Clinical and pathological analysis of colonic Crohn's disease, including a subgroup with ulcerative colitis-like features

Soucy, Geneviève; Wang, Helen H.; Farraye, Francis A.; Schmidt, Jason; Farris, Alton B.; Lauwers, Gregory Y.; Cerda, Sandra; Dendrinos, Kleanthis; Odze, Robert D.

doi:10.1038/modpathol.2011.120

Cited by 74 publications

(47 citation statements)

References 39 publications

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“…In these cases, a diagnosis of CD may be established by noting the presence of typical changes of CD in other regions of the GI tract, or by the presence of major features of CD in the colon, such as granulomas, rectal sparing from onset of disease, or most commonly, severe anal or perianal disease. In a recent study by Soucy et al, 69 UC-like CD was noted in 14% and 13% of patients with isolated colonic CD and ileocolonic CD, respectively. Overall, patients with UC-like CD were younger in age and had a higher incidence of limited left-sided colitis compared with patients with classic CD.…”

Section: Crohn's Disease With Uc-like Featuresmentioning

confidence: 85%

“…1 A small percentage of patients with clinically and/or serologically defined CD, with involvement of the colon, or the colon and distal ileum, may show UC-like pathologic changes in their resection specimen, such as mucosal-only disease (without mural involvement), isolated rectal involvement, or diffuse colonic disease. [67][68][69][70] Patients with these features have been termed 'superficial' (UC-like) CD ( Figure 5). Essentially, patients with superficial (UC-like) CD have either ambiguous, or CD-like features, clinically, and UClike features pathologically.…”

Section: Crohn's Disease With Uc-like Featuresmentioning

confidence: 99%

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A contemporary and critical appraisal of ‘indeterminate colitis‘

Odze

2015

Modern Pathology

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Distinguishing ulcerative colitis (UC) from Crohn's disease (CD) is normally based on evaluation of a variety of clinical, radiologic, serologic and pathologic findings, the latter in biopsy and/or resection specimens. Unfortunately, some patients with IBD show overlapping pathologic features of UC and CD, which makes definite distinction between these two disorders difficult or even impossible. In most instances of uncertainty, the patient shows clinical and pathologic features of UC, but in addition, the patient's colon resection specimen reveals one or more CD-like features. In this setting, a diagnosis of indeterminate colitis (IC) is often rendered. IC is not a distinct disease entity, and, thus, it has no diagnostic criteria. The most common causes of uncertainty in IBD pathology that may lead to a diagnosis of IC in a colon resection specimen includes the presence of fulminant (severe and toxic) colitis, insufficient radiologic, endoscopic, or pathologic information (including analysis of prior biopsies) on the patient, failure to utilize major diagnostic criteria as hard evidence in favor of CD, failure to recognize unusual variants of UC and CD that may mimic each other, failure to recognize non-IBD mimics and other superimposed diseases that cause unusual pathologic features in a resection specimen, an attempt to distinguish UC from CD in mucosal biopsies of the colon and ileum, or an attempt to change the patients diagnosis (of UC or CD) based on pouch or diversion-related complications. Details of each of these causes of uncertainty are discussed, in detail, in this review article. A diagnosis of IC should never be made clinically or by pathologists based on evaluation of pre-resection colonic mucosal biopsies. Ultimately, the majority of indeterminate cases represent UC, and, thus, most of these patient can be treated safely with a colectomy combined with an ileal pouch anal anastomosis procedure.

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Section: Crohn's Disease With Uc-like Featuresmentioning

confidence: 85%

Section: Crohn's Disease With Uc-like Featuresmentioning

confidence: 99%

A contemporary and critical appraisal of ‘indeterminate colitis‘

Odze

2015

Modern Pathology

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“…Compared with classic CD patients, UC-like CD patients were younger, and left-sided colitis was more common. 86 Studies on pouch outcome in UC-like CD show conflicting results. [86][87][88] This may in part be due to the different criteria used for the diagnosis of UC-like CD, necessitating further study and standardization of the diagnostic criteria.…”

Section: Cd: Variantmentioning

confidence: 99%

“…[85][86][87][88] This variant, so called UC-like CD, or superficial CD, may be initially misclassified as UC and subsequently reclassified as CD after pouch complications. Fortunately, this variant is very rare, comprising only 1% of IBD.…”

Section: Cd: Variantmentioning

confidence: 99%

Clinical Aspects of Idiopathic Inflammatory Bowel Disease: A Review for Pathologists

Lee¹,

Westerhoff²,

Shen³

et al. 2016

Archives of Pathology &Amp; Laboratory Medicine

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Context.—Idiopathic inflammatory bowel disease manifests with different clinical phenotypes showing varying behavior and risk for neoplasia. The clinical questions that are posed to pathologists differ depending on phase of the disease and the clinical circumstances. Understanding the clinical aspects of the dynamic disease process will enhance the role of pathology in optimizing the care of patients with inflammatory bowel disease. Objective.—To review clinical and surgical aspects of inflammatory bowel disease that are relevant to practicing pathologists. Data Sources.—The literature was reviewed. Conclusions.—Diagnosis and management of inflammatory bowel disease require an integrated evaluation of clinical, endoscopic, radiologic, and pathologic features. Therefore, close interaction between clinicians and pathologists is crucial. Having this team approach improves understanding of the pertinent clinical and surgical aspects of the disease and assists in the recognition of unusual presentation of variants, as well as mimics of idiopathic inflammatory bowel disease, by pathologists.

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“…Another microscopic feature is the adipocyte hyperplasia in the submucosa of CD creating a similar histologic feature seen in the mesentery [30]. However, only colonic specimens were evaluated.…”

Section: Characteristics Of Mesenteric Adipose Tissue and Its Possiblmentioning

confidence: 99%

The Role of Mesenteric Adipose Tissue in Crohn’s Disease

Leal¹,

Pascoal²,

Silva³

et al. 2018

Adipose Tissue

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Inflammatory bowel disease (IBD) has become an increasingly frequent chronic health problem in the last few decades, particularly in developing countries. In young adults, one of the most common forms of IBD is Crohn's disease (CD). CD is a multifactorial genetic disease characterized by a transmural granulomatous inflammation that especially affects the terminal ileum and the colon. As it involves defective inflammatory pathways, the immune adaptive complex, and environmental factors, this disease has periods of remission and recurrence followed by diarrhea, abdominal pain, and malnutrition, which often lead to lumen bowel stenosis associated to multiple fistulas. In addition, the growth of mesenteric adipose tissue (MAT) near the affected intestinal area is a hallmark of CD. Evidence linking the development of mesenteric and intestinal alterations in CD is increasing. The aim of this chapter is to address adipose tissue in general, the morphological and functional differences between its compartments, the main characteristics of MAT in CD, and its possible role in the etiopathology of this immune-mediated disease.

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Clinical and pathological analysis of colonic Crohn's disease, including a subgroup with ulcerative colitis-like features

Cited by 74 publications

References 39 publications

A contemporary and critical appraisal of ‘indeterminate colitis‘

A contemporary and critical appraisal of ‘indeterminate colitis‘

Clinical Aspects of Idiopathic Inflammatory Bowel Disease: A Review for Pathologists

The Role of Mesenteric Adipose Tissue in Crohn’s Disease

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