Behcet's Disease Mimicking Crohn's Disease: A Diagnostic Pitfall in GI Tract Biopsies.

Behcet's disease is a rare entity. It's a multi-systemic inflammatory disease of unknown etiology characterized by recurrent ulcers and vasculitis, mainly including the oral cavity, eyes, gastrointestinal tract and joints. Crohn's disease is a chronic inflammatory disorder that may affect the same organs as Behcet's disease, however more frequently the gastrointestinal tract. Distinguishing Behcet's disease from Crohn's disease can be challenging due to the overlapping clinical presentation and similar morphology features on pathology biopsy specimens. This is a case report of a 32-year-old female who first presented at the emergency department with fatigue, weight loss, arthralgia, and erythema nodosum. The patient was admitted for oral ulcers, skin rash, genital ulcers, and melena one month later. Treatment with prednisone was started at the time and further workup for Behcet's disease versus inflammatory bowel disease was started. Her esophagus biopsy shows granulomatous-like vasculitis, and her colon biopsies show overlapping features with Crohn's disease. Herein, we present a rare and interesting case in which Behcet's disease mimics inflammatory bowel disease on the gastrointestinal tract biopsies but with some unique findings and diagnostic pitfalls for gastrointestinal tract vasculitis and ulceration.

Tumor budding activity is an independent prognostic factor in squamous cell carcinoma of the vulva.

Tumor budding activity (TBA) is recognized as a potential prognostic factor in carcinomas from several anatomic sites. This study evaluates the prognostic value of TBA in a cohort of squamous cell carcinoma of the vulva (VSCC). TBA, defined as clusters of <5 tumor cells that are detached from the main tumor and that infiltrate into surrounding stroma, was assessed in 82 cases of surgically excised VSCC and correlated with patient outcomes. All cases were classified into one of 3 groups: no TBA, low TBA (1-14 foci), and high TBA (≥15 foci). Twenty-three (29.1%), 37 (45.1%), and 22 (26.8%) cases showed no, low, and high TBA, respectively. High TBA was associated with reduced overall survival (OS) on multivariate analysis independent of FIGO stage, human papillomavirus (HPV) status, and p53 status. The majority of tumors with high TBA displayed a p53 mutant staining pattern (77.3%, 17 of 22). The 17 patients whose tumors displayed a p53 mutant/high TBA profile had worse outcomes when compared with 15 patients whose tumors showed a p53 mutant/no TBA or p53 mutant/low TBA profile (mean OS 37.5 versus 63.3 months, respectively, P = .002). High TBA was observed in only 5 of 47 HPV-associated cases, and this subset also seemed to display a worse patient outcome as compared with the rest of the HPV-associated cohort (OS 16.8 versus 142.8 months, P < .0001). In summary, these findings indicate that TBA is an independent prognostic indicator in VSCC patients, and that high TBA is associated with worse clinical outcomes.

The significance of recurrence in endometrial polyps: a clinicopathologic analysis.

A subset of endometrial polyps recurs after resection. The clinicopathologic significance of the phenomenon is evaluated herein. Consecutive cases of recurrent polyps (index polyp removed by hysteroscopy-directed polypectomy or by curettage; at least one more polyp diagnosed ≤12 months after) were compared with an age-matched control group of nonrecurrent polyps regarding 15 clinicopathologic features. A total of 107 (5.6%) of the 1908 polyps diagnosed in a sampling specimen during the study period was a recurrence, and 102 (6.9%) of the 1478 patients who were diagnosed with an endometrial polyp in a sampling specimen had at least 1 recurrence. Eighty-six percent of patients with any recurrences had only one recurrence, with a mean duration between the index polyp and the first recurrence of 4.36 months. On univariate analyses, the recurrent polyps were, compared with controls, significantly larger, had a higher stromal mitotic index, and more frequently displayed prominent thick-walled vessels in most fragments of the polyp. However, on Cox regression multivariate analyses, no single clinicopathologic feature was significantly associated with a recurrence. No malignancies were diagnosed during the follow-up of the study and control group patients at median follow-up durations of 23 and 34 months, respectively. In conclusion, the recurrence of an endometrial polyp is relatively uncommon (5.6% of polyps) and does not portend an increased risk of malignancy. We could not identify any clinicopathologic features that conclusively predict a recurrence.