Talk:Inflammatory bowel disease

Crohn's disease

Microscopic description

A. The sections show small bowel mucosa with well-formed, non-caseating granuloma. There is cryptitis, villous blunting, focal crypt abscess, mucosal ulceration, and crypt loss.

B. The sections shows colonic-type mucosa with a non-caseating granuloma and cryptitis.

C-D. The sections show colonic-type mucosa with patchy inflammation. There are foci of cryptitis, edema and mild architectural changes.

E-H. The sections show colonic-type mucosa with focal Paneth cell metaplasia and mild architectural changes including crypt elongation and crypt drop-out.

Final diagnosis

A. Terminal ileum, biopsy - Moderate granulomatous ilietis. B. Ileal-cecal valve, biopsy - Mild active granulomatous ileal-cecal valve-itis. C. Cecum, biopsy - Mild patchy active colitis. D. Ascending colon, biopsy - Mild patchy active colitis. E. Transverse colon, biopsy - Chronic inflammatory changes. No active colitis. F. Descending colon, biopsy - Chronic inflammatory changes. No active colitis. G. Sigmoid colon, biopsy - Chronic inflammatory changes. No active colitis. H. Rectum, biopsy - Chronic inflammatory changes. No active colitis.

Comment

The histomorphological findings (patchy inflammation, granulomas, ileitis, paneth cell metaplasia, crypt loss, crypt elongation) are suggestive of Crohn's disease. An infective etiology should be considered, as it cannot be definitely excluded on pathologic grounds.

Query early IBD

COLON, BIOPSIES:
- MINIMAL FOCAL ACTIVE COLITIS.

COMMENT:
Cryptitis is seen in a small number of crypts in only one of a larger number of tissue
fragments. Nonspecific patchy epithelial apoptosis is present in multiple fragments.
No chronic changes are apparent. The number of intraepithelial lymphocytes is within
normal limits. Clinical correlation is suggested.

IBD dysplasia

COLON, HEPATIC FLEXURE, BIOPSY:
- LOW-GRADE DYSPLASIA, SEE COMMENT.

COMMENT:
The area of dysplasia may represent an IBD-related area of polypoid dysplasia 
or a sporadic adenoma. This distinction cannot be made on morphology alone; 
clinical/endoscopic correlation is required.

Re-anastomosis with mechanical reactive changes

"SMALL BOWEL", RESECTION AND NEW ANASTOMOSIS:
- LARGE BOWEL WITH POST-SURGICAL CHANGES, NEGATIVE FOR ACTIVE INFLAMMATION.
- SMALL BOWEL WITH FOCAL MUCOSA EROSIONS -- FAVOUR REACTIVE, SEE COMMENT.
- SKIN WITH REACTIVE CHANGES.
- NEGATIVE FOR DYSPLASIA.

COMMENT:
The small bowel section focally shows erosions at the tips of the villi close to the
interface with the skin; this is favoured to be a mechanical phenomenon. The small bowel
more distant from the small bowel-skin junction shows no active inflammation.

One foreign body-type granuloma is present. No other granulomata are identified.
The bowel shows increased eosinophils and intraepithelial lymphocytes, and basal
plasmacytosis compatible with a chronic inflammatory process.