METASTATIC CROHNS-DISEASE - REPORT OF 3 CASES WITH SPECIAL REFERENCE TO HISTOPATHOLOGIC FINDINGS

Background: Metastatic Crohn's disease is a rare, often unrecognized c utaneous disorder lacking definite histopathologic criteria. The purpo se of this study was to document clinicopathologic and immunologic fin dings in 3 patients with metastatic Crohn's disease. The histopatholog ic findings are evaluated in correlation to those reported in the lite rature in an attempt to better define the histopathologic features. Ob servations: None of the patients showed signs of depressed cell-mediat ed immune response as evaluated with skill tests and T-cell subtyping of blood samples. One of the patients had antineutrophil cytoplasmic a ntibodies. Polymerase chain reaction, a highly efficient method of amp lifying low levels of specific DNA sequences, did not show mycobacteri al DNA in the samples studied. Granulomas of the sarcoid type with num erous foreign body and Langhans giant cells were the dominating featur es. In accordance with previous results, we found vascular involvement in 2 cases, manifested as granulomatous perivasculitis in both. We al so found necrobiotic areas in all 3 cases. Conclusions: We propose tha t both necrobiosis and granulomatous perivasculitis be added to the hi stopathologic characteristics of metastatic Crohn's disease. Patients may even have a positive antineutrophil cytoplasmic antibody test resu lt.