48,479
edits
(+cat.) |
|||
(8 intermediate revisions by the same user not shown) | |||
Line 1: | Line 1: | ||
{{ Infobox diagnosis | |||
| Name = {{PAGENAME}} | |||
| Image = Ulcerative colitis (2) active.jpg | |||
| Width = | |||
| Caption = Active colitis in a case of ulcerative colitis. [[H&E stain]]. | |||
| Synonyms = | |||
| Micro = active changes ([[cryptitis]], [[crypt abscesses]], erosions), chronic changes (architectural distortion, basal plasmacytosis, foveolar metaplasia, Paneth cell metaplasia), lack of [[granulomas]], mucin depletion (common) | |||
| Subtypes = | |||
| LMDDx = [[Crohn's disease]], [[infectious colitis]], [[ischemic colitis]], [[diversion colitis]] | |||
| Stains = | |||
| IHC = | |||
| EM = | |||
| Molecular = | |||
| IF = | |||
| Gross = | |||
| Grossing = | |||
| Site = [[colon]] | |||
| Assdx = [[primary sclerosing cholangitis]], [[toxic megacolon]] | |||
| Syndromes = | |||
| Clinicalhx = +/-FHx of IBD | |||
| Signs = | |||
| Symptoms = +/-diarrhea +/-blood per rectum | |||
| Prevalence = uncommon | |||
| Bloodwork = | |||
| Rads = | |||
| Endoscopy = | |||
| Prognosis = | |||
| Other = | |||
| ClinDDx = other types colitis ([[infectious colitis|infectious]], [[Crohn's disease]], [[ischemic colitis|ischemic]]) | |||
| Tx = medical and/or surgical | |||
}} | |||
'''Ulcerative colitis''', abbreviated '''UC''', is a type of [[inflammatory bowel disease]]. | |||
==General== | |||
*May be associated with ''[[toxic megacolon]]''. | |||
Epidemiology: | |||
*Associated with ''[[primary sclerosing cholangitis]]''. | |||
*[[Appendicitis]] is considered protective against UC.<ref name=pmid19685454>{{Cite journal | last1 = Beaugerie | first1 = L. | last2 = Sokol | first2 = H. | title = Appendicitis, not appendectomy, is protective against ulcerative colitis, both in the general population and first-degree relatives of patients with IBD. | journal = Inflamm Bowel Dis | volume = | issue = | pages = | month = Aug | year = 2009 | doi = 10.1002/ibd.21064 | PMID = 19685454 }}</ref><ref name=pmid19273505>{{Cite journal | last1 = Timmer | first1 = A. | last2 = Obermeier | first2 = F. | title = Reduced risk of ulcerative colitis after appendicectomy. | journal = BMJ | volume = 338 | issue = | pages = b225 | month = | year = 2009 | doi = | PMID = 19273505 }}</ref> | |||
*[[Smoking]] is protective; the opposite is true for [[Crohn's disease]].<ref name=pmid19273505/> | |||
==Gross== | |||
*Conventionally considered to be contiguous, i.e. no "skip lesions", with rectal involvement being most severe. | |||
*Dependent on the study one reads... rectal sparing may be seen in 15% of UC patients.<ref>{{cite journal |author=Bernstein CN, Shanahan F, Anton PA, Weinstein WM |title=Patchiness of mucosal inflammation in treated ulcerative colitis: a prospective study |journal=Gastrointest. Endosc. |volume=42 |issue=3 |pages=232-7 |year=1995 |month=September |pmid=7498688 |doi= |url=}}</ref> | |||
==Microscopic== | |||
Features: | |||
*Inflammation: | |||
**Active: | |||
***Neutrophils: | |||
****Intraepithelial ([[cryptitis]]).† | |||
****Clusters in crypts ([[crypt abscesses]]). | |||
****Erosions. | |||
**Chronic: | |||
***Architectural distortion. | |||
***Basal plasmacytosis. | |||
***Foveolar metaplasia. | |||
***[[Paneth cell metaplasia]] (distal). | |||
**Lack of [[granulomas]]. | |||
*Mucin depletion - common in UC.<ref name=pmid2318990>{{Cite journal | last1 = McCormick | first1 = DA. | last2 = Horton | first2 = LW. | last3 = Mee | first3 = AS. | title = Mucin depletion in inflammatory bowel disease. | journal = J Clin Pathol | volume = 43 | issue = 2 | pages = 143-6 | month = Feb | year = 1990 | doi = | PMID = 2318990 }}</ref> | |||
Notes: | |||
*†Neutrophils are usually numerous in the lamina propria in minimal/mild active inflammation. | |||
*No full wall-thickness inflammation. | |||
*Epithelial apoptosis correlated with inflammation.<ref name=pmid19958058>{{Cite journal | last1 = Seidelin | first1 = JB. | last2 = Nielsen | first2 = OH. | title = Epithelial apoptosis: cause or consequence of ulcerative colitis? | journal = Scand J Gastroenterol | volume = 44 | issue = 12 | pages = 1429-34 | month = | year = 2009 | doi = 10.3109/00365520903301212 | PMID = 19958058 }}</ref> | |||
DDx: | |||
*[[Crohn's disease]]. | |||
*[[Infectious colitis]]. | |||
*[[Ischemic colitis]]. | |||
*[[Diversion colitis]]. | |||
*[[Diverticular disease-associated colitis]]<ref name=pmid12406450>{{Cite journal | last1 = Ludeman | first1 = L. | last2 = Warren | first2 = BF. | last3 = Shepherd | first3 = NA. | title = The pathology of diverticular disease. | journal = Best Pract Res Clin Gastroenterol | volume = 16 | issue = 4 | pages = 543-62 | month = Aug | year = 2002 | doi = | PMID = 12406450 }}</ref> restricted to areas with [[diverticular disease]]. | |||
===Images=== | |||
<gallery> | |||
Image: Ulcerative colitis (2) endoscopic biopsy.jpg | UC. (WC/KGH) | |||
Image: Ulcerative colitis (2) active.jpg | UC. (WC/KGH) | |||
Image: Ulcerative_colitis_(1)_active.jpg | UC. (WC/KGH) | |||
</gallery> | |||
==Sign out== | |||
<pre> | |||
SIGMOID COLON, BIOPSY: | |||
- MODERATE ACTIVE COLITIS WITH CHRONIC CHANGES, SEE COMMENT. | |||
- NEGATIVE FOR DYSPLASIA. | |||
COMMENT: | |||
No granulomata are identified. The sampled mucosa is diffusely inflamed. Crypt drop-out and | |||
architectural distortion are present. | |||
The findings are consistent with inflammatory bowel disease; however, an infectious etiology | |||
should be considered as a possibility. | |||
</pre> | |||
<pre> | |||
SIGMOID COLON, BIOPSY: | |||
- MILD ACTIVE COLITIS, SEE COMMENT. | |||
- NEGATIVE FOR DYSPLASIA. | |||
COMMENT: | |||
No granulomata are identified. | |||
</pre> | |||
<pre> | |||
A. RIGHT COLON, BIOPSY: | |||
- MODERATE ACTIVE COLITIS, SEE COMMENT. | |||
- NEGATIVE FOR DYSPLASIA. | |||
B. LEFT COLON, BIOPSY: | |||
- MODERATE-TO-SEVERE CHRONIC ACTIVE COLITIS, SEE COMMENT. | |||
- NEGATIVE FOR DYSPLASIA. | |||
COMMENT: | |||
No granulomata are identified. The mucosa is diffusely inflamed. Architectural distortion | |||
is present in the left colon. The findings are consistent with ulcerative colitis; | |||
however, an infectious etiology should be considered as a possibility. | |||
</pre> | |||
<pre> | |||
RECTUM, BIOPSY: | |||
- MODERATE DIFFUSE CHRONIC ACTIVE PROCTITIS. | |||
- NEGATIVE FOR DYSPLASIA. | |||
COMMENT: | |||
No definite granulomata are identified. Crypt drop-out is present. | |||
Within the proper clinical context, these are findings of | |||
inflammatory bowel disease. | |||
</pre> | |||
===Inactive disease=== | |||
<pre> | |||
SIGMOID COLON, BIOPSY: | |||
- CHRONIC COLITIS, SEE COMMENT. | |||
- NEGATIVE FOR ACTIVE COLITIS. | |||
- NEGATIVE FOR DYSPLASIA. | |||
COMMENT: | |||
The sections show chronic changes (basal plasmacytosis, marked crypt architectural | |||
distortion, crypt branching); however, no active colitis is present. Also, lamina propria | |||
neutrophils, which are often easy to identify in an active colitis, are not apparent. | |||
Appreciable numbers of lamina propria eosinophils are present and focally intraepithelial. | |||
No granulomas are identified. Clinical correlation is required. | |||
</pre> | |||
===Surveillance=== | |||
<pre> | |||
A. ASCENDING COLON, BIOPSY: | |||
- COLONIC MUCOSA WITHOUT APPARENT PATHOLOGY. | |||
- NEGATIVE FOR ACTIVE COLITIS. | |||
- NEGATIVE FOR DYSPLASIA. | |||
B. TRANSVERSE COLON, BIOPSY: | |||
- COLONIC MUCOSA WITHOUT APPARENT PATHOLOGY. | |||
- NEGATIVE FOR ACTIVE COLITIS. | |||
- NEGATIVE FOR DYSPLASIA. | |||
C. DESCENDING COLON, BIOPSY: | |||
- COLONIC MUCOSA WITHOUT APPARENT PATHOLOGY. | |||
- NEGATIVE FOR ACTIVE COLITIS. | |||
- NEGATIVE FOR DYSPLASIA. | |||
D. SIGMOID COLON, BIOPSY: | |||
- COLONIC MUCOSA WITHOUT APPARENT PATHOLOGY. | |||
- NEGATIVE FOR ACTIVE COLITIS. | |||
- NEGATIVE FOR DYSPLASIA. | |||
E. RECTUM, BIOPSY: | |||
- RECTAL MUCOSA WITHOUT APPARENT PATHOLOGY. | |||
- NEGATIVE FOR ACTIVE PROCTITIS. | |||
- NEGATIVE FOR DYSPLASIA. | |||
COMMENT: | |||
Morphologically benign lymphoid aggregates are found focally. No granulomas are | |||
identified. Minimal architectural changes are seen focally. | |||
</pre> | |||
<pre> | |||
A. CECUM, BIOPSY: | |||
- QUIESCENT INFLAMMATORY BOWEL DISEASE. | |||
- NEGATIVE FOR DYSPLASIA. | |||
B. ASCENDING COLON, BIOPSY: | |||
- QUIESCENT INFLAMMATORY BOWEL DISEASE. | |||
- NEGATIVE FOR DYSPLASIA. | |||
C. COLON, HEPATIC FLEXURE, BIOPSY, | |||
- QUIESCENT INFLAMMATORY BOWEL DISEASE. | |||
- NEGATIVE FOR DYSPLASIA. | |||
D. TRANSVERSE COLON, BIOPSY: | |||
- QUIESCENT INFLAMMATORY BOWEL DISEASE. | |||
- NEGATIVE FOR DYSPLASIA. | |||
E. COLON, SPLENIC FLEXURE, BIOPSY: | |||
- QUIESCENT INFLAMMATORY BOWEL DISEASE. | |||
- NEGATIVE FOR DYSPLASIA. | |||
F. DESCENDING COLON, BIOPSY: | |||
- QUIESCENT INFLAMMATORY BOWEL DISEASE. | |||
- NEGATIVE FOR DYSPLASIA. | |||
G. SIGMOID COLON, BIOPSY: | |||
- QUIESCENT INFLAMMATORY BOWEL DISEASE. | |||
- NEGATIVE FOR DYSPLASIA. | |||
H. RECTUM, BIOPSY: | |||
- QUIESCENT INFLAMMATORY BOWEL DISEASE. | |||
- NEGATIVE FOR DYSPLASIA. | |||
COMMENT: | |||
No granulomas are identified. Mild architectural distortion is present. No active | |||
inflammation is identified. Scattered mucosal lymphoid nodules with germinal center | |||
formation are present. | |||
</pre> | |||
===Granulomas and inflamed crypts - clinically UC=== | |||
<pre> | |||
A. CECUM, BIOPSY: | |||
- ACTIVE CECITIS, MILD. | |||
- SMALL MUCOSAL GRANULOMAS, SUPERFICIAL, SEE COMMENT. | |||
- NEGATIVE FOR DYSPLASIA. | |||
... | |||
COMMENT - PART A: | |||
The small granulomas are mucosal and near, but not all adjacent to, inflamed crypts; this | |||
finding raises the possibility of Crohn's disease. It should be noted that mucosal | |||
granulomas may be seen in ulcerative colitis beside inflamed crypts. | |||
COMMENT - GENERAL: | |||
The inflammation is diffuse and chronic changes are seen throughout. Distal paneth cell | |||
metaplasia is present. The diffuse nature of the inflammation would be more in keeping with | |||
ulcerative colitis. Clinical correlation is required. | |||
</pre> | |||
===Micro=== | |||
The sections show focal intraepithelial neutrophils (cryptitis). No crypt abscesses are identified. Granulation tissue is present. There is focal Paneth cell metaplasia and foveolar metaplasia. No granulomata are identified. | |||
==See also== | |||
*[[Inflammatory bowel disease]]. | |||
*[[Crohn's disease]]. | |||
*[[Invisible colonic dysplasia]]. | |||
==References== | |||
{{Reflist|2}} | |||
[[Category:Diagnosis]] | [[Category:Diagnosis]] | ||
[[Category:Gastrointestinal pathology]] |
edits