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Colitis pp 49-89 | Cite as

Elementary Lesions of Inflammation

  • Gavino Faa
  • Daniela Fanni
  • Maria Leo
  • Karel Geboes
Chapter

Abstract

A diagnosis of the etiology or the type of colitis is usually not based upon a single discriminatory feature but rather upon a combination of “multiple” microscopic features. These should ideally be evidence based and reproducible and have good specificity and sensitivity. Genuine inflammation of the colonic (and small intestinal) mucosa is characterized by changes in the epithelial and lamina propria cell compartments. Both types of changes should be present. Alterations of the epithelial cells can be subdivided in changes of surface epithelial cells, crypt and surface architectural changes, and metaplasia. Typically there is a change of height of lining epithelial cells. In normal mucosa the surface epithelial height exceeds the height of crypt epithelium. The changes occurring in the lamina propria are not a reaction that develops from a zero baseline of leukocytes. Essentially, these changes are characterized by an increase in total cellularity, a more or less prominent redistribution of the infiltrating cells so that the infiltrate may or may not have a similar density throughout the lamina propria, including the basal part and changes in composition. A good understanding of the different lesions characteristic of inflammation will improve the diagnostic results.

Keywords

Architectural change Crypt branching Crypt distortion Mucosal atrophy Crypt atrophy Crypt regeneration Cytokine Magnifying endoscopy Surface irregularity Tenascin Erosion Ulceration Restitution Pyloric gland metaplasia Metaplasia Ulcer-associated cell lineage Mucin depletion Apoptosis Paneth cell metaplasia Lamina propria cellularity Eosinophils Granuloma Lamina propria Basal plasmacytosis Eosinophilic colitis Allergic colitis Emperipolesis Epithelioid cell Basement membrane Collagenous colitis 

References

  1. 1.
    Jenkins D, Goodall A, Drew K, et al. What is colitis? Statistical approach to distinguishing clinically important inflammatory change in rectal biopsy specimens. J Clin Pathol. 1988;41:72–9.CrossRefPubMedPubMedCentralGoogle Scholar
  2. 2.
    Schmitz-Moormann P, Himmelmann GW. Does quantitative histology of rectal biopsy improve the differential diagnosis of Crohn’s disease and ulcerative colitis in adults? Pathol Res Pract. 1988;183:481–8.CrossRefPubMedPubMedCentralGoogle Scholar
  3. 3.
    Schumacher G, Kollberg B, Sandstedt B. A prospective study of first attacks of inflammatory bowel disease and infectious colitis. Histologic course during the 1st year after presentation. Scand J Gastroenterol. 1994;29:318–32.CrossRefPubMedPubMedCentralGoogle Scholar
  4. 4.
    Dundas SAC, Dutton J, Skipworth P. Reliability of rectal biopsy in distinguishing between chronic inflammatory bowel disease and acute self-limiting colitis. Histopathology. 1997;31:60–6.CrossRefPubMedGoogle Scholar
  5. 5.
    Jenkins D, Balsitis M, Gallivan S, et al. Guidelines for the initial biopsy diagnosis of suspected chronic idiopathic inflammatory bowel disease. The British Society of Gastroenterology Initiative. J Clin Pathol. 1997;50:93–105.CrossRefPubMedPubMedCentralGoogle Scholar
  6. 6.
    Nostrant T, Kumar NB, Appelman HD. Histopathology differentiates acute self-limited colitis from ulcerative colitis. Gastroenterology. 1987;92:318–28.CrossRefPubMedPubMedCentralGoogle Scholar
  7. 7.
    Seldenrijk CA, Morson BC, Meuwissen SGM, et al. Histopathological evaluation of colonic mucosal biopsy specimens in chronic inflammatory bowel disease: diagnostic implications. Gut. 1991;32:1514–20.CrossRefPubMedPubMedCentralGoogle Scholar
  8. 8.
    Theodossi A, Spiegelhalter DJ, Jass J, et al. Observer variation and discriminatory value of biopsy features in inflammatory bowel disease. Gut. 1994;35:961–8.CrossRefPubMedPubMedCentralGoogle Scholar
  9. 9.
    Washington K, Greenson JK, Montgomery E, et al. Histopathology of ulcerative colitis in initial rectal biopsy in children. Am J Surg Pathol. 2002;26:1441–9.CrossRefPubMedPubMedCentralGoogle Scholar
  10. 10.
    Bentley E, Jenkins D, Campbell F, Warren BF. How could pathologists improve the initial diagnosis of colitis? Evidence from an international workshop. J Clin Pathol. 2002;55:955–60.CrossRefPubMedPubMedCentralGoogle Scholar
  11. 11.
    Robert ME, Tang L, Hao M, Reyes-Mugica M. Patterns of inflammation in mucosal biopsies of ulcerative colitis. Perceived differences in pediatric populations are limited to children younger than 10 years. Am J Surg Pathol. 2004;28:183–9.CrossRefPubMedPubMedCentralGoogle Scholar
  12. 12.
    Cerilli LK, Greenson JK. The differential diagnosis of colitis in endoscopic biopsy specimens: a review article. Arch Pathol Lab Med. 2012;136:854–64.CrossRefPubMedGoogle Scholar
  13. 13.
    Tanaka M, Saito H, Fukuda S, et al. Simple mucosal biopsy criteria differentiating among Crohn’s disease, ulcerative colitis and other forms of colitis: measurement of validity. Scand J Gastroenterol. 2000;35:281–6.CrossRefPubMedPubMedCentralGoogle Scholar
  14. 14.
    Francoeur C, Bouatrouss Y, Seltana A, et al. Degeneration of the pericryptal myofibroblast sheath by proinflammatory cytokines in inflammatory bowel diseases. Gastroenterology. 2009;136:268–77.CrossRefPubMedGoogle Scholar
  15. 15.
    Odze R, Antonioli D, Peppercorn M, Goldman H. Effect of topical 5-amino-salicylic acid (5-ASA) therapy on rectal mucosal biopsy morphology in chronic ulcerative colitis. Am J Surg Pathol. 1993;17:869–75.CrossRefPubMedPubMedCentralGoogle Scholar
  16. 16.
    Kleer CG, Appelman HD. Ulcerative colitis: patterns of involvement in colorectal biopsies and changes with time. Am J Surg Pathol. 1998;22:983–9.CrossRefPubMedPubMedCentralGoogle Scholar
  17. 17.
    Nishio Y, Ando T, Maeda O, et al. Pit patterns in rectal mucosa assessed by magnifying colonoscope are predictive or relapse in patients with quiescent ulcerative colitis. Gut. 2006;55:1768–73.CrossRefPubMedPubMedCentralGoogle Scholar
  18. 18.
    Buda A, Hatern G, Neumann H, et al. Confocal laser endomicroscopy for prediction of disease relapse in ulcerative colitis: a pilot study. J Crohns Colitis. 2013;8:304–11.CrossRefPubMedPubMedCentralGoogle Scholar
  19. 19.
    MacIntosh DG, Thompson WG, Patel DG, et al. Is rectal biopsy necessary in irritable bowel syndrome? Am J Gastroenterol. 1992;87:1407–9.PubMedPubMedCentralGoogle Scholar
  20. 20.
    Tanaka M, Riddell RH. The pathological diagnosis and differential diagnosis of Crohn’s disease. Hepato-Gastroenterology. 1990;37:18–31.PubMedPubMedCentralGoogle Scholar
  21. 21.
    Geboes K, De Hertogh G, Ectors N. Drug-induced pathology in the large intestine. Curr Diagn Pathol. 2006;12:239–47.CrossRefGoogle Scholar
  22. 22.
    Henrikson CK, Argenzio RA, Liacos JA, Khosla J. Morphologic and functional effects of bile salt on the porcine colon during injury and repair. Lab Investig. 1989;60:72–87.PubMedGoogle Scholar
  23. 23.
    Shidham VB, Chang CC, Shidham G, et al. Colon biopsies for evaluation of acute graft-versus-host disease (A-GVHD) in allogeneic bone marrow transplant patients. BMC Gastroenterol. 2003;27:3–5.Google Scholar
  24. 24.
    Tanaka M, Saito H, Kusumi T, et al. Spatial distribution and histogenesis of colorectal Paneth cell metaplasia in idiopathic inflammatory bowel disease. J Gastroenterol Hepatol. 2001;16:1353–9.CrossRefPubMedGoogle Scholar
  25. 25.
    Wright NA, Pike C, Elia G. Induction of a novel epidermal growth factor-secreting cell lineage by mucosal ulceration in human gastrointestinal stem cells. Nature. 1990;343:82–5.CrossRefPubMedGoogle Scholar
  26. 26.
    Surawicz CM, Belic L. Rectal biopsy helps to distinguish acute self-limited colitis from idiopathic inflammatory bowel disease. Gastroenterology. 1984;86:104–13.PubMedPubMedCentralGoogle Scholar
  27. 27.
    Rubio CA, Johansson C, Uribe A, Kock Y. A quantitative method of estimating inflammation in the rectal mucosa. IV. Ulcerative colitis in remission. Scand J Gastroenterol. 1984;19:525–30.CrossRefPubMedGoogle Scholar
  28. 28.
    Spiller RC, Jenkins D, Thornley JP, et al. Increased rectal mucosal enteroendocrine cells, T lymphocytes, and increased gut permeability following acute Campylobacter enteritis and in post-dysenteric irritable bowel syndrome. Gut. 2000;47:804–11.CrossRefPubMedPubMedCentralGoogle Scholar
  29. 29.
    Tsang P, Rotterdam H. Biopsy diagnosis of colitis: possibilities and pitfalls. Am J Surg Pathol. 1999;23:423–30.CrossRefPubMedGoogle Scholar
  30. 30.
    Bejarano PA, Aranda-Michel J, Fenoglio-Preiser C. Histochemical and immunohistochemical characterization of foamy histiocytes (muciphages and xanthelasma) of the rectum. Am J Surg Pathol. 2000;24:1009–15.CrossRefPubMedPubMedCentralGoogle Scholar
  31. 31.
    Rubio CA, Johansson C, Kock Y. A quantitative method of estimating inflammation in the rectal mucosa. II. Normal limits in symptomatic patients. Scand J Gastroenterol. 1982;17:1077–81.PubMedPubMedCentralGoogle Scholar
  32. 32.
    Villanacci V, Antonelli E, Reboldi GP, et al. Endoscopic biopsy samples of colitides patients: role of basal plasmacytosis. J Crohns Colitis. 2014;8:1438.CrossRefPubMedGoogle Scholar
  33. 33.
    Alimchadani M, Lai JP, Aung PP, et al. Gastrointestinal histopathology in chronic granulomatous disease: a study of 87 patients. Am J Surg Pathol. 2013;37:1365–72.CrossRefGoogle Scholar
  34. 34.
    James DG. A clinicopathological classification of granulomatous disorders. Postgrad Med J. 2000;76:457–65.CrossRefPubMedPubMedCentralGoogle Scholar
  35. 35.
    Janssen CE, Rosé CD, De Hertogh G, et al. Morphological and immunohistochemical characteristics of the NOD2-related pediatric granulomatous disorders Blau syndrome and Crohn’s disease. J Allergy Clin Immunol. 2012;129:1076–84.CrossRefPubMedGoogle Scholar
  36. 36.
    Xia P, Wang S, Guo Z, Yao X. Emperipolesis, entosis and beyond: dance with fate. Cell Res. 2008;18:705–7.CrossRefPubMedGoogle Scholar
  37. 37.
    Schmehl K, Florian S, Jacobasch G, et al. Deficiency of epithelial basement membrane laminin in ulcerative colitis affected human colonic mucosa. Int J Color Dis. 2000;15:39–48.CrossRefGoogle Scholar
  38. 38.
    Müller S, Neureiter D, Stolte M, et al. Tenascin: a sensitive and specific diagnostic marker of minimal collagenous colitis. Virchows Arch. 2001;438:435–41.CrossRefPubMedPubMedCentralGoogle Scholar

Copyright information

© Springer International Publishing AG, part of Springer Nature 2018

Authors and Affiliations

  • Gavino Faa
    • 1
  • Daniela Fanni
    • 1
  • Maria Leo
    • 1
  • Karel Geboes
    • 2
    • 3
  1. 1.Division of Pathology, Department of Surgical SciencesUniversity Hospital San Giovanni di Dio, University of CagliariCagliariItaly
  2. 2.Department of PathologyGhent University HospitalGhentBelgium
  3. 3.Department of PathologyKU LeuvenLeuvenBelgium

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