Crohn's disease of the anal region.
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Biomedical subjects
Publications and source records attributed to B C Morson.
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The clinical and pathological features of 15 cases of malignant melanoma of the anal canal are described. It would appear from this study that these tumours arise from squamous epithelium lining that part of the anal canal at or just above the line of the anal valves.
The pathology of 21 cases of muco-epidermoid carcinoma of the anal canal is described. These tumours are defined as squamous or transitional cell carcinomas containing areas which secrete mucin of undoubted epithelial origin within the clumps of tumour cells. They are found in that part of the anal canal just above the dentate line where the epithelium is variable in type and represents an embryological transition between rectal and squamous mucous membrane. The histogenesis of these tumours is discussed and the opinion given that they arise from the surface epithelium of the upper anal canal rather than from the anal glands.
Ten of a total of 106 children with chronic inflammatory bowel disease seen between 1973 and 1983 were aged 3 years or less (9%). These are the subject of this study. Colonoscopy and biopsy revealed ulcerative colitis in two, Crohn's disease in two, cow's milk-induced colitis in two, and colitis of indeterminate type in four. The children were followed up and reassessed 2 years post-treatment. The four children with ulcerative colitis and Crohn's disease were asymptomatic 6 months after treatment with sulfasalazine and/or prednisolone. The two breast-fed infants with allergic colitis who were treated with cow's milk-free diet in baby and mother showed clinical, endoscopic, and histological resolution. One of the remaining four children with indeterminate colitis is well and off all treatment, and two are well with minimal symptoms and taking sulfasalazine. One child continued to have frequent relapses and subsequently had subtotal colectomy performed with clinical improvement. Histopathology showed features suggestive of intestinal Behcet's disease. The present study shows that colonoscopy and mucosal biopsy allow a firm diagnosis to be established in 60% of cases of this selected group of very young children. In our experience colitis in infancy and early childhood appears to be a heterogeneous group of conditions. An initial assessment of indeterminate colitis should be followed with multiple mucosal biopsies to attempt further categorization.
A brother and sister of first cousin Pakistani parents presented with recurrent mouth ulcers and chronic diarrhoea in the neonatal period. Diarrhoea persisted in spite of treatment with oral prednisolone and sulphasalazine. Both children required subtotal colectomy with ileostomy. Histopathology of the resected colons was virtually identical and showed multiple deep "flask"-shaped ulcers, often penetrating to the serosa, in the presence of chronic inflammation, but without any of the characteristic histological features of Crohn's disease. The appearance closely resembled the colitis of Beh,cet's syndrome. Both children (aged 6 and 3.5 years, respectively) have continued to have recurrent perianal disease with intermittent bloody diarrhoea since the operation. Apart from the initial symptoms of oral aphthous ulcerations in both children, no other major criteria have developed so far. Intestinal Behçet's syndrome should be considered in the differential diagnosis of chronic inflammatory bowel disease in childhood.
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Diverticular disease is basically a disorder of muscle function, particularly of the sigmoid colon. Increase in tone of the muscle layers of the bowel with consequent muscular thickening of a characteristic pattern. The thickening is not a true cellular hypertrophy and there is no evidence of muscle cell hyperplasia. The formation of diverticula are distributed along the points of greatest weakness in the bowel wall, namely where the blood supply penetrates, suggests that pulsion plays a major role in their development. The inflammation in diverticular disease is purely a complication of the diverticulosis.
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