findings further support the concept of multinucleated stromal giant cells being morphological reactive variants of indigenous stromal cells, possibly related to an interaction with mast cells. A distinction should be made between http://jcp.bmj.com/ these stromal giant cells and those of histiocytic origin as the former are probably of no importance diagnostically or clinically.

1 Pitt MA, Roberts ISD, Agbamu DA, Eyden BP. The

nature of atypical multinucleated stromal cells: A study on October 1, 2021 by guest. Protected copyright. of 37 cases from different sites. Histopathology 1993; 23:137-45. 2 Abdul-Karim FW, Cohen RE. Atypical stromal cells of the female genital tract. Histopathology 1990;17:249-53. 3 Schinella RA. Stromal atypia in anal papiliae. Dis Colon Rectum 1976;19:611-13. 4 Campbell AP. Multinucleated stromal giant cells in ado- lescent gynaecomastia. J Clin Pathol 1992;45:443-4. 5 Talbot IC, Price AB. Biopsy pathology in colorectal disease. London: Chapman and Hall, 1987:57-61. 6 Shekitka KM, Helwig EB. Deceptive bizarre stromal cells in polyps and ulcers of the gastrointestinal tract. Cancer Figure IA Multinucleated stromal giant cells scattered within the colonic lamina propria 199 1;67:2111-17. (arrowheads). Figure B (top left) Multinucleated stromal giant cell with "rosette" 7 Lloyd G, Green FW, Fox H, Mani V, Turnberg L. Mast arrangement of nuclei. Figure C (top right) Multinucleated stromal giant cell with a cells and immunoglobulin E in inflammatory bowel dis- "grape-like" arrangement ofnuclei. ease. Gut 1975;16:861.