title: Association of granulomas in mesenteric lymph nodes in Crohn's disease with younger age and transmural inflammation.
abstract: OBJECTIVE
  Mesenteric lymph nodes were usually removed during bowel resection surgery for Crohn's disease (CD). Mesenteric lymph node (MLN) granuloma predicted postoperative disease recurrence in patients with CD after ileocolic resection (ICR). This study was aimed to identify factors associated with MLN granulomas in a cohort of CD patients who underwent ICR.
  
  
  METHODS
  The study group consisted of 18 patients with CD who underwent the index ICR between 2004 and 2012 and had MLN granulomas. The control group included 32 cases negative for MLN granulomas, which were randomly selected from the same period. Clinicodemographic and histological features were compared in these two groups.
  
  
  RESULTS
  The presence of MLN granuloma was associated with younger age, perianal disease, and ileocolic disease. Gender, body mass index, smoking status, disease duration, extraintestinal manifestation, length of bowel resected, total number of nodes examined, medical treatment, and indications for surgery were not significantly different between the groups. The presence of MLN granuloma was associated with mural granuloma, transmural inflammation, mural abscess, hypertrophy of the muscularis propria, fibrosis of the muscularis propria, and serosal fibrosis in the small bowel. The multivariable analysis confirms that MLN granuloma was associated with age and transmural inflammation.
  
  
  CONCLUSIONS
  In CD patients who underwent the index ICR, the presence of MLN granuloma was associated with younger age and transmural inflammation. Our current results suggest that the detection of MLN granulomas may be enhanced in patients at higher risk, that is, younger patients or those with transmural inflammation on imaging or histopathology.
authors.affiliation: Universitätsmedizin, Georg-August-University of Göttingen, Göttingen, Germany.
authors.forename: Xingwen
authors.initials: X
authors.lastname: Sun
authors.affiliation: Department of Anatomic Pathology, Cleveland Clinic Foundation, Cleveland, Ohio, USA.
authors.forename: Lisi
authors.initials: L
authors.lastname: Yuan
authors.affiliation: Department of Colorectal Surgery, Cleveland Clinic Foundation, Cleveland, Ohio, USA.
authors.forename: Yi
authors.initials: Y
authors.lastname: Li
authors.affiliation: Department of Gastroenterology/Hepatology, Cleveland Clinic Foundation, Cleveland, Ohio, USA.
authors.forename: Bo
authors.initials: B
authors.lastname: Shen
authors.affiliation: Department of Internal Medicine, Yale University School of Medicine, New Haven, Connecticut, USA.
authors.forename: Hao
authors.initials: H
authors.lastname: Xie
authors.affiliation: Department of Anatomic Pathology, Cleveland Clinic Foundation, Cleveland, Ohio, USA.
authors.forename: Xiuli
authors.initials: X
authors.lastname: Liu
mesh_terms: D000328:Adult; D000367:Age Factors; D000368:Aged; D015331:Cohort Studies; D003082:Colectomy; D003424:Crohn Disease / Q000209:etiology* / Q000601:surgery*; D005260:Female; D006099:Granuloma / Q000209:etiology* / Q000601:surgery; D006801:Humans; D007082:Ileum / Q000601:surgery; D007249:Inflammation; D008198:Lymph Nodes; D008206:Lymphatic Diseases / Q000209:etiology* / Q000601:surgery; D008297:Male; D008643:Mesentery; D008875:Middle Aged; D012008:Recurrence; D012307:Risk Factors; D055815:Young Adult
keywords: Crohn's disease; fibrosis; granuloma; ileocolic resection; mesenteric lymph node; transmural inflammation