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

Abstract

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.

Immunostaining Detection of Cytomegalovirus in Gastrointestinal Biopsies: Clinicopathological Correlation at a Large Academic Health System

“…Proponents of the “innocent bystander” hypothesis state that CMV virus has a propensity towards colonizing inflamed, granulated ulcer beds, and suggest that the presence of CMV represents tropism towards areas of inflammation, rather than a reflection of true disease [21, 24]. Nonetheless, there have been several studies presenting solid evidence to support testing for CMV in cases of moderate to severe colitis, and if CMV is present, treating with ganciclovir [15, 17]. …”

“…Diagnosis of CMV infection/reactivation in biopsied tissues is classically based on histopathological identification of virus-infected cells (viral cytopathic effect) on hematoxylin-eosin (H&E) stained slides, and/or detection of CMV intranuclear inclusions by immunohistochemistry (IHC) studies [15]. Although IHC may not be the most sensitive method for detecting CMV, it is widely used in many academic centers and private practice.…”

Non-neoplastic colorectal disease biopsies: evaluation and differential diagnosis

“…In established cases, the diagnosis is often relatively easy to make. Other patterns of injury seen in IBD may include pseudomembrane formation, 74 IELs 87 and fibrosis, all of which may coexist or predominate and hence make the diagnosis less straightforward. Furthermore, the full spectrum of 'classic' histological findings may be absent early in the course of the disease when neither the clinical presentation nor the endoscopic features are suggestive.…”

Enteric Viruses and Inflammatory Bowel Disease

“…Inflammatory bowel disease (IBD), which includes ulcerative colitis (UC) and Crohn's disease (CD), is an important public health issue with an estimated 6.8 million cases worldwide and prevalence rates ranging from 79.5 to 84.3 per 100,000 individuals [1]. Both CD and UC are characterized by chronic mucosal inflammation, with CD affecting proximal to distal segments of the gastrointestinal tract (stomach, small intestine, large intestine) and UC affecting only the distal segments (colon and rectum) [2]. The pathological features of CD and UC are different.…”

“…In CD, there is transmural inflammation involving the full thickness of the bowel, with lymphoplasmacytic aggregates, epithelioid granulomas, mucosal edema, scarring fibrosis, and neural thickening of tissues. In UC, histopathology usually shows patchy mucosal ulcerations, mucosal edema, hemorrhagic foci of the lamina propria, and cryptic damage [2]. Paneth cell metaplasia has been described in the distal colon in both conditions [3].…”