Histology of the Mucosa in Sigmoid Colon Specimens With Diverticular Disease:Observations for the Interpretation of Sigmoid Colonoscopic Biopsy Specimens

Abstract

We examined retrospectively 100 sigmoid colon resection specimens removed for diverticulitis (DD [diverticular diseasel-diverticulitis), 53 adenocarcinoma specimens that also had diverticulosis (DD-adenocarcinoma), and 50 adenocarcinoma specimens that did not have DD (adenocarcinoma only) to study the mucosal changes that occur in DD. Documenting these histologic features could be helpful in deciphering changes seen in colonoscopic biopsy specimens from the sigmoid colon in older patients. Prominent mucosal folds were present in approximately 90% of all DD specimens. Increased mucosal lymphoplasmacytic inflammation at the bases of the prominent folds was present in 15% and 9% of DD-diverticulitis and DD-adenocarcinoma specimens, respectively. Eleven percent of the DD-diverticulitis and 4% of the DD-adenocarcinoma specimens had prolapselike mucosal abnormalities of the mucosa on the surface of the prominent mucosal folds. Mildly Diverticular disease (DD) is common in the sigmoid colon. In Western countries, it affects more than 30% of p e o p l e older than 60 y e a r s .

Origin of symptoms in diverticular disease

“…However, the study reported that there was no correlation with the type or duration of symptoms, endoscopic evidence of mucosal inflammation, or length of colon resected. Despite lack of correlation between symptoms and inflammation, this retrospective work highlights the possible relevance of clinically undetected low-grade colitis 60 or pericolic abscess formation in patients who are chronically symptomatic.…”

Morphologic Basis for Developing Diverticular Disease, Diverticulitis, and Diverticular Bleeding

“…The initial inflammatory histopathologic features of diverticulitis are prominent mucosal folds with mild cryptitis, crypt distortion, mucosal ulcerations, and periostal inflammatory infiltrates composed of lymphocytes, neutrophils, and activated macrophages [ 11 , 12 , 13 ] (fig. 1b ).…”

S2k-Leitlinie Divertikelkrankheit/Divertikulitis

“…Zusätzlich kann ein verengter Divertikelhals zur längeren Retention von keimbelasteten Stuhl im Divertikellumen sowie zur Bildung von Kotsteinen führen, die über eine mechanische Irritation des Divertikelrands Druckulzerationen hervorrufen können [20]. Histopathologisch zeigen sich prominente Schleimhautaufwerfungen mit gestörter Kryptenarchitektur und Kryptitis, Ulzerationen mit lymphozytären und neutrophilen Infiltraten, Fibrosierung der Lamina propria mucosae sowie eine Hyperplasie und Aufsplitterung der Lamina muscularis mucosae [21]. Rezidivierende Entzündungsschübe können langfristig zur lokalen Fibrosierung, Wandverdickung und Stenosierung führen, ggf.…”