Lam-Himlin, Dora M

ABSTRACT Granulomatosis with polyangiitis (GPA) is a rare small vessel vasculitis that commonly presents with multiorgan involvement of the upper airways, lungs, and kidneys. We report a 55 year-old-man who presented with painful oral ulcers, diffuse joint pain, epistaxis, and intermittent maroon bowel movements. Infectious evaluation was unremarkable. Rheumatologic evaluation demonstrated elevated c-anti-neutrophil cytoplasmic antibody and proteinase 3 antibodies. Colonoscopy with terminal ileum biopsies demonstrated angiocentric inflammatory findings supportive of a diagnosis of GPA. This case was unusual in its presentation with predominately oral manifestations. A diagnosis of GPA should remain on the differential for patients with gastrointestinal bleeding, and these systemic symptoms require a high level of suspicion to lead to timely diagnosis.

This review, based on the content of the 2020 US Gastrointestinal Pathology Society’s Rodger Haggitt Lecture, concerns an array of tubular gastrointestinal tract dysplastic or possible “predysplastic lesions” with an almost purely morphologic focus based on our collaborative efforts over the past few years. These processes include esophageal epidermoid metaplasia, Barrett esophagus-associated dysplasia, polypoid gastric dysplastic lesions, small intestinal dysplasia, and the ability of metastases to mimic it, the controversial “serrated epithelial change” encountered in the setting of long-standing ulcerative and Crohn colitis, and recently described anal columnar human papilloma virus-associated neoplasms.

Lymphoepithelial cysts (LECs) of the pancreas are benign, rare pancreatic cysts that are found predominantly in men. These cysts can present as a diagnostic conundrum given their rarity and difficulty of distinguishing these cysts from those with malignant potential. We present an incidental case of a LEC in a middle-aged man.