Small Bowel

Diffuse plasma cell infiltration of the small intestine is geographically unique, and correlates with socioeconomic status. Diagnostic possibilities include re active plasma cell infiltration or neoplastic processes. Multiple theories have been proposed for this occurrence and revolve around continual antigen challenge with chronic parasitic infestations or exposure to luminal pathogens, then subsequent neoplastic terminal differentaion. Diffuse plasmacytic infiltration or small intestine lymphoproliferative disorders are associated with characteristics similar to those in diffuse intestinal lymphoma or Mediterranean lymphoma. Specifically, these characteristics are geography, age, sex, type of infiltrate, proximal small intestinal involvement and a-chain production [36].

An interesting correlate is the association of cholera pandemics and Vibrio cholera toxin stimulation of IgA plasma cells [37]. Helicobacter pylori has been shown to have a significant association with small intestinal lymphoma [38], Primary small intestinal lymphoma or extranodal lymphoma represents a group of heterogeneous disorders with varied histological findings of histiocytic, lymphocytic infiltration or undifferentiated lymphoma. A true histiocytic lymphoma may occur late in Celiac disease. The variants of this disorder, small intestinal lymphoproliferative disorders, have groups which are characterized by serological abnormalities of the alpha heavy chain of IgA [39]. Alsabti et al. [40] studied normal family members of 8 patients with a-chain disease. Both patients and family members demonstrated increased circulating B lymphocytes, decreased T lymphocytes and defective cellular immune responses. These findings, and serologic abnormalities of a-chain in multiple members of four families, suggest a hereditary form of B-cell disease of IgA class. Characterization of these disorders is facilitated by demonstrating monoclonal plasma cell populations by immunoperoxidase staining for k and X chains [41], However, in an immunoperoxidase study of immunoproliferative disease of the small bowel, failure of light chain is not a constant finding. Some cases may secrete a complete IgA molecule and others may be nonsecreting [42], In another case report of massive plasma cell infiltration of the small bowel a relative failure of secretory component is proposed for the findings of high levels of polymeric IgA [43]. The outcome of primary small intestinal lymphoma is poor, a 59% 5-year survival with multi-modal approaches [44], Poor outcome has been also been associated with cell turnover rate [45],

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