Biopsy interpretation of colonic biopsies when inflammatory bowel disease is excluded

Abstract

The interpretation of colonic biopsies related to inflammatory conditions can be challenging because the colorectal mucosa has a limited repertoire of morphologic responses to various injurious agents. Only few processes have specific diagnostic features, and many of the various histological patterns reflect severity and duration of the disease. Importantly the correlation with endoscopic and clinical information is often cardinal to arrive at a specific diagnosis in many cases.

Inflammatory bowel disease biopsies: updated British Society of Gastroenterology reporting guidelines

“… Crypt distortion occurs in a minority of infective colitides,18 26 33 59 particularly in the healing phase or if infection is severe or prolonged 4 11 59

A few infective colitis biopsies have basal plasmacytosis or other evidence of chronic inflammation 4 18 26

…”

“…Crypt distortion occurs in a minority of infective colitides,18 26 33 59 particularly in the healing phase or if infection is severe or prolonged 4 11 59…”

“…Yersinia and TB can elicit granulomas, occasionally cause crypt distortion, and may mimic CD 59 114. Caseous necrosis and demonstrable acid fast bacilli indicate TB but are confined to a minority of cases.…”

“…TB is favoured over IBD by confluent granulomas, numerous granulomas, Langhans giant cells, a lymphoid cuff around granulomas, and granulomas more than 400 μm in diameter 115. Yersinia is favoured over IBD by granulomas with central necrosis, granulomas surrounded by a lymphoid cuff, and stellate abscesses 59 114…”

“…Amoebic colitis if prolonged can cause crypt distortion but tends to lack other features of IBD 59. This and other protozoan infections can coexist with IBD and worsen disease activity 116.…”