Histopathological evaluation of ulcerative colitis in colonoscopic biopsies

Abstract

Background: Histopathologic evaluation of colonoscopic mucosal biopsy remains one of the earliest modalities of investigation in patients clinically suspected of ulcerative colitis. Pathologists should be aware of classical histomorphological features to avoid misdiagnosis. The aim of the present study was to evaluate histopathologic features as well as to determine possible atypical presentation.Materials and Methods: Forty newly diagnosed cases of ulcerative colitis were included in the study. Colonoscopic biopsies taken from rectum as well as various areas of colon and ileum depending upon clinical extent of involvement were submitted for histopathological evaluation. Diagnosis of ulcerative colitis was made by correlating clinical, endoscopic and histopathologic findings.Results: Out of 47 cases suspected of ulcerative colitis, histopathologic features were consistent with Ulcerative colitis in 40 cases. Almost all cases (97.5%) showed diffuse active colitis. Cryptitis (100%), crypt abscesses (75%) and basal plasmacytosis (85%) along with crypt architectural abnormalities (75%) and goblet cell depletion (70%) were classical histological changes associated with ulcerative colitis in active phase. Atypical presentations noticed were focal active colitis (2.5%), backwash ileitis (2.5%), rectal sparing (2.5%) and skip areas (5%).Conclusion: Accurate diagnosis of ulcerative colitis requires elaborate knowledge of histopathologic features along with awareness of possible atypical presentation.

Variation of histopathological features in colonic mucosal biopsy with clinical diagnosis of suspicious inflammatory bowel disease in Dr. Soetomo General Academic Hospital, Surabaya period 2015 - 2019

“…Study by Surawicz and Belic reported that crypt distortion is also one of the characteristics of IBD besides basal lymphoplasmacytosis (Surawicz & Belic, 1984). Various studies showed distorted architectural crypt in UC could occur ranging from 57% to 100% cases (Dhakhwa et al, 2016).…”

Focal Active Colitis: What Are Its Clinical Implications? A Narrative Review

“…However, FAC patterns can be observed in cases of UC that are resolving under medical treatment, and areas of the colon and rectum that were previously inflamed in UC can return to an almost normal histological appearance. Medications associated with FAC include nonsteroidal anti-inflammatory drugs (NSAIDs), mycophenolic acid, and ipilimumab, among others [11,12]. While diarrhea is the most common reason for a workup in many of these patients, FAC can also be incidentally discovered because of bowel preparation with Phospho-soda in asymptomatic patients undergoing screening colonoscopy [6].…”