![]() Care needs to be taken because histological features of chronicity in IBD may be masked in acute relapses or by superimposed infection. This is usually associated with a degree of mucous depletion, which relates to the degree of disease activity reflected by the presence of inflammation, ulceration, degeneration, and regeneration of the mucosa. This is reflected by the degree of acute inflammatory cell infiltrate with or without crypt abscess/cryptitis. In the clinical setting of IBD, this feature favors CD over UC but can be seen in ischemic colitis and radiation injury. Focal Injuryįocal injury occurs when 1 part of the specimen (or 1 fragment) is entirely normal and another part (or another fragment) is abnormal or the abnormality is less than 50% of the specimen size. In the clinical setting of IBD, this feature can be seen in both ulcerative colitis (UC) and Crohn’s disease (CD). This means that the entire or most of the specimen is abnormal. These patterns can be any 1 or a combination of the following: Diffuse Injury Most abnormal colonic mucosal biopsies do not provide a specific etiological diagnosis but rather show a pattern of injury. Issuing an initial pattern-based report with differential diagnosis, followed by a final diagnosis taken in a combined clinico-pathological conference (CPC) environment. Standardizing histopathological terminologies īeing aware of the range of histopathological features in colonic biopsies in inflammatory bowel disease (IBD) patients and the spectrum of “normality” Įncouraging procurement of adequate information for the histopathologist 1 How can this material be best used? We maintain that, in addition to good biopsy specimens, there are 4 important factors that help to ensure clear communication between the pathologist and the treating clinician to reach a more accurate histopathological diagnosis. The continuous development of the colonoscopy technology has enabled clinicians to have a better view of the colon and provided pathologists with more material. IBD, histopathology reporting, new system INTRODUCTION As the paper addresses mucosal biopsies, the entity of indeterminate colitis will not be included in this article as this diagnosis is strictly based on colonic resectate. We discourage the use the term “nonspecific colitis” as we have shown that it has no clinical value or agreed-upon and recognized histopathological features. ![]() If a CPC facility is not available, we offer an alternative evidence-based arrangement. This system carries objective parameters and standardizes reporting to significantly minimize the interobserver variations among reporting pathologists. This type of report offers a working diagnosis for the clinician before the final diagnosis, which is recommended to be undertaken in a setting of combined clinico-pathological conference (CPC). In these cases, the author has initiated a reproducible system of pattern-based reporting with a differential diagnosis. Often the clinical information on the accompanying request form is not available to the pathologist. This article attempts to detail the histological criteria of UC and CD and also informs on a lifelong approach of reporting colonic biopsies from patients with IBD. Colonic biopsies are essential for establishing a diagnosis, monitoring treatment, and/or identifying complications. Crohn’s disease (CD) and ulcerative colitis (UC) are common diseases for convenience, we lump them together as inflammatory bowel disease (IBD). ![]()
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