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Widespread mural thickening of the entire gastrointestinal tract from the esophagus to sigmoid colon associated with ascites.
The patient went on to have numerous tests and esophageal/gastric/duodenal biopsies that confirmed the diagnosis of eosinophilic gastroenteritis and excluded other differentials.
Sections show specialized acid-secreting gastric mucosa with muscularis mucosae. The superficial and deep glands are architecturally normal and lined by gland columnar cells. The lamina propria contains mildly increased numbers of chronic inflammatory cells with moderate increased numbers of eosinophils. There is no dysplasia, no intestinal metaplasia and no invasive malignancy. Helicobacter are not seen The presence of marked eosinophilic infiltration within the duodenal biopsies with milder gastric eosinophilia is supportive of a diagnosis of eosinophilic gastroenteritis. There may be a component of eosinophilic esophagitis.
MICROSCOPIC DESCRIPTION The smears and cell block section show occasional mesothelial cells, lymphocytes, histiocytes, abundant eosinophils and red blood cells. No malignant cells are identified.
DIFFERENTIAL CELL COUNT Eosinophils: 98% Neutrophils: 00% Lymphocytes: 2%
DIAGNOSIS: Ascitic fluid: Marked eosinophilia; negative for malignancy.
Full blood exam
- Hb: 108L
- WCC: 10.3
- neutrophils 6.3
- lymphocytes 2.1
- monocytes 0.7
- eosinophils 1.2H
- Plt: 455
Serology negative for the following: Cysticercosis, Cytomegalovirus (CMV), Epstein Barr Virus, Hepatitis B Core and Surface Antibodies and Hepatitis B Surface Antigen, Hepatitis C Antibody, HIV 1/2 Antigen/Antibody, QuantiFERON-TB Gold, Schistosoma, Strongyloides, Syphilis-TP, Toxocara, Anti-Sm, Anti-RNP, Anti-Ro, Anti-La, Anti-Scl70, Anti-Jo, Cryptosporidium Antigen, Giardia Antigen.
Fecal MCS negative for the following: Entamoeba histolytica, Oocysts, Ova, cysts or parasites (Modified Acid Fast and Trichrome and Ethyl Acetate concentration)
Parasite antigens not detected including: Cyclospora, Cryptosporidium
The b2a2 and b3a2 (p210) BCR-ABL transcripts were NOT detected.
Case credit: Assoc Prof Damien Stella, Royal Melbourne Hospital.