1- Superficial esophageal mucosal fragments with prominent intraepithelial eosinophilia, greatest in the superficial and mid-epithelial layers. Peak counts show multiple foci with >15 eosinophils per high-power field (HPF, 400×), with occasional eosinophil microabcsesses (clusters of >4 eosinophils). There is associated basal cell hyperplasia with expansion of the basal layer, focal elongation of papillae into the upper third of the epithelium, and spongiosis (intercellular edema). Surface epithelial sloughing and scattered degranulated eosinophils are noted. No evidence of atypia or malignancy.
2- Gastric mucosa showing moderate infiltration by lymphocytes and plasma cells. Lymphocytes aggregate in some foci to form lymphoid follicles with active germinal centers. Neutrophils are seen infiltrating glands thus indicating activity. H. pylori characteristic forms are present. There is no evidence of intestinal metaplasia, atypia or malignancy.
3-Ileal mucosa showing moderate infiltration by lymphocytes and plasma cells. Lymphocytes aggregate in some foci to form lymphoid follicles with active germinal centers. Villi are intact and are negative for atrophy and ulceration. No evidence of specific granulomas. No evidence of malignancy.
4- Intact colonic mucosa with mild reduction in the number of mucigenic cells and mild infiltration by lymphocytes, plasma cells and neutrophils. However, crypt abscesses are not identified. No evidence of atypical or malignant cells.
Epigastric pain, chronic diarrhea, multiple terminal nodules???
Four biopsies were received :
1- Gastric biopsy : soft tissue fragments collectively measured 0.9 cm, totally embedded.
2- Esophageal biopsy: soft tissue fragments collectively measured 0.8 cm, totally embedded.
3- Terminal ileum biopsy : soft tissue fragments collectively measured 0.9 cm, totally embedded.
4- Colonic biopsy : soft tissue fragments collectively measured 1. 3 cm, totally embedded.