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My GI doc sent me this link today regarding mastocytic entrocolitis. I thought it was quite well written as it covered in detail the feedback mechanisms and immunologic dependencies of mast cells and the role they play in both immunity and gastrointestinal disease.
Several studies have noted an increased number of mast cells in the mucosa of patients with gastrointestinal diseases such as irritable bowel syndrome, mastocytic enterocolitis, and systemic mastocytosis. The role of mast cells in the symptomatology of these and other diseases has only recently been fully appreciated and could provide avenues for new therapeutic opportunities. This paper examines studies that have evaluated the role of mast cells in various gastrointestinal diseases.
That's the article written by my gastroenterologist. (Listed as corresponding author.) He had the awareness 3 years ago to biopsy my gut for mast cells (among other things), even though it looked "clean" during my colonoscopy. The biopsy came back positive, with a diagnosis of mastocytic enterocolitis. The rest is history as they say!
Dr. D. would give me updates on his progress with the article during my appointments. He is quite passionate about "getting the word out" to his fellow GI docs about mast cells and GI disease. Seems we have come full circle now, knowing that your GI doc shared the citation with you. Dr. D. will be so happy to learn that your physician shared the article with you.
Julie that's great you have a GI doc that is writing the book on this subject...quite literally. If you have any other articles feel free to post them.
So if I am understanding correctly, blood tests are not enough to determine mast cell activity? It has to be via biopsy, AND the pathologist needs to know how to do it?
So if one blood test showed slightly elevated tryptase, and the next one showed normal levels, this doesn't mean that I don't have mast cell activity.
I don't have a lot of the symptoms you guys have, but I have all the respiratory and eye issues.
I will tell my doc about the article on Friday, when I see him, but I am not having another colonoscopy to get a biopsy sample.
Interesting, though that the GIs are beginning to see the light.
I may be wrong on this (and if I am someone will correct me I hope) but I read either here or elsewhere that the tissue sample taken can still be used to test for mast cell involvement. I'm hoping that's the case as I'm due to visit my GI and I plan to bring the issue up with him.
You're quite correct. Pathologists make a cursory examination of the complete sample, (the "gross" evaluation), and then they prepare a slide from a thin slice of the sample, and use an appropriate stain, before examining it under the microscope. Regardless of what happens to the slides, the rest of the biopsy samples are stored, in case of future needs, so additional new slides can be made at any time, and stained as desired. Here's a description of the process, from the American Cancer Society site:
Routine biopsy processing for histology
After the doctor removes the biopsy specimen, it is placed in a container with formalin (a mixture of water and formaldehyde) or some other fluid to preserve it. The container is labeled with the patient's name and other identifying information (hospital number and birth date, for example), site of biopsy (exactly where on the body it was taken from), and then sent to the pathology lab with a paper called a pathology requisition form. This form also identifies who submitted the biopsy, the date the biopsy was taken, information about the patient's symptoms, other abnormal test results, and what type of disease the doctor expects the biopsy may show.
Next, the pathologist or an assistant looks at the specimen without a microscope. In medicine, gross means seen without a microscope. This is what the pathologist observes by simply looking at, measuring, or feeling the tissue. Looking at the whole sample before it is processed further is called the gross examination and includes the tissue sample's size, color, consistency, and other characteristics. The lab staff may even take a picture of the sample as part of the record. The gross examination is important since the pathologist often sees features that suggest cancer. It also helps the pathologist decide which parts of a large biopsy are the most critical to study under a microscope.
For small biopsies, for example, like a punch biopsy or a core needle biopsy, the entire specimen is usually looked at under a microscope. The tissue to be looked at under the microscope is placed into small containers called cassettes. The cassettes hold the tissue securely while it is processed, and help keep small samples from getting lost. After processing, which may take a few hours but is usually done overnight, the tissue sample is placed into a mold with hot paraffin wax. The wax cools to form a solid block that protects the tissue. This paraffin wax block with the embedded tissue is placed on an instrument called a microtome, which cuts very thin slices of the tissue. These thin slices of the specimen are placed on glass slides, and dipped into a series of stains or dyes to change the color of the tissue. The color makes cells more distinctive when viewed under a microscope. For most biopsy specimens, routine processing as described above is all that is needed. At this point (usually the day after the biopsy was done), the pathologist looks at the tissue under a microscope. Looking at the solid specimens in this way is called histology, which is the study of the structures of cells and tissues.
It is suspected that some of the hardest material known to science can be found in the skulls of GI specialists who insist that diet has nothing to do with the treatment of microscopic colitis.
That's Good to know Tex. In another recent post I had responded that the slides could not be re-stained but I was unaware that they kept the bulk part of the biopsy. It makes a lot of sense though.
I wasn't sure about that, either, so I decided to look it up. I'm not sure how long they keep the samples, but I think they usually keep them for at least several years. Some of the unusual stuff is probably saved indefinitely.
Tex
It is suspected that some of the hardest material known to science can be found in the skulls of GI specialists who insist that diet has nothing to do with the treatment of microscopic colitis.
Visit the Microscopic Colitis Foundation Website
