{"id":47347,"date":"2026-07-29T22:58:56","date_gmt":"2026-07-29T14:58:56","guid":{"rendered":"https:\/\/medicine.nus.edu.sg\/pathweb\/?page_id=47347"},"modified":"2026-08-08T21:22:44","modified_gmt":"2026-08-08T13:22:44","slug":"gitgc-1","status":"publish","type":"page","link":"https:\/\/medicine.nus.edu.sg\/pathweb\/short-cases\/gitgc-1\/","title":{"rendered":"Short cases &#8211; GIT case 1"},"content":{"rendered":"\n<h2>\n\t\t\tGIT case 1\t<\/h2>\n\t<p><em>Case writer: Dr Ooi Li Yin<\/em><\/p>\n\t<p><strong>Clinical history:<\/strong><\/p>\n<ul>\n<li>\n79M gentleman originally from Myanmar, lived in Singapore for past 10 years.\n<\/li>\n<li>\nPresented with positive Faecal Immunochemical Test (FIT). Asymptomatic otherwise.\n<\/li>\n<li>\nColonoscopy shows an ulcer in the caecum\n<\/li>\n<li>\nAn endoscopic mucosal biopsy of the caecum is performed.\n<\/li>\n<li>What are the histologic findings?<\/li>\n<li>What are your differential diagnoses?<\/li>\n<li>What clinical information would be helpful in your diagnostic workup?<\/li>\n<li>What ancillary tests would you do?<\/li>\n<\/ul>\n\n<figure itemscope itemtype=\"https:\/\/schema.org\/ImageObject\">\n\t\t\t\t<a href=\"https:\/\/medicine.nus.edu.sg\/pathweb\/wp-content\/uploads\/2026\/07\/GITC4.png\"  target=\"_self\" itemprop=\"url\">\n\t\t\t\t<img decoding=\"async\" src=\"https:\/\/medicine.nus.edu.sg\/pathweb\/wp-content\/uploads\/2026\/07\/GITC4-1024x912.png\" alt=\"GITC4\" height=\"570\" width=\"640\" title=\"GITC4\" onerror=\"this.style.display='none'\" loading=\"lazy\" \/>\n\t\t\t\t<\/a>\n\t<\/figure>\n<figure itemscope itemtype=\"https:\/\/schema.org\/ImageObject\">\n\t\t\t\t<a href=\"https:\/\/medicine.nus.edu.sg\/pathweb\/wp-content\/uploads\/2026\/07\/GITC1-1-scaled.png\"  target=\"_self\" itemprop=\"url\">\n\t\t\t\t<img decoding=\"async\" src=\"https:\/\/medicine.nus.edu.sg\/pathweb\/wp-content\/uploads\/2026\/07\/GITC1-1-1024x752.png\" alt=\"GITC1\" height=\"470\" width=\"640\" title=\"GITC1\" onerror=\"this.style.display='none'\" loading=\"lazy\" \/>\n\t\t\t\t<\/a>\n\t<\/figure>\n<figure itemscope itemtype=\"https:\/\/schema.org\/ImageObject\">\n\t\t\t\t<a href=\"https:\/\/medicine.nus.edu.sg\/pathweb\/wp-content\/uploads\/2026\/07\/GITC2-scaled.png\"  target=\"_self\" itemprop=\"url\">\n\t\t\t\t<img decoding=\"async\" src=\"https:\/\/medicine.nus.edu.sg\/pathweb\/wp-content\/uploads\/2026\/07\/GITC2-1024x769.png\" alt=\"GITC2\" height=\"481\" width=\"640\" title=\"GITC2\" onerror=\"this.style.display='none'\" loading=\"lazy\" \/>\n\t\t\t\t<\/a>\n\t<\/figure>\n<figure itemscope itemtype=\"https:\/\/schema.org\/ImageObject\">\n\t\t\t\t<a href=\"https:\/\/medicine.nus.edu.sg\/pathweb\/wp-content\/uploads\/2026\/07\/GITC3-scaled.png\"  target=\"_self\" itemprop=\"url\">\n\t\t\t\t<img decoding=\"async\" src=\"https:\/\/medicine.nus.edu.sg\/pathweb\/wp-content\/uploads\/2026\/07\/GITC3-1024x771.png\" alt=\"GITC3\" height=\"482\" width=\"640\" title=\"GITC3\" onerror=\"this.style.display='none'\" loading=\"lazy\" \/>\n\t\t\t\t<\/a>\n\t<\/figure>\n\t<p>Click picture to enlarge<\/p>\n\t\t\t\t\t<a role=\"heading\" aria-level=\"2\" tabindex=\"-1\"  id=\"fl-accordion--label-0\">Histologic findings <\/a>\n\t\t\t\t\t\t\t\t\t\t\t<button type=\"button\" id=\"fl-accordion--icon-0\" aria-expanded=\"false\" aria-controls=\"fl-accordion--panel-0\"><i>Expand<\/i><\/button>\n\t\t\t\t\t<p>&nbsp;<\/p>\n<table>\n<tbody>\n<tr>\n<td><img loading=\"lazy\" decoding=\"async\" src=\"https:\/\/medicine.nus.edu.sg\/pathweb\/wp-content\/uploads\/2026\/07\/GITC5.png\" alt=\"\" width=\"2288\" height=\"1722\" \/><\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n<ul>\n<li>Non-neoplastic colonic mucosal fragment with ulceration, active (neutrophilic) inflammation, and increased chronic inflammatory cells<\/li>\n<li>The necrotic debris on the luminal surface contains aggregates of oval-shaped organisms that resemble macrophages<\/li>\n<li>The organisms contain abundant pale, vacuolated cytoplasm and small central round nuclei<\/li>\n<li>Erythrophagocytosis is evident (arrows)<\/li>\n<li>Colonoscopy shows an ulcer with yellowish exudates<\/li>\n<\/ul>\n\t\t\t\t\t<a role=\"heading\" aria-level=\"2\" tabindex=\"-1\"  id=\"fl-accordion--label-1\">Differential Diagnoses<\/a>\n\t\t\t\t\t\t\t\t\t\t\t<button type=\"button\" id=\"fl-accordion--icon-1\" aria-expanded=\"false\" aria-controls=\"fl-accordion--panel-1\"><i>Expand<\/i><\/button>\n\t\t\t\t\t<p>&nbsp;<\/p>\n\n<p>In a colonic biopsy with ulceration, the main differential diagnoses are:<\/p>\n<ul>\n<li>Infection (e.g. bacterial, viral, parasitic\/protozoal)<\/li>\n<li>Inflammatory bowel disease (look for features of chronicity: crypt distortion, epithelial metaplasia, basal plasmacytosis)<\/li>\n<li>Drug-induced injury (e.g. NSAIDs, mycophenolate, immune checkpoint inhibitors; correlate with medication history)<\/li>\n<li>Ischaemia (look for withered crypts, lamina propria hyalinization; consider in elderly patients or history of vascular compromise)<\/li>\n<li>Hence, it would be helpful to know of history of travel to endemic areas, underlying conditions or medication, as well as possible immunocompromised state<\/li>\n<\/ul>\n<p>The following infective causes may show histological clues:<\/p>\n<p><img decoding=\"async\" src=\"https:\/\/medicine.nus.edu.sg\/pathweb\/wp-content\/uploads\/2026\/07\/GITC6-scaled.png\" alt=\"\" \/><\/p>\n\t\t\t\t\t<a role=\"heading\" aria-level=\"2\" tabindex=\"-1\"  id=\"fl-accordion--label-2\">Ancillary Tests <\/a>\n\t\t\t\t\t\t\t\t\t\t\t<button type=\"button\" id=\"fl-accordion--icon-2\" aria-expanded=\"false\" aria-controls=\"fl-accordion--panel-2\"><i>Expand<\/i><\/button>\n\t\t\t\t\t\n<p>&nbsp;<\/p>\n<p><img decoding=\"async\" src=\"https:\/\/medicine.nus.edu.sg\/pathweb\/wp-content\/uploads\/2026\/07\/GITC7.png\" alt=\"\" \/><\/p>\n<p>&nbsp;<\/p>\n<ul>\n<li>\nPAS stain highlights round to oval trophozoites clustered within necrotic debris. The organisms show abundant magenta granular cytoplasm due to glycogen-rich cytoplasm, measuring approximately 15-30 \u03bcm.\n<\/li>\n<li>\nThe findings are those of <i>Entamoeba histolytica <\/i>trophozoites\n<\/li>\n<li>\nCMV immunohistochemical stain was negative.\n<\/li>\n<li>\nPAS and CMV are helpful ancillary tests in colonic ulcers.\n<\/li>\n<\/ul>\n\t\t\t\t\t<a role=\"heading\" aria-level=\"2\" tabindex=\"-1\"  id=\"fl-accordion--label-3\">Diagnosis and Learning Points <\/a>\n\t\t\t\t\t\t\t\t\t\t\t<button type=\"button\" id=\"fl-accordion--icon-3\" aria-expanded=\"false\" aria-controls=\"fl-accordion--panel-3\"><i>Expand<\/i><\/button>\n\t\t\t\t\t<p>&nbsp;<\/p>\n\n<p><u><b>Diagnosis<\/b><\/u><\/p>\n<ul>\n<li>Colonic ulcer with <i>Entamoeba histolytica<\/i> trophozoites, consistent with amoebic colitis<\/li>\n<\/ul>\n<p>Note: Serological testing detected the presence of amoebic antibody. The patient was treated with metronidazole and paromomycin, with complete resolution of the caecal ulcer\u00a0on repeat colonoscopy 6 months later.<\/p>\n<p><u><b>Learning Points<\/b><\/u><\/p>\n<ul>\n<li>Amoebic colitis may occur anywhere, being more common in tropical regions<\/li>\n<li>It is caused by <i>Entamoeba histolytica<\/i><\/li>\n<li>It typically affects the\u00a0 right-sided colon, followed by the rectosigmoid colon<\/li>\n<li>Patients may be asymptomatic, or may present with diarrhoea<\/li>\n<li>Endoscopically and radiologically, the affected colon shows ulcers with yellowish exudates and skip lesions, and the wall may be thickened, potentially mimicking malignancy (amoeboma)<\/li>\n<li>Histological diagnosis relies on\u00a0the identification of <i>Entamoeba histolytica<\/i> trophozoites, usually found within ulcer slough or granulation tissue. PAS highlights the trophozoite cytoplasm but is not specific. Erythrophagocytosis (ingested RBCs) is the hallmark feature that distinguishes <i>Entamoeba histolytica<\/i> from non-pathogenic amoebae. Correlation with stool PCR, stool antigen testing, or serology\u00a0can be helpful.<\/li>\n<li>Appropriate anti-amoebic therapy (e.g. metronidazole followed by a luminal agent) usually results in resolution<\/li>\n<\/ul>\n\n\n","protected":false},"excerpt":{"rendered":"<p>GIT case 1 Case writer: Dr Ooi Li Yin Clinical history: 79M gentleman originally from Myanmar, lived in Singapore for past 10 years. Presented with positive Faecal Immunochemical Test (FIT). Asymptomatic otherwise. Colonoscopy shows an ulcer in the caecum An endoscopic mucosal biopsy of the caecum is performed. What are the histologic findings? What are [&hellip;]<\/p>\n","protected":false},"author":828,"featured_media":0,"parent":47288,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"","meta":{"_acf_changed":false,"footnotes":""},"class_list":["post-47347","page","type-page","status-publish","hentry"],"acf":[],"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v25.4 - https:\/\/yoast.com\/wordpress\/plugins\/seo\/ -->\n<title>NUS Pathweb<\/title>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" href=\"https:\/\/medicine.nus.edu.sg\/pathweb\/short-cases\/gitgc-1\/\" \/>\n<meta property=\"og:locale\" content=\"en_US\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:description\" content=\"GIT case 1 Case writer: Dr Ooi Li Yin Clinical history: 79M gentleman originally from Myanmar, lived in Singapore for past 10 years. 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