Colitis

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Author: Mikael Häggström [note 1]

Comprehensiveness

On this resource, the following formatting is used for comprehensiveness:

  • Minimal depth
  • (Moderate depth)
  • ((Comprehensive))

Microscopic evaluation

  • Look for signs of active (or acute) and/or chronic colitis:

Signs of active (or acute) colitis:[1]

Active colitis may also cause ischemic changes (including superficial necrosis, hemorrhage, crypt shrinkage/dropout, fibrin thrombi)

Signs of chronic colitis:[1]

Chronic colitis may also cause elevation of crypts relative to the muscularis mucosa. Other findings include basal plasmacytosis and mucin depletion.[1]

In addition, look for the following types of colitis:

(Consider the clinical and/or endoscopic findings in the evaluation.)

Further workup of colitis

Distinguish:

  • (Severity: Mild, moderate or severe.)
  • Presence of crypt regeneration, granuloma, inflammatory pseudomembranes, parasites or viral inclusions.
  • Presence of epithelial dysplasia or even cancer. If unsure of the latter, consider immunohistochemistry for cytokeratins such as CK AE1/AE3. Further information: Evaluation of suspected malignancies
  • ((Distribution: Patchy versus diffuse))

Apart from histologically defined diagnoses (collagenous colitis, lymphocytic colitis), there is no need to speculate about the exact underlying diagnosis (such as Crohn's disease, ulcerative colitis etc.).

Microscopy report

A biopsy report generally does not state the diagnosis, but should state any presence of chronic colitis, give an indication of disease activity, as well as state the presence of any epithelial damage (erosions and ulcerations).[1]

Example of a normal sample, when colitis was suspected in the referral:

( Optionally: Colonic/Rectal mucosa without significant histopathologic changes.) Negative for acute and chronic colitis.

Example of findings of both active and chronic colitis:

(Ascending, transverse, descending, and sigmoid colon, biopsies:) ((Patchy)) (mild) chronic active colitis((, with associated cryptitis and crypt abscesses.)) (Negative for ulceration, granulomata and dysplasia.)

Notes

  1. For a full list of contributors, see article history. Creators of images are attributed at the image description pages, seen by clicking on the images. See Patholines:Authorship for details.

Main page

References

  1. 1.0 1.1 1.2 1.3 Kellermann L, Riis LB. (2021). "A close view on histopathological changes in inflammatory bowel disease, a narrative review. ". Dig Med Res 4 (3). Archived from the original. . 
  2. Martha M. Yearsley, M.D.. Lymphocytic colitis. Pathology Outlines. Last author update: 28 July 2020
  3. Benjamin J. Van Treeck, M.D., Catherine E. Hagen, M.D.. Collagenous colitis. Pathology Outlines. Topic Completed: 3 August 2020. Minor changes: 29 September 2020

Image sources