Multinucleated epithelial giant cells in colorectal polyps: A potential mimic of viropathic and/or dysplastic changes

Neeraja Kambham, Megan Troxell, Teri A. Longacre

Research output: Contribution to journalArticle

11 Citations (Scopus)

Abstract

Multinucleated epithelial giant cells (MEG) simulating viral cytopathic effect and/or dysplasia have been reported in the esophagus in association with inflammation, but the occurrence of similar cells in the colon has not been documented. Twenty-three colon specimens (22 biopsies and 1 partial colectomy) featuring MEG from 21 patients were evaluated for a variety of histologic features and correlated with clinical, endoscopic, and follow-up data. Patients included 9 males and 12 females (mean age, 64.9 years; range, 45-86 years). Eleven cases were obtained from 10 asymptomatic patients undergoing surveillance biopsies. Presenting symptoms in the remaining patients were dyspepsia, anemia, abdominal pain, and hematochezia. Over half (13 of 23) of the specimens were from descending and rectosigmoid colon, and almost all were visualized as polyps on endoscopy. Microscopically, all but 1 of the cases featured multiple MEG (range, 6 to >50 cells per biopsy) in the base and mid crypt zones of inflamed polyps with serrated architecture. Immunohistochemical stains for CMV, HSV, adenovirus, EBV, and polyoma virus were negative and no viral particles were identified on ultrastructural examination. Nuclear staining for hMLH1 and hMSH2, markers of microsatellite instability, was similar in distribution to adjacent serrated crypts, but reduced staining intensity was noted in occasional multinucleated cells. Expression of Ki-67 and cleaved caspase 3 was consistent with a quiescent or low proliferative state. Clinical follow-up was available for 9 patients (mean duration, 22.7 months). One patient died of heart failure; all others were well at last follow-up. Bizarre MEG may occasionally be seen within the crypts of inflamed polyps with serrated architecture, raising concern for dysplasia or viral infection. Immunohistochemical and ultrastructural studies fail to establish a viral etiology, and follow-up does not indicate clinically aggressive disease. These changes appear to represent a nonspecific, possibly degenerative response to inflammation and injury, and should be distinguished from dysplasia.

Original languageEnglish (US)
Pages (from-to)912-919
Number of pages8
JournalAmerican Journal of Surgical Pathology
Volume29
Issue number7
DOIs
StatePublished - Jul 2005
Externally publishedYes

Fingerprint

Giant Cells
Polyps
Epithelial Cells
Biopsy
Colon
Viral Cytopathogenic Effect
Staining and Labeling
Inflammation
Descending Colon
Polyomavirus
Microsatellite Instability
Gastrointestinal Hemorrhage
Colectomy
Dyspepsia
Virus Diseases
Human Herpesvirus 4
Adenoviridae
Caspase 3
Virion
Abdominal Pain

Keywords

  • Colon
  • Dysplasia
  • Hyperplasia
  • Multinucleated cells
  • Polyp
  • Viral inclusion

ASJC Scopus subject areas

  • Anatomy
  • Pathology and Forensic Medicine

Cite this

Multinucleated epithelial giant cells in colorectal polyps : A potential mimic of viropathic and/or dysplastic changes. / Kambham, Neeraja; Troxell, Megan; Longacre, Teri A.

In: American Journal of Surgical Pathology, Vol. 29, No. 7, 07.2005, p. 912-919.

Research output: Contribution to journalArticle

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