{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,8]],"date-time":"2026-10-08T03:04:56Z","timestamp":1791428696130,"version":"4.3.3"},"reference-count":29,"publisher":"Wiley","issue":"11","license":[{"start":{"date-parts":[[2014,4,14]],"date-time":"2014-04-14T00:00:00Z","timestamp":1397433600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["APMIS"],"published-print":{"date-parts":[[2014,11]]},"abstract":"<jats:p>After an earlier study defining immunolabeled lymphoid follicles, obstructed lymphatics, and granulomas of the diseased ilea of 24 <jats:styled-content style=\"fixed-case\">C<\/jats:styled-content>rohn's disease patients, we chose to trace the lymphatics of these cases and 10 additional by serial sectioning. Particular attention was given to establishing physical continuity between granuloma\u2010obstructed lymphatics and lymphatics with \u2018lymphocytic thrombi\u2019. Formalin\u2010fixed paraffin\u2010embedded tissue blocks from resected diseased ilea and proximal colons from 34 patients were reviewed. Patients were 13 men and 21 women, aged 14\u201360\u00a0years. Duration of disease ranged from 1\u00a0month to 10\u00a0years. Immunohistochemistry employed D2\u201040 antibody to label lymphatics and anti\u2010<jats:styled-content style=\"fixed-case\">CD<\/jats:styled-content>68 to label granulomas. Twenty\u2010nine of the 34 (85%) resection tissues had lymphangectasia, in mucosa, submucosa, and subserosa. In 53% of the specimens, lymphatics of the various layers were obstructed by granulomas that filled the lumina. In 44%, 15\/34, there were also distended lymphatics that were totally plugged with lymphocytes. In 10 of the 15, serial sections revealed continuity between the lymphocyte\u2010plugged lymphatics and the endolymphatic granulomatous obstruction downstream. In 5 of the cases, D2\u201040 immunostaining revealed redundant lymphatic endothelium interwoven with the granuloma cells. Granulomas totally obstruct lymphatics in all layers of the intestine in <jats:styled-content style=\"fixed-case\">C<\/jats:styled-content>rohn's disease. Upstream of these obstructions, lymphatics are distended with lymphocytes. The degree and extent of this potentially irreversible \u2018lymphangitis nodosa\u2019 have undoubtedly confounded treatment regimens and clinical trials. There currently are no imaging methods to demonstrate the lymphangitis, nor treatments to resolve it.<\/jats:p>","DOI":"10.1111\/apm.12268","type":"journal-article","created":{"date-parts":[[2014,4,15]],"date-time":"2014-04-15T03:05:12Z","timestamp":1397531112000},"page":"1125-1129","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":42,"title":["Granulomas obstruct lymphatics in all layers of the intestine in <scp>C<\/scp>rohn's disease"],"prefix":"10.1111","volume":"122","author":[{"given":"Herbert J.","family":"Van Kruiningen","sequence":"first","affiliation":[{"name":"Department of Pathobiology and Veterinary Science University of Connecticut Storrs CT USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Aaron W.","family":"Hayes","sequence":"additional","affiliation":[{"name":"Department of Pathobiology and Veterinary Science University of Connecticut Storrs CT USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jean\u2010Frederic","family":"Colombel","sequence":"additional","affiliation":[{"name":"Henry D. Janowitz Division of Gastroenterology Icahn School of Medicine at Mount Sinai New York NY USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2014,4,14]]},"reference":[{"key":"e_1_2_7_2_1","doi-asserted-by":"publisher","DOI":"10.1136\/gut.2007.123166"},{"key":"e_1_2_7_3_1","first-page":"181","article-title":"Regional ileitis","volume":"72","author":"Blackburn G","year":"1939","journal-title":"St Bartholomew's Hospital Report"},{"key":"e_1_2_7_4_1","first-page":"475","article-title":"Cicatrizing enteritis (regional ileitis) as a pathologic entity: analysis of one hundred and twenty cases","volume":"24","author":"Warren S","year":"1948","journal-title":"Am J Pathol"},{"key":"e_1_2_7_5_1","unstructured":"VanPatter WN.Pathology and pathogenesis of regional enteritis. 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