Colitis: Difference between revisions

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{{Comprehensiveness}}
{{Comprehensiveness}}
==Microscopic evaluation==
==Microscopic evaluation==
[[File:Histopathology of collagenous colitis.jpg|thumb|200px|Also look for '''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:Histopathology of a crypt abscess.jpg|thumb|190px|Crypt abscess: neutrophils in the crypt lumen.]]
*Look for signs of '''active''' (or acute) and/or '''chronic''' colitis:
*Look for signs of '''active''' (or acute) and/or '''chronic''' colitis:


Signs of '''active''' (or acute) colitis:
Signs of '''active''' (or acute) colitis:<ref name=Kellermann2021/>
*Neutrophilic cryptitis
<gallery mode=packed heights=170>
*Neutrophilic crypt abscesses
File:Histopathology of neutrophilic cryptitis in active colitis, annotated.jpg|Neutrophilic cryptitis (neutrophils within crypt epithelium)
*Ulceration or granulation tissue
File:Histopathology of a crypt abscess.jpg|Crypt abscesses (luminal neutrophilic aggregates)
*Ischemic changes (including superficial necrosis, hemorrhage, crypt shrinkage/dropout, fibrin thrombi)
File:Histopathology of small crypt abscess.jpg|In fact, one neutrophil is enough for the feature
File:Histopathology of a mucosal fold.jpg|Normal mucosal fold for comparison
File:Histopathology of gland destruction in active colitis.jpg|Gland destruction
File:Histopathology of colonic ulceration.jpg|Ulceration (seen here as absence of epithelium, granulation tissue with many fibroblasts)
</gallery>
Active colitis may also cause ischemic changes (including superficial necrosis, hemorrhage, crypt shrinkage/dropout, fibrin thrombi)


Signs of '''chronic''' colitis:
Signs of '''chronic''' colitis:<ref name=Kellermann2021/>
*Abnormal crypt orientation
<gallery mode=packed heights=170>
*Abnormal crypt branching
File:Histopathology of a degenerated crypt of chronic inactive colitis.jpg|Crypt degeneration
*Paneth cell or gastric metaplasia (only applies in the left colon and rectum)
File:Histopathology of colonic crypt branching.jpg|Crypt branching and other architectural distortions
*Elevation of crypts relative to the muscularis mucosa
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/>


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 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.
</gallery>
{{Moderate-begin}}Consider the clinical and/or endoscopic findings in the evaluation.{{Moderate-end}}
{{Moderate-begin}}Consider the clinical and/or endoscopic findings in the evaluation.{{Moderate-end}}


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*Presence of '''crypt regeneration''', '''granuloma''', inflammatory '''pseudomembranes''', '''parasites''', '''viral inclusions''' or '''epithelial dysplasia'''.
*Presence of '''crypt regeneration''', '''granuloma''', inflammatory '''pseudomembranes''', '''parasites''', '''viral inclusions''' or '''epithelial dysplasia'''.
*{{Moderate-begin}}Distribution: '''Patchy''' versus '''diffuse'''{{Moderate-end}}
*{{Moderate-begin}}Distribution: '''Patchy''' versus '''diffuse'''{{Moderate-end}}
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===
===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).<ref name=Kellermann2021>{{cite journal|author=Kellermann L, Riis LB.|title=A close view on histopathological changes in inflammatory bowel disease, a narrative review.|journal=Dig Med Res|year=2021|volume=4|issue=3|url=https://dmr.amegroups.org/article/view/7171/html}}</ref>
Example of a normal sample, when colitis was suspected in the referral:
Example of a normal sample, when colitis was suspected in the referral:
{|class=wikitable
{|class=wikitable

Revision as of 12:21, 3 October 2023

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]

  • Neutrophilic cryptitis (neutrophils within crypt epithelium)
    Neutrophilic cryptitis (neutrophils within crypt epithelium)
  • Crypt abscesses (luminal neutrophilic aggregates)
    Crypt abscesses (luminal neutrophilic aggregates)
  • In fact, one neutrophil is enough for the feature
    In fact, one neutrophil is enough for the feature
  • Normal mucosal fold for comparison
    Normal mucosal fold for comparison
  • Gland destruction
    Gland destruction
  • Ulceration (seen here as absence of epithelium, granulation tissue with many fibroblasts)
    Ulceration (seen here as absence of epithelium, granulation tissue with many fibroblasts)

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

Signs of chronic colitis:[1]

  • Crypt degeneration
    Crypt degeneration
  • Crypt branching and other architectural distortions
    Crypt branching and other architectural distortions
  • Error creating thumbnail:
    Paneth cell (pictured) or gastric metaplasia (only applies in the left colon and rectum)

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, viral inclusions or epithelial dysplasia.
  • (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:) 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


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