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The histopathological approach to inflammatory bowel disease: a practice guide

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Abstract

Inflammatory bowel diseases (IBDs) are lifelong disorders predominantly present in developed countries. In their pathogenesis, an interaction between genetic and environmental factors is involved. This practice guide, prepared on behalf of the European Society of Pathology and the European Crohn’s and Colitis Organisation, intends to provide a thorough basis for the histological evaluation of resection specimens and biopsy samples from patients with ulcerative colitis or Crohn’s disease. Histopathologically, these diseases are characterised by the extent and the distribution of mucosal architectural abnormality, the cellularity of the lamina propria and the cell types present, but these features frequently overlap. If a definitive diagnosis is not possible, the term indeterminate colitis is used for resection specimens and the term inflammatory bowel disease unclassified for biopsies. Activity of disease is reflected by neutrophil granulocyte infiltration and epithelial damage. The evolution of the histological features that are useful for diagnosis is time- and disease-activity dependent: early disease and long-standing disease show different microscopic aspects. Likewise, the histopathology of childhood-onset IBD is distinctly different from adult-onset IBD. In the differential diagnosis of severe colitis refractory to immunosuppressive therapy, reactivation of latent cytomegalovirus (CMV) infection should be considered and CMV should be tested for in all patients. Finally, patients with longstanding IBD have an increased risk for the development of adenocarcinoma. Dysplasia is the universally used marker of an increased cancer risk, but inter-observer agreement is poor for the categories low-grade dysplasia and indefinite for dysplasia. A diagnosis of dysplasia should not be made by a single pathologist but needs to be confirmed by a pathologist with expertise in gastrointestinal pathology.

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Authors and Affiliations

  1. Institute of Pathology, Medical University of Graz, Auenbruggerplatz 25, 8036, Graz, Austria

    Cord Langner

  2. Department of Gastroenterology, Hospital de Sao Joao, Rua José da Silva Passos 48, 4240-044, Porto, Portugal

    Fernando Magro

  3. Department of Pathology, University Hospital Antwerp, Wilrijkstraat 10, 2650, Edegem, Belgium

    Ann Driessen

  4. Department of Pathology, Ankara University Medical School, Sihhiye, 06100, Ankara, Turkey

    Arzu Ensari

  5. A’ Department of Gastroenterology, Evangelismos Hospital, 45-47 Ypsilantou Street, 10676, Athens, Greece

    Gerassimos J. Mantzaris

  6. Institute of Pathology, Spedali Civili, Piazzale Spedali Civili, 1, 25100, Brescia, Italy

    Vincenzo Villanacci

  7. Department of Pathology, Carol Davila University of Medicine and Pharmacy, Bucharest, Romania

    Gabriel Becheanu

  8. Instituto de Anatomia Patologica, Escola Superior de Tecnologia da Saúde de Lisboa & Faculdade de Medicina da Universidade de Lisboa, Av. D. João II, Lote 4.69.01, 1990-096, Lisbon, Portugal

    Paula Borralho Nunes

  9. Institute for Pathology, Kantonsspital Baselland, Mühlemattstrasse 11, 4410, Liestal, Switzerland

    Gieri Cathomas

  10. Dip di Medicina Interna e Terapia Medica U.O. Malattie di Fegato e dell’Apparato Digerente, Università di Messina Azienda Policlinico Universitario, Pad. C–III piano, Via C. Valeria 1, 98100, Messina, Italy

    Walter Fries

  11. Department of Pathology, Cliniques Universitaires St Luc, UCL, Avenue Hippocrate 10, 1200, Brussels, Belgium

    Anne Jouret-Mourin

  12. Department of Medicine (DIMED), Surgical Pathology and Cytopathology Unit, University of Padua, Padua, Italy

    Claudia Mescoli

  13. Department of Pathology and Laboratory Medicine, Mayo Clinic Arizona, 13400 East Shea Boulevard, Scottsdale, AZ, 85259, USA

    Giovanni de Petris

  14. Gastrointestinal and Liver Pathology Research Laboratory, Karolinska Institute and University Hospital, 171-76, Stockholm, Sweden

    Carlos A. Rubio

  15. Gloucestershire Cellular Pathology Laboratory, Cheltenham General Hospital, Sandford Road, Cheltenham, Gloucestershire, GL53 7AN, UK

    Neil A. Shepherd

  16. Institute of Pathology, Klinikum Bayreuth, Preuschwitzer Straße 101, 95445, Bayreuth, Germany

    Michael Vieth

  17. Gastroenterology and Hepatology, Sheba Medical Center, 52621, Tel Hashomer, Israel

    Rami Eliakim

  18. Department of Pathology, UZ Leuven, Herestraat 49, 3000, Leuven, Belgium

    Karel Geboes

  19. Department of Pathology, UZ Gent, De Pintelaan, 185, 9000, Gent, Belgium

    Karel Geboes

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  1. Cord Langner
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  2. Fernando Magro
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  3. Ann Driessen
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  15. Neil A. Shepherd
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Corresponding author

Correspondence to Cord Langner.

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On behalf of the European Society of Pathology (ESP) and the European Crohn’s and Colitis Organisation (ECCO).

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Langner, C., Magro, F., Driessen, A. et al. The histopathological approach to inflammatory bowel disease: a practice guide. Virchows Arch 464, 511–527 (2014). https://doi.org/10.1007/s00428-014-1543-4

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  • DOI: https://doi.org/10.1007/s00428-014-1543-4

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