Surgical Pathology of Primary Intestinal Myopathy.

Raj P Kapur
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Abstract

Context.—: Pathologic evaluation of intestinal biopsies or resection specimens is often part of the diagnostic workup for patients with pseudo-obstruction or other forms of severe intestinal dysmotility. Some of these patients have one of several types of primary intestinal myopathy, but the pathologic features that identify and/or distinguish these conditions have been incompletely defined and need to be readdressed in the context of newly recognized genetic etiologies.

Objective.—: To convey a practical approach to surgical pathology diagnosis of primary intestinal myopathy based on a comprehensive review of pathology findings in patients with primary intestinal myopathy, including data collected from patients with intestinal myopathy-related pathogenic gene variants.

Data sources.—: A review of the literature as well as cases from multiple institutions that were examined by the author.

Conclusions.—: Microscopic alterations indicative of primary intestinal myopathy must be distinguished from nonspecific findings associated with chronic distension, surgical procurement, or preanalytic tissue processing. Most histopathologically recognizable forms of primary intestinal myopathy can be grouped as either structural alterations of the muscularis propria or degenerative leiomyopathies. Some histopathologic findings correlate with specific types of primary intestinal myopathy, but biopsies or resections from many patients with pathogenic variants in genes that encode smooth muscle contractile proteins show no diagnostic alterations. In some situations, an invasive procedure to obtain tissue for histopathologic evaluation has limited utility and molecular genetic testing may be a superior initial diagnostic approach.

原发性肠肌病的外科病理学。
上下文。-:对于假性梗阻或其他形式的严重肠蠕动障碍患者,肠活检或切除标本的病理评估通常是诊断工作的一部分。其中一些患者有几种类型的原发性肠肌病之一,但识别和/或区分这些疾病的病理特征尚未完全定义,需要在新认识的遗传病因的背景下重新定义。-:通过对原发性肠肌病患者的病理发现的综合回顾,包括从肠肌病相关致病基因变异患者收集的数据,传达一种实用的手术病理诊断方法。数据源。-:对作者所研究的文献和多个机构的案例进行综述。-:指示原发性肠肌病的显微镜改变必须与慢性扩张、手术获取或分析前组织处理相关的非特异性发现区分开来。大多数组织病理学上可识别的原发性肠肌病可分为固有肌层的结构改变或退行性平滑肌病。一些组织病理学结果与特定类型的原发性肠肌病相关,但对许多编码平滑肌收缩蛋白的基因致病性变异的患者进行活检或切除,没有发现诊断上的改变。在某些情况下,通过侵入性手术获取组织进行组织病理学评估的效用有限,而分子基因检测可能是一种更好的初步诊断方法。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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