21989              CROHN’S DISEASE (?) OF THE STOMACH

The patient was a man aged 42 with a history of dyspeptic symptoms.  He had been losing his appetite for about a year and had lost 14½ kilos in weight.  For the last 3 weeks he could take only fluids.  Barium meal showed a constant prepyloric deformity and a subtotal gastrectomy was performed.

The specimen consists of portion of the stomach with the pylorus and the first 3 cms of the duodenum.  There is marked fibrous and muscular thickening of the pylorus with considerable narrowing of the pyloric canal. The gastric mucosa in the prepyloric region shows chronic irregular cobblestone thickening over an area measuring approximately 10 cms in diameter.  Several scattered satellite mucosal nodules form pseudopolypi at the periphery of the lesion.  There are some very large lymph nodes in the omentum.  Histology shows ulceration of the surface with infiltration by dense masses of chronic inflammatory cells.  Deep cracks with abscess formation are present but the process is virtually confined to the mucosa and does not extend to the serosa.  The submucosa is congested but not inflamed.  The muscularis is thickened.  There are lymphoid follicles with large germ centres in the submucosa.  Adjacent lymph nodes are grossly enlarged and hyperplastic with prominent germ centres.  No tuberculoid granulomata are present.