The importance of clinicopathological correlation in the diagnosis of inflammatory conditions of the colon: histological patterns with clinical implications

Abstract

Histological reaction patterns within the colon are not disease-specific but reflect mechanisms of injury and duration of disease. By correlating these patterns with known causes of colonic inflammation, we provide guidelines to enhance the diagnostic value of colonoscopic samples. Normal histological features are reviewed, and the sequence of inflammation and repair is used as the basis for appreciating pathological deviations. The common histological patterns of acute colitis with and without features of pseudomembranous or ischemic colitis and the morphological features of chronic colitis with and without crypt destruction are collated with clinical and endoscopic features to emphasize the importance of dialogue between the pathologist and gastroenterologist. Less common patterns, including eosinophilic colitis, graft-versus-host disease, chronic mucosal prolapse, portal hypertensive colopathy, and nonspecific or idiopathic ulcer, illustrate variations in the basic reaction patterns. Difficulties in differential diagnosis are underscored, and biopsy strategies are suggested.

Inhibitory Effect of Recombinant IL-25 on the Development of Dextran Sulfate Sodium-Induced Experimental Colitis in Mice

“…Histologically, IBDs were characterized by inflammation of the intestinal mucosa with massive infiltration by inflammatory cells (2). Ulcerative colitis was reported to show cytokine profile of Th2 response and to only affect the part of large intestine (3).…”

Clinical value of fecal calprotectin in determining disease activity of ulcerative colitis

“…It is important to accurately evaluate intestinal mucosa infl ammation in the management of these patients, particularly for the assessment of therapeutic effectiveness. Colonoscopy and biopsy are useful in the assessment of intestinal mucosa inflammation of patients with UC, but these examinations can be a heavy burden to the patient [2,3] . Clinical evaluations including laboratory tests such as C-reactive protein (CRP) [4][5][6] , erythrocyte sedimentation rate (ESR) [7] , acid glycoprotein (AGP) [8] , and platelet count [9,10] , have been used for the determination of disease activity of UC, but none of them are specifi c for gut infl ammation [11] .…”

Chronic Diarrhea as the Presenting Complaint of Systemic Lupus Erythematosus in a Man

“…Other causes of diarrhea, including pancreatitis, eosinophilic enteritis, pneumatosis cystoides intestinalis and celiac disease were unlikely given that radiology and intestinal biopsies were noncontributory. The results of the intestinal biopsies performed in our patient were suggestive of lymphocytic colitis, NSAID use or autoimmune disease (11). Infection (bacterial, viral and parasitic) and inflammatory bowel disease are common causes of chronic diarrhea in India, and awareness of this complaint as an initial manifestation of SLE is low.…”