Colitis: A Practical Approach to Colon Biopsy Interpretation by Karel Geboes, Sonia Nemolato, Maria Leo, Gavino Faa

By Karel Geboes, Sonia Nemolato, Maria Leo, Gavino Faa

This concise publication explains the way to study endoscopic mucosal biopsies of the colon bought for analysis and persist with up of colitis typically and inflammatory bowel illnesses (ulcerative colitis, Crohn’s ailment and microscopic colitis) particularly. this can be accomplished via the presentation of uncomplicated lesions in a number of drawings including an explanatory textual content and microscopic images. the outline is finished via a assessment of assorted differential diagnostic concerns and kinds of colitis.

Colitis: a pragmatic method of Colon Biopsy Interpretation is aimed toward normal pathologists and pathologists in education and likewise gastroenterologists to aid them know how an actual analysis may be reached.

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Example text

Gland metaplasia (PGM) (synonyms: pseudopyloric gland metaplasia; mucus gland metaplasia) of the terminal ileum is a feature indicative of chronic mucosal inflammation, commonly related to mucosal ulceration and repair. The lesion can be observed in 2–27 % of ileal biopsies from patients with Crohn’s disease. It can also be observed in biopsies from an ileoanal pouch. It is generally accepted that it has not been observed in backwash ileitis associated with ulcerative colitis. It can however occur in other diseases than Crohn’s and has been reported for instance in ileal tuberculosis.

3 Elementary Lesions of Inflammation 29 a b Fig. 2 (a, b) Schematic representation of branching crypts in a perpendicular (a) and transverse section (b) 30 G. Faa et al. a b Fig. 3 (a, b) Architectural changes: variability in the cryptal internal diameter in perpendicular (a) and transverse sections (b) 3 Elementary Lesions of Inflammation a b Fig. 4 (a, b) Architectural changes: variability in the intercryptal distance 31 32 G. Faa et al. a b Fig. 5 (a–d) Architectural changes: deformation of crypts and crypt architectural distortion in perpendicular and transverse section (a, b) and microphotographs (×20 & ×40) of perpendicular sections.

This is however not so for all diseases that can affect the colon. In general, when no guidelines are available, it seems appropriate to take biopsies from lesions but also from noninvolved areas and to submit these samples to the laboratory in separate containers with an indication of the site of origin. All tissue samples should be fixed immediately by immersion in buffered formalin or an equivalent solution prior to transport to the laboratory of pathology. Orientation of the samples using filter paper (submucosal side down) before fixation may yield better results, because it allows perpendicular sections and thus a better assessment of architectural abnormalities.

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