Branching crypts in inflammatory bowel disease revisited

Abstract

Histologic sections from patients with inflammatory bowel disease (IBD) usually exhibit crypts with architectural distortions and branching crypts. It has been postulated that crypt branching should be assessed only in well‐oriented, upright crypts. However, those crypts are mostly found in sections from colectomy specimens and colon mucosectomies. Sections from endoscopic biopsies are fortuitously cut in a horizontal plane, a procedure mostly revealing cross‐cut crypt rings. In endoscopic biopsies from UC patients we previously detected cross‐cut crypts heralding the crest domain of branching crypts. Recently, the scrutiny of biopsies from IBD patients revealed that branching‐crest domains concurred either with crypts in symmetric branching, typified by twin, amalgamating back‐to‐back isometrics crypt‐rings, or with crypts in asymmetric branching, characterized by ≥2 amalgamating anisometric crypt‐rings; both symmetric and asymmetric branching‐crest domains were encased by a thin muscularis mucosae. Quantitative studies in biopsies from Swedish and German patients with IBD showed that crypts in asymmetric branching outnumbered those in symmetric branching. Because crypt‐branching seldom occurs in the normal colon in adults and considering that colon crypts typically divide once or twice during a lifetime, the accruing of asymmetric branching crypts in IBD biopsies emerges as a significant histologic parameter. Although the biological significance of asymmetric crypt‐branching in IBD remains at present elusive, their occurrence deserves to be further investigated. The future policy will be to include in our pathologic reports, the number of crypts in asymmetric branching, in order to monitor their frequency in prospective surveillance biopsies in patients with IBD.

Antimetabolite Drugs Exhibit Distinctive Immunomodulatory Mechanisms and Effects on the Intestinal Microbiota in Experimental Autoimmune Uveitis

“…Although the pathophysiological mechanism for this phenomenon is not well understood, it could be due to compensation to inflammatory damage. 25 Furthermore, in experimental autoimmune encephalomyelitis, the ileal submucosa becomes thickened, as presented by Nouri and colleagues. 26 In EAU and non-immunized C57Bl/6J mice, we did not observe microscopic hemorrhage, crypt branching, or any gross intestinal abnormalities in the treatment groups.…”

Novel histological repertoire of crypt-associated anomalies in inflamed colon mucosa

“…This possibility seems to be validated by the finding of crypt-associated anomalies interspersed with crypts in asymmetric branching. 16 ► That crypt-associated anomalies never reach the stadium of asymmetric branching as they are digested by mast cells and/ or gut microbiome proteases. 25 26 In conclusion, this survey describes a series of previously unreported anomalies evolving in crypts from the colon mucosa with inflammation.…”

“…The presence of epithelial crests in ring-shaped cross-cut crypts identified the beginning of crypt branching. 16 Their results showed that the number of crypts in asymmetric branching surpassed that of crypts in symmetric branching. 14 Recently, while reviewing sections from patients with UC, a series of previously unreported cryptassociated histological anomalies were detected; they were regarded as histological artefacts.…”

“…11 12 However, daily praxis shows that sections from endoscopic biopsies are fortuitously cut at the laboratory in a horizontal plane, a procedure often yielding cross-cut ring-shaped crypts. More recently, Rubio et al [13][14][15][16] reported the occurrence of increased numbers of branching crypts in endoscopic biopsies from patients with IBD. The presence of epithelial crests in ring-shaped cross-cut crypts identified the beginning of crypt branching.…”

“…More recently, Rubio et al 13–16 reported the occurrence of increased numbers of branching crypts in endoscopic biopsies from patients with IBD. The presence of epithelial crests in ring-shaped cross-cut crypts identified the beginning of crypt branching 16. Their results showed that the number of crypts in asymmetric branching surpassed that of crypts in symmetric branching 14…”