Vasculitis Involving the Gastrointestinal System Is Often Incidental but Critically Important: A 10-Year Experience at a Tertiary Care Hospital

• Published in: American journal of clinical pathology 2020-10, Vol.154 (4), p.536-552
• Main Authors: Zhang, Xiaoming, Furth, Emma Elizabeth, Tondon, Rashmi
• Format: Article
• Language: English
• Subjects: Anatomical specimens; Diagnosis; Gastrointestinal diseases; Medical diagnosis; Methods; Pathology; Patients; Systemic vasculitis; Vasculitis
• ISSN: 0002-9173; 1943-7722
• DOI: 10.1093/AJCP/AQAA083

Objectives: This study was aimed to investigate the significance of unexpected vasculitis identified in gastrointestinal (GI) specimens by determining its prevalence and correlation with clinical outcomes. Methods: GI specimens with histologic evidence of vasculitis were identified in our pathology database over a 10-year period (January 2008 to August 2018). Clinical history, treatment, and follow-up were reviewed. Results: Of the 131,367 GI pathology cases received over the 10-year study period, 29 (0.02%) cases showea histologic evidence of GI vasculitis. The majority (69%, 20/29) were not clinically suspected. Of these, 20%o (4/20) of patients were subsequently diagnosed with systemic vasculitis. During the mean follow-up period of 34.0 months, 24%o (4/17) of the patients with this unexpected diagnosis died as the result of direct complications of GI vasculitis. We also found that 95% of cases with unexpected vasculitis in their GI pathology specimens were communicated in a timely manner to the ordering physicians, which necessitated the immediate initiation of additional workups in 85% of these patients. Conclusions: The GI involvement of vasculitis is rarely encountered by pathologists, but its diagnosis carries tremendous clinical significance with a high mortality rate. Therefore, timely communication is highly recommended for the early diagnosis and treatment of this disease. Key Words: Vasculitis; Gastrointestinal system; Critical diagnosis; Urgent diagnosis; Significant/unexpected diagnosis