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Interpretation of Colonic Biopsies in Patients with Diarrhea

  • Sarah M. Dry
  • Galen R. Cortina
  • Klaus J. Lewin

Abstract

Accurate biopsy interpretation rests heavily on excellent communication between the endoscopist and the pathologist. We cannot overemphasize the importance of communication. Without proper clinical information, the pathologist may render an unhelpful or, worse yet, misleading diagnosis. Some pathologists prefer to arrive at an independent histopathologic diagnosis without first looking at the history or clinical question to avoid interpretation bias. However, the only approach for consistent, precise diagnoses in colonic biopsy pathology is the one that ultimately combines all pertinent information available from clinical, radiological, and laboratory sources, with the histopathogy to arrive at the final interpretation. A strikingly realistic study pitting histopathologic interpretation alone against a composite approach (clinical, radiologic, endoscopy, histopathology) in the diagnosis of colitis confirmed that the composite approach led to greater agreement and definitiveness (1). A schematic representation of the composite approach to diagnosis is given in Fig. 1.

Keywords

Lamina Propria Ischemic Colitis Mucosal Biopsy Colonic Biopsy Microscopic Colitis 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

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References

  1. 1.
    Shivananda S, Hordijk ML, Ten Kate FJ, Probert CS, Mayberry JF. Differential diagnosis of inflammatory bowel disease: a comparison of various diagnostic classifications. Scand. J. Gastroenterol., 26 (1991) 167–173.Google Scholar
  2. 2.
    Weinstein WM. Mucosal biopsy techniques and interaction with the pathologist. Gastrointest. Endosc. Clin. N. Am., 10 (2000) 555–572.Google Scholar
  3. 3.
    Carpenter HA, Talley NJ. The importance of clinicopathological correlation in the diagnosis of inflammatory conditions of the colon: histological patterns with clinical implications. Am. J. Gastroenterol., 95 (2000) 878–896.PubMedCrossRefGoogle Scholar
  4. 4.
    Beaugerie L, Luboinski J, Brousse N, et al. Drug induced lymphocytic colitis. Gut, 35 (1994) 426–428.PubMedCrossRefGoogle Scholar
  5. 5.
    Beaugerie L, Patey N, Brousse N. Ranitidine, diarrhoea, and lymphocytic colitis. Gut, 37 (1995) 708–711.PubMedCrossRefGoogle Scholar
  6. 6.
    Berrebi D, Sautet A, Flejou JF, Dauge MC, Peuchmaur M, Potet F. Ticlopidine induced colitis: a histopathological study including apoptosis. J.Clin. Pathol., 51 (1998) 280–283.PubMedCrossRefGoogle Scholar
  7. 7.
    Kleer CG, Appelman HD. Ulcerative colitis: patterns of involvement in colorectal biopsies and changes with time. Am. J. Surg. Pathol., 22 (1998) 983–989.PubMedCrossRefGoogle Scholar
  8. 8.
    Odze R, Antonioli D, Peppercorn M, Goldman H. Effect of topical 5-aminosalicylic acid (5-ASA) therapy on rectal mucosal biopsy morphology in chronic ulcerative colitis. Am. J. Surg. Pathol., 17 (1993) 869–875.PubMedCrossRefGoogle Scholar
  9. 9.
    Deana DG, Dean PJ. Reversible ischemic colitis in young women. Association with oral contraceptive use. Am. J. Surg. Pathol., 19 (1995) 454–462.CrossRefGoogle Scholar
  10. 10.
    Boutros HH, Pautler S, Chakrabarti S. Cocaine-induced ischemic colitis with small-vessel thrombosis of colon and gallbladder. J. Clin. Gastroenterol., 24 (1997) 49–53.PubMedCrossRefGoogle Scholar
  11. 11.
    Makapugay LM, Dean PJ. Diverticular disease-associated chronic colitis. Am. J. Surg. Pathol., 20 (1996) 94–102.CrossRefGoogle Scholar
  12. 12.
    Fenoglio-Preiser CM, Noffsinger AE, Stemmermann GN, Lantz PE, Listrom MB, Rilke FO. Gastrointestinal Pathology: An Atlas and Text. 2nd ed., Lippincott-Raven, Philadelphia, PA, 1999.Google Scholar
  13. 13.
    Lewin KJ, Riddell RH, Weinstein WM. Gastrointestinal Pathology and Its Clinical Implications. IgakuShoin, New York, NY, 1992.Google Scholar
  14. 14.
    Ming SC, Goldman H. Pathology of the Gastrointestinal Tract, 2nd ed., W.B. Saunders, Baltimore, MD, 1998.Google Scholar
  15. 15.
    Lockhart-Mummery HE, Morson BC. Crohn’s disease (regional enteritis) of the large intestine and its distinction from ulcerative colitis. Gut, 1 (1960) 87–105.PubMedCrossRefGoogle Scholar
  16. 16.
    Kleer CG, Appelman HD. Surgical pathology of Crohn’s disease. Surg. Clin. N. Am., 81 (2001) 13–30.PubMedCrossRefGoogle Scholar
  17. 17.
    Price AB, Morson BC. Inflammatory bowel disease: the surgical pathology of Crohn’s disease and ulcerative colitis. Hum. Pathol., 6 (1975) 7–29.PubMedCrossRefGoogle Scholar
  18. 18.
    Mottet NK. Histopathologic Spectrum of Regional Enteritis and Ulcerative Colitis. Saunders, Philadelphia, PA, 1971.Google Scholar
  19. 19.
    Geller SA. Pathology of inflammatory bowel disease: a critical appraisal in diagnosis and management. In Inflammatory Bowel Disease: From Bench to Bedside. Targan SR, Shanahan F (eds.), Williams and Wilkins, Baltimore, MD, 1994.Google Scholar
  20. 20.
    Lazenby AJ, Yardley JH, Giardiello FM, Jessurun J, Bayless TM. Lymphocytic (“microscopic”) colitis: a comparative histopathologic study with particular reference to collagenous colitis. Hum. Pathol., 20 (1989) 18–28.PubMedCrossRefGoogle Scholar
  21. 21.
    Levine DS, Haggitt RC. Colon. Histology for Pathologists. Sternberg SS (ed.), Lippincott-Raven, Philadelphia, PA, 1997.Google Scholar
  22. 22.
    Goldstein NS, Leon-Armin C, Mani A. Crohn’s colitis-like changes in sigmoid diverticulitis specimens is usually an idiosyncratic inflammatory response to the diverticulosis rather than Crohn’ s colitis. Am. J. Surg. Pathol., 24 (2000) 668–675.PubMedCrossRefGoogle Scholar
  23. 23.
    Ma CK, Gottlieb C, Haas PA. Diversion colitis: a clinicopathologic study of 21 cases. Hum. Pathol., 21 (1990) 429–436.PubMedCrossRefGoogle Scholar
  24. 24.
    Hague S, Eisen RA, West AB. The morphologic features of diversion colitis: studies of a pediatric population with no other disease of the intestinal mucosa [see comments]. Hum. Pathol., 24 (1993) 211–219.CrossRefGoogle Scholar
  25. 25.
    Jawhari A, Talbot IC. Microscopic, lymphocytic and collagenous colitis [see comments]. Histopathology,29 (1996)101–110.CrossRefGoogle Scholar
  26. 26.
    Giardiello FM, Lazenby AJ. The atypical colitides. Gastroenterol. Clin. N. Am., 28 (1999) 479–490.CrossRefGoogle Scholar
  27. 27.
    Mashako MN, Sonsino E, Navarro J, et al. Microscopic colitis: a new cause of chronic diarrhea in children? J. Pediat. Gastroenterol. Nutr., 10 (1990) 21–26.CrossRefGoogle Scholar
  28. 28.
    Puri AS, Khan EM, Kuman M, Pandey R, Choudhuri G. Association of lymphocytic (microscopic) colitis with tropical sprue. J. Gastroenterol. Hepatol., 9 (1994) 105–107.PubMedCrossRefGoogle Scholar
  29. 29.
    Hamid S, Jafri W, Abbas Z, et al. Microscopic colitis: a diagnosis to consider. J. Pak. Med. Assoc., 43 (1993) 203–205.PubMedGoogle Scholar
  30. Zins BJ, Sandborn WJ, Tremaine WJ. Collagenous and lymphocytic colitis: subject review and therapeutic alternatives. Am. J. Gastroenterol.,90 (1995) 1394–1400.Google Scholar
  31. 31.
    Bryant DA, Mintz ED, Puhr ND, Griffin PM, Petras RE. Colonic epithelial lymphocytosis associated with an epidemic of chronic diarrhea. Am. J. Surg. Pathol., 20 (1996) 1102–1109.PubMedCrossRefGoogle Scholar
  32. 32.
    Mills LR, Schuman BM, Thompson WO. Lymphocytic colitis. A definable clinical and histological diagnosis. Dig. Dis. Sci., 38 (1993) 1147–1151.PubMedCrossRefGoogle Scholar
  33. 33.
    Pulimood AB, Ramakrishna BS, Mathan MM. Collagenous gastritis and collagenous colitis: a report with sequential histological and ultrastructural findings. Gut, 44 (1999) 881–885.PubMedCrossRefGoogle Scholar
  34. 34.
    Robert ME, Ament ME, Weinstein WM. The histologic spectrum and clinical outcome of refractory and unclassified sprue. Am. J. Surg. Pathol., 24 (2000) 676–687.PubMedCrossRefGoogle Scholar
  35. 35.
    Lazenby AJ, Yardley JH, Giardiello FM, Bayless TM. Pitfalls in the diagnosis of collagenous colitis: experience with 75 cases from a registry of collagenous colitis at the Johns Hopkins Hospital. Hum. Pathol., 21 (1990) 905–910.PubMedCrossRefGoogle Scholar
  36. 36.
    Hosseini M, Lee J. Gastrointestinal mucormycosis mimicking ischemic colitis in a patient with systemic lupus erythematosus. Am. J. Gastroenterol., 93 (1998) 1360–1362.PubMedCrossRefGoogle Scholar
  37. 37.
    Okada M, Konishi F, Sakuma K, Kanazawa K, Koiwai H, Kaizaki Y. Perforation of the sigmoid colon with ischemic change due to polyarteritis nodosa. J. Gastroenterol., 34 (1999) 400–404.PubMedCrossRefGoogle Scholar
  38. 38.
    Ryan CK, Potter GD. Disinfectant colitis. Rinse as well as you wash [editorial]. J. Clin. Gastroenterol., 21 (1995) 6–9.PubMedCrossRefGoogle Scholar

Copyright information

© Humana Press Inc., Totowa, NJ 2003

Authors and Affiliations

  • Sarah M. Dry
  • Galen R. Cortina
  • Klaus J. Lewin

There are no affiliations available

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