Colitis: Difference between revisions

(7 intermediate revisions by the same user not shown)

Line 1:

{{Top

<noinclude>{{Top

|author1=[[User:Mikael Häggström|Mikael Häggström]]

|author2=

}}

Most commonly found by [[endoscopic gastrointestinal biopsies]].

{{Comprehensiveness}}</noinclude>

==Microscopic evaluation==

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

Line 23:

File:Histopathology of a degenerated crypt of chronic inactive colitis.jpg|Crypt degeneration

File:Histopathology of crypt branching of colon.jpg|Crypt branching and other architectural distortions

File:Histopathology Paneth cell metaplasia.jpg|[[Paneth cell]] (pictured) or gastric metaplasia (only applies in the left colon and rectum)

File:Histopathology Paneth cell metaplasia.jpg|Paneth cell (pictured) or gastric metaplasia (only applies in the left colon and rectum)

</gallery>

Chronic colitis may also cause elevation of crypts relative to the muscularis mucosa. Other findings include basal plasmacytosis and mucin depletion.<ref name=Kellermann2021/>

Have a high threshold for chronic colitis in the '''rectum''', as it often shows chronic changes even without any disease.

===Special types===

In addition, look for the following types of colitis:

File:Histopathology of lymphocytic colitis, high magnification.png|'''Lymphocytic colitis''', characterized by > 20 intraepithelial lymphocytes per 100 epithelial cells, away from lymphoid aggregates.<ref>{{cite web|url=https://www.pathologyoutlines.com/topic/colonlymphocytic.html|title=Lymphocytic colitis|author=Martha M. Yearsley, M.D.|website=Pathology Outlines}} Last author update: 28 July 2020</ref>

File:Histopathology of lymphocytic colitis, low magnification.png|'''Lymphocytic colitis''' also shows increased lymphocytes, plasma cells, eosinophils, and occasional neutrophils in lamina propria, but with preserved architecture

File:Histopathology of lymphocytic colitis, low magnification.png|'''Lymphocytic colitis''' generally also shows increased lymphocytes, plasma cells, eosinophils, and occasional neutrophils in lamina propria, but with preserved architecture

File:Histopathology of collagenous colitis.jpg|'''Collagenous colitis''', with a thickened subepithelial collagen band that is typically more than 10 μm in thickness.<ref>{{cite web|url=https://www.pathologyoutlines.com/topic/coloncollagenous.html|website=Pathology Outlines|title=Collagenous colitis|author=Benjamin J. Van Treeck, M.D., Catherine E. Hagen, M.D.}} Topic Completed: 3 August 2020. Minor changes: 29 September 2020</ref>

File:Histology of a normal colonic mucosal epithelium.jpg|Compare to normal colonic mucosa, which can have a band of basal epithelial cytoplasm.

Line 48:

Line 51:

</gallery>

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.).

{| class="wikitable"

|+ Histologic activity in ulcerative colitis

! Feature

! Mild activity

! Moderate activity

! Severe activity

|-

! Example images

| [[File:Histopathology of neutrophilic cryptitis in active colitis, annotated.jpg|150px]]

| [[File:Histopathology of gland destruction in active colitis.jpg|150px]]

| [[File:Histopathology of severe ulcerative colitis.jpg|150px]]

|-

! Neutrophilic inflammation

| Scattered or focal neutrophils

| Multifocal or relatively diffuse neutrophilic inflammation

| Marked, diffuse neutrophilic inflammation

|-

! Cryptitis

| Focal; few crypts involved

| Multifocal; numerous crypts involved

| Widespread, often with destructive crypt injury

|-

! Crypt abscesses

| Absent or rare

| Readily identified; may be multiple

| Numerous and widespread

|-

! Surface epithelial injury

| Minimal or absent

| Definite epithelial attenuation or injury

| Extensive epithelial destruction

|-

! Erosion

| Usually absent; may be very focal

| May be present

| Common, often adjacent to ulceration

|-

! Ulceration

| Absent

| Absent in most grading systems

| Present, with mucosal loss and granulation tissue

|-

! Crypt loss or destruction

| Minimal

| Focal active crypt destruction may be present

| Extensive crypt loss or destruction

|-

! Fibrinopurulent exudate

| Absent or minimal

| May be focal

| Prominent, particularly over ulcerated mucosa

|-

! Practical interpretation

| Limited active inflammation with preserved mucosal surface

| Increased and multifocal active inflammation without definite ulceration

| Ulceration and substantial mucosal destruction

|}

===Microscopy report===

Line 54:

Line 114:

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

{|class=wikitable

| {{Moderate-begin}} ~~Optionally:~~ Colonic/Rectal mucosa without significant histopathologic changes.{{Moderate-end}} Negative for acute and chronic colitis.

| {{Moderate-begin}}Colonic/Rectal mucosa without significant histopathologic changes.{{Moderate-end}} Negative for {{Moderate-begin}}acute and chronic{{Moderate-end}} colitis.

|}

Line 60:

Line 120:

{|class=wikitable

| {{Moderate-begin}}Ascending, transverse, descending, and sigmoid colon, biopsies:{{Moderate-end}} {{Comprehensive-begin}}Patchy{{Comprehensive-end}} {{Moderate-begin}}mild{{Moderate-end}} chronic active colitis{{Comprehensive-begin}}, with associated cryptitis and crypt abscesses.{{Comprehensive-end}} {{Moderate-begin}}Negative for ulceration, granulomata and dysplasia.{{Moderate-end}}

|}

|}<noinclude>

{{Bottom}}</noinclude>

@@ Line 1: / Line 1: @@
-{{Top
+<noinclude>{{Top
 |author1=[[User:Mikael Häggström|Mikael Häggström]]
 |author2=
 }}
+Most commonly found by [[endoscopic gastrointestinal biopsies]].
-{{Comprehensiveness}}
+{{Comprehensiveness}}</noinclude>
 ==Microscopic evaluation==
 *Look for signs of '''active''' (or acute) and/or '''chronic''' colitis:
@@ Line 23: / Line 23: @@
 File:Histopathology of a degenerated crypt of chronic inactive colitis.jpg|Crypt degeneration
 File:Histopathology of crypt branching of colon.jpg|Crypt branching and other architectural distortions
-File:Histopathology Paneth cell metaplasia.jpg|[[Paneth cell]] (pictured) or gastric metaplasia (only applies in the left colon and rectum)
+File:Histopathology Paneth cell metaplasia.jpg|Paneth cell (pictured) or gastric metaplasia (only applies in the left colon and rectum)
 </gallery>
 Chronic colitis may also cause elevation of crypts relative to the muscularis mucosa. Other findings include basal plasmacytosis and mucin depletion.<ref name=Kellermann2021/>
+Have a high threshold for chronic colitis in the '''rectum''', as it often shows chronic changes even without any disease.
+===Special types===
 In addition, look for the following types of colitis:
 <gallery mode=packed heights=170>
 File:Histopathology of lymphocytic colitis, high magnification.png|'''Lymphocytic colitis''', characterized by > 20 intraepithelial lymphocytes per 100 epithelial cells, away from lymphoid aggregates.<ref>{{cite web|url=https://www.pathologyoutlines.com/topic/colonlymphocytic.html|title=Lymphocytic colitis|author=Martha M. Yearsley, M.D.|website=Pathology Outlines}} Last author update: 28 July 2020</ref>
-File:Histopathology of lymphocytic colitis, low magnification.png|'''Lymphocytic colitis''' also shows increased lymphocytes, plasma cells, eosinophils, and occasional neutrophils in lamina propria, but with preserved architecture
+File:Histopathology of lymphocytic colitis, low magnification.png|'''Lymphocytic colitis''' generally also shows increased lymphocytes, plasma cells, eosinophils, and occasional neutrophils in lamina propria, but with preserved architecture
 File:Histopathology of collagenous colitis.jpg|'''Collagenous colitis''', with a thickened subepithelial collagen band that is typically more than 10 μm in thickness.<ref>{{cite web|url=https://www.pathologyoutlines.com/topic/coloncollagenous.html|website=Pathology Outlines|title=Collagenous colitis|author=Benjamin J. Van Treeck, M.D., Catherine E. Hagen, M.D.}} Topic Completed: 3 August 2020. Minor changes: 29 September 2020</ref>
 File:Histology of a normal colonic mucosal epithelium.jpg|Compare to normal colonic mucosa, which can have a band of basal epithelial cytoplasm.
@@ Line 48: / Line 51: @@
 </gallery>
 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.).
+{| class="wikitable"
+|+ Histologic activity in ulcerative colitis
+! Feature
+! Mild activity
+! Moderate activity
+! Severe activity
+|-
+! Example images
+| [[File:Histopathology of neutrophilic cryptitis in active colitis, annotated.jpg|150px]]
+| [[File:Histopathology of gland destruction in active colitis.jpg|150px]]
+| [[File:Histopathology of severe ulcerative colitis.jpg|150px]]
+|-
+! Neutrophilic inflammation
+| Scattered or focal neutrophils
+| Multifocal or relatively diffuse neutrophilic inflammation
+| Marked, diffuse neutrophilic inflammation
+|-
+! Cryptitis
+| Focal; few crypts involved
+| Multifocal; numerous crypts involved
+| Widespread, often with destructive crypt injury
+|-
+! Crypt abscesses
+| Absent or rare
+| Readily identified; may be multiple
+| Numerous and widespread
+|-
+! Surface epithelial injury
+| Minimal or absent
+| Definite epithelial attenuation or injury
+| Extensive epithelial destruction
+|-
+! Erosion
+| Usually absent; may be very focal
+| May be present
+| Common, often adjacent to ulceration
+|-
+! Ulceration
+| Absent
+| Absent in most grading systems
+| Present, with mucosal loss and granulation tissue
+|-
+! Crypt loss or destruction
+| Minimal
+| Focal active crypt destruction may be present
+| Extensive crypt loss or destruction
+|-
+! Fibrinopurulent exudate
+| Absent or minimal
+| May be focal
+| Prominent, particularly over ulcerated mucosa
+|-
+! Practical interpretation
+| Limited active inflammation with preserved mucosal surface
+| Increased and multifocal active inflammation without definite ulceration
+| Ulceration and substantial mucosal destruction
+|}
 ===Microscopy report===
@@ Line 54: / Line 114: @@
 Example of a normal sample, when colitis was suspected in the referral:
 {|class=wikitable
-| {{Moderate-begin}} Optionally: Colonic/Rectal mucosa without significant histopathologic changes.{{Moderate-end}} Negative for acute and chronic colitis.
+| {{Moderate-begin}}Colonic/Rectal mucosa without significant histopathologic changes.{{Moderate-end}} Negative for {{Moderate-begin}}acute and chronic{{Moderate-end}} colitis.
 |}
@@ Line 60: / Line 120: @@
 {|class=wikitable
 | {{Moderate-begin}}Ascending, transverse, descending, and sigmoid colon, biopsies:{{Moderate-end}} {{Comprehensive-begin}}Patchy{{Comprehensive-end}} {{Moderate-begin}}mild{{Moderate-end}} chronic active colitis{{Comprehensive-begin}}, with associated cryptitis and crypt abscesses.{{Comprehensive-end}} {{Moderate-begin}}Negative for ulceration, granulomata and dysplasia.{{Moderate-end}}
-|}
+|}<noinclude>
-{{Bottom}}
+{{Bottom}}</noinclude>

Colitis: Difference between revisions

Navigation menu

Search