Colitis - Revision history

Mikael Häggström: /* Further workup of colitis */ line break

2026-07-29T02:49:57Z

Further workup of colitis: line break

← Older revision		Revision as of 22:49, 28 July 2026
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	\| [[File:Histopathology of gland destruction in active colitis.jpg\|150px]]		\| [[File:Histopathology of gland destruction in active colitis.jpg\|150px]]
	\| [[File:Histopathology of severe ulcerative colitis.jpg\|150px]]		\| [[File:Histopathology of severe ulcerative colitis.jpg\|150px]]
			\|-
	! Neutrophilic inflammation		! Neutrophilic inflammation
	\| Scattered or focal neutrophils		\| Scattered or focal neutrophils

Mikael Häggström: /* Microscopic evaluation */ +Images

2026-07-29T02:49:25Z

Microscopic evaluation: +Images

← Older revision		Revision as of 22:49, 28 July 2026
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	*{{Comprehensive-begin}}Distribution: '''Patchy''' versus '''diffuse'''{{Comprehensive-end}}		*{{Comprehensive-begin}}Distribution: '''Patchy''' versus '''diffuse'''{{Comprehensive-end}}
	<gallery mode=packed heights=170>		<gallery mode=packed heights=170>
	File:Histopathology of severe ulcerative colitis.jpg\|'''Severe''' colitis (ulcerative colitis in this case): mucosal ulceration with loss of crypt architecture and replacement by inflamed granulation tissue containing abundant neutrophils, lymphocytes, and plasma cells.
	File:Histopathology of granuloma of colonic mucosa.jpg\|A non-necrotizing '''granuloma'''. It is seen as an aggregate of histiocytes in the center of the image, having ample eosinophilic cytoplasm.		File:Histopathology of granuloma of colonic mucosa.jpg\|A non-necrotizing '''granuloma'''. It is seen as an aggregate of histiocytes in the center of the image, having ample eosinophilic cytoplasm.
	File:Non-proliferative versus proliferative colonic crypts.jpg\|'''Dysplastic''' crypt at right. In such case, consider '''[[tubular and ⁄or villous adenoma]]'''.		File:Non-proliferative versus proliferative colonic crypts.jpg\|'''Dysplastic''' crypt at right. In such case, consider '''[[tubular and ⁄or villous adenoma]]'''.
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	! Severe activity		! Severe activity
	\|-		\|-
			! Example images
			\| [[File:Histopathology of neutrophilic cryptitis in active colitis, annotated.jpg\|150px]]
			\| [[File:Histopathology of gland destruction in active colitis.jpg\|150px]]
			\| [[File:Histopathology of severe ulcerative colitis.jpg\|150px]]
	! Neutrophilic inflammation		! Neutrophilic inflammation
	\| Scattered or focal neutrophils		\| Scattered or focal neutrophils

Mikael Häggström: /* Further workup of colitis */ Table

2026-07-29T02:46:30Z

Further workup of colitis: Table

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 </gallery>
 Apart from histologically defined diagnoses (collagenous colitis, lymphocytic colitis), there is no need to speculate about the exact underlying diagnosis (such as Crohn's disease, ulcerative colitis etc.).
 ===Microscopy report===

Mikael Häggström: /* Further workup of colitis */ +Severe

2026-07-29T01:43:03Z

Further workup of colitis: +Severe

← Older revision		Revision as of 21:43, 28 July 2026
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	*{{Comprehensive-begin}}Distribution: '''Patchy''' versus '''diffuse'''{{Comprehensive-end}}		*{{Comprehensive-begin}}Distribution: '''Patchy''' versus '''diffuse'''{{Comprehensive-end}}
	<gallery mode=packed heights=170>		<gallery mode=packed heights=170>
			File:Histopathology of severe ulcerative colitis.jpg\|'''Severe''' colitis (ulcerative colitis in this case): mucosal ulceration with loss of crypt architecture and replacement by inflamed granulation tissue containing abundant neutrophils, lymphocytes, and plasma cells.
	File:Histopathology of granuloma of colonic mucosa.jpg\|A non-necrotizing '''granuloma'''. It is seen as an aggregate of histiocytes in the center of the image, having ample eosinophilic cytoplasm.		File:Histopathology of granuloma of colonic mucosa.jpg\|A non-necrotizing '''granuloma'''. It is seen as an aggregate of histiocytes in the center of the image, having ample eosinophilic cytoplasm.
	File:Non-proliferative versus proliferative colonic crypts.jpg\|'''Dysplastic''' crypt at right. In such case, consider '''[[tubular and ⁄or villous adenoma]]'''.		File:Non-proliferative versus proliferative colonic crypts.jpg\|'''Dysplastic''' crypt at right. In such case, consider '''[[tubular and ⁄or villous adenoma]]'''.

Mikael Häggström: /* Microscopic evaluation */ generally

2025-03-20T15:10:44Z

Microscopic evaluation: generally

← Older revision		Revision as of 11:10, 20 March 2025
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	Have a high threshold for chronic colitis in the '''rectum''', as it often shows chronic changes even without any disease.		Have a high threshold for chronic colitis in the '''rectum''', as it often shows chronic changes even without any disease.

			===Special types===
	In addition, look for the following types of colitis:		In addition, look for the following types of colitis:
	<gallery mode=packed heights=170>		<gallery mode=packed heights=170>
	File:Histopathology of lymphocytic colitis, high magnification.png\|'''Lymphocytic colitis''', characterized by > 20 intraepithelial lymphocytes per 100 epithelial cells, away from lymphoid aggregates.<ref>{{cite web\|url=https://www.pathologyoutlines.com/topic/colonlymphocytic.html\|title=Lymphocytic colitis\|author=Martha M. Yearsley, M.D.\|website=Pathology Outlines}} Last author update: 28 July 2020</ref>		File:Histopathology of lymphocytic colitis, high magnification.png\|'''Lymphocytic colitis''', characterized by > 20 intraepithelial lymphocytes per 100 epithelial cells, away from lymphoid aggregates.<ref>{{cite web\|url=https://www.pathologyoutlines.com/topic/colonlymphocytic.html\|title=Lymphocytic colitis\|author=Martha M. Yearsley, M.D.\|website=Pathology Outlines}} Last author update: 28 July 2020</ref>
	File:Histopathology of lymphocytic colitis, low magnification.png\|'''Lymphocytic colitis''' also shows increased lymphocytes, plasma cells, eosinophils, and occasional neutrophils in lamina propria, but with preserved architecture		File:Histopathology of lymphocytic colitis, low magnification.png\|'''Lymphocytic colitis''' generally also shows increased lymphocytes, plasma cells, eosinophils, and occasional neutrophils in lamina propria, but with preserved architecture
	File:Histopathology of collagenous colitis.jpg\|'''Collagenous colitis''', with a thickened subepithelial collagen band that is typically more than 10 μm in thickness.<ref>{{cite web\|url=https://www.pathologyoutlines.com/topic/coloncollagenous.html\|website=Pathology Outlines\|title=Collagenous colitis\|author=Benjamin J. Van Treeck, M.D., Catherine E. Hagen, M.D.}} Topic Completed: 3 August 2020. Minor changes: 29 September 2020</ref>		File:Histopathology of collagenous colitis.jpg\|'''Collagenous colitis''', with a thickened subepithelial collagen band that is typically more than 10 μm in thickness.<ref>{{cite web\|url=https://www.pathologyoutlines.com/topic/coloncollagenous.html\|website=Pathology Outlines\|title=Collagenous colitis\|author=Benjamin J. Van Treeck, M.D., Catherine E. Hagen, M.D.}} Topic Completed: 3 August 2020. Minor changes: 29 September 2020</ref>
	File:Histology of a normal colonic mucosal epithelium.jpg\|Compare to normal colonic mucosa, which can have a band of basal epithelial cytoplasm.		File:Histology of a normal colonic mucosal epithelium.jpg\|Compare to normal colonic mucosa, which can have a band of basal epithelial cytoplasm.

Mikael Häggström: /* Microscopic evaluation */ Rectum

2025-03-20T15:07:54Z

Microscopic evaluation: Rectum

← Older revision		Revision as of 11:07, 20 March 2025
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	File:Histopathology of a degenerated crypt of chronic inactive colitis.jpg\|Crypt degeneration		File:Histopathology of a degenerated crypt of chronic inactive colitis.jpg\|Crypt degeneration
	File:Histopathology of crypt branching of colon.jpg\|Crypt branching and other architectural distortions		File:Histopathology of crypt branching of colon.jpg\|Crypt branching and other architectural distortions
	File:Histopathology Paneth cell metaplasia.jpg\|[[Paneth cell]] (pictured) or gastric metaplasia (only applies in the left colon and rectum)		File:Histopathology Paneth cell metaplasia.jpg\|Paneth cell (pictured) or gastric metaplasia (only applies in the left colon and rectum)
	</gallery>		</gallery>
	Chronic colitis may also cause elevation of crypts relative to the muscularis mucosa. Other findings include basal plasmacytosis and mucin depletion.<ref name=Kellermann2021/>		Chronic colitis may also cause elevation of crypts relative to the muscularis mucosa. Other findings include basal plasmacytosis and mucin depletion.<ref name=Kellermann2021/>

			Have a high threshold for chronic colitis in the '''rectum''', as it often shows chronic changes even without any disease.

	In addition, look for the following types of colitis:		In addition, look for the following types of colitis:

Mikael Häggström: linked

2025-03-20T15:03:50Z

linked

← Older revision		Revision as of 11:03, 20 March 2025
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	{{Top		<noinclude>{{Top
	\|author1=[[User:Mikael Häggström\|Mikael Häggström]]		\|author1=[[User:Mikael Häggström\|Mikael Häggström]]
	\|author2=		\|author2=
	}}		}}
			Most commonly found by [[endoscopic gastrointestinal biopsies]].
	{{Comprehensiveness}}		{{Comprehensiveness}}</noinclude>
	==Microscopic evaluation==		==Microscopic evaluation==
	*Look for signs of '''active''' (or acute) and/or '''chronic''' colitis:		*Look for signs of '''active''' (or acute) and/or '''chronic''' colitis:
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	{\|class=wikitable		{\|class=wikitable
	\| {{Moderate-begin}}Ascending, transverse, descending, and sigmoid colon, biopsies:{{Moderate-end}} {{Comprehensive-begin}}Patchy{{Comprehensive-end}} {{Moderate-begin}}mild{{Moderate-end}} chronic active colitis{{Comprehensive-begin}}, with associated cryptitis and crypt abscesses.{{Comprehensive-end}} {{Moderate-begin}}Negative for ulceration, granulomata and dysplasia.{{Moderate-end}}		\| {{Moderate-begin}}Ascending, transverse, descending, and sigmoid colon, biopsies:{{Moderate-end}} {{Comprehensive-begin}}Patchy{{Comprehensive-end}} {{Moderate-begin}}mild{{Moderate-end}} chronic active colitis{{Comprehensive-begin}}, with associated cryptitis and crypt abscesses.{{Comprehensive-end}} {{Moderate-begin}}Negative for ulceration, granulomata and dysplasia.{{Moderate-end}}
	\|}		\|}<noinclude>
	{{Bottom}}		{{Bottom}}</noinclude>

Mikael Häggström: /* Microscopy report */ Moderate

2025-03-20T14:56:18Z

Microscopy report: Moderate

← Older revision		Revision as of 10:56, 20 March 2025
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	Example of a normal sample, when colitis was suspected in the referral:		Example of a normal sample, when colitis was suspected in the referral:
	{\|class=wikitable		{\|class=wikitable
	\| {{Moderate-begin}} ~~Optionally:~~ Colonic/Rectal mucosa without significant histopathologic changes.{{Moderate-end}} Negative for acute and chronic colitis.		\| {{Moderate-begin}}Colonic/Rectal mucosa without significant histopathologic changes.{{Moderate-end}} Negative for {{Moderate-begin}}acute and chronic{{Moderate-end}} colitis.
	\|}		\|}

Mikael Häggström: /* Further workup of colitis */ Expanded

2023-11-06T17:23:59Z

Further workup of colitis: Expanded

← Older revision		Revision as of 13:23, 6 November 2023
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	Distinguish:		Distinguish:
	*{{Moderate-begin}}'''Severity''': Mild, moderate or severe.{{Moderate-end}}		*{{Moderate-begin}}'''Severity''': Mild, moderate or severe.{{Moderate-end}}
	*Presence of '''crypt regeneration''', '''granuloma''', inflammatory '''pseudomembranes''', '''parasites''', '''viral inclusions''', '''epithelial dysplasia''' or even '''cancer''' {{further\|Evaluation of suspected malignancies~~\|linebreak=no~~}}.		*Presence of '''crypt regeneration''', '''granuloma''', inflammatory '''pseudomembranes''', '''parasites''' or '''viral inclusions'''.
			*Presence of '''epithelial dysplasia''' or even '''cancer'''. If unsure of the latter, consider [[immunohistochemistry]] for cytokeratins such as CK AE1/AE3. {{further\|Evaluation of suspected malignancies}}
	*{{Comprehensive-begin}}Distribution: '''Patchy''' versus '''diffuse'''{{Comprehensive-end}}		*{{Comprehensive-begin}}Distribution: '''Patchy''' versus '''diffuse'''{{Comprehensive-end}}
	<gallery mode=packed heights=170>		<gallery mode=packed heights=170>
			File:Histopathology of granuloma of colonic mucosa.jpg\|A non-necrotizing '''granuloma'''. It is seen as an aggregate of histiocytes in the center of the image, having ample eosinophilic cytoplasm.
	File:Non-proliferative versus proliferative colonic crypts.jpg\|'''Dysplastic''' crypt at right. In such case, consider '''[[tubular and ⁄or villous adenoma]]'''.		File:Non-proliferative versus proliferative colonic crypts.jpg\|'''Dysplastic''' crypt at right. In such case, consider '''[[tubular and ⁄or villous adenoma]]'''.
	File:Histopathology of signet ring cell carcinoma of ileum.jpg\|Look particularly in ulcers for '''signet ring cells'''.		File:Histopathology of signet ring cell carcinoma of ileum.jpg\|Look particularly in ulcers for '''signet ring cells'''.
	~~File:Histopathology of granuloma of colonic mucosa.jpg\|A non-necrotizing '''granuloma'''. It is seen as an aggregate of histiocytes in the center of the image, having ample eosinophilic cytoplasm.~~
	</gallery>		</gallery>
	Apart from histologically defined diagnoses (collagenous colitis, lymphocytic colitis), there is no need to speculate about the exact underlying diagnosis (such as Crohn's disease, ulcerative colitis etc.).		Apart from histologically defined diagnoses (collagenous colitis, lymphocytic colitis), there is no need to speculate about the exact underlying diagnosis (such as Crohn's disease, ulcerative colitis etc.).

Mikael Häggström: /* Further workup of colitis */ +Cancer

2023-11-06T17:21:00Z

Further workup of colitis: +Cancer

← Older revision		Revision as of 13:21, 6 November 2023
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	Distinguish:		Distinguish:
	*{{Moderate-begin}}'''Severity''': Mild, moderate or severe.{{Moderate-end}}		*{{Moderate-begin}}'''Severity''': Mild, moderate or severe.{{Moderate-end}}
	*Presence of '''crypt regeneration''', '''granuloma''', inflammatory '''pseudomembranes''', '''parasites''', '''viral inclusions''' or '''epithelial dysplasia'''.		*Presence of '''crypt regeneration''', '''granuloma''', inflammatory '''pseudomembranes''', '''parasites''', '''viral inclusions''', '''epithelial dysplasia''' or even '''cancer''' {{further\|Evaluation of suspected malignancies\|linebreak=no}}.
	*{{Comprehensive-begin}}Distribution: '''Patchy''' versus '''diffuse'''{{Comprehensive-end}}		*{{Comprehensive-begin}}Distribution: '''Patchy''' versus '''diffuse'''{{Comprehensive-end}}
	<gallery mode=packed heights=170>		<gallery mode=packed heights=170>
	File:Non-proliferative versus proliferative colonic crypts.jpg\|'''Dysplastic''' crypt at right. In such case, consider '''[[tubular and ⁄or villous adenoma]]'''.		File:Non-proliferative versus proliferative colonic crypts.jpg\|'''Dysplastic''' crypt at right. In such case, consider '''[[tubular and ⁄or villous adenoma]]'''.
			File:Histopathology of signet ring cell carcinoma of ileum.jpg\|Look particularly in ulcers for '''signet ring cells'''.
	File:Histopathology of granuloma of colonic mucosa.jpg\|A non-necrotizing '''granuloma'''. It is seen as an aggregate of histiocytes in the center of the image, having ample eosinophilic cytoplasm.		File:Histopathology of granuloma of colonic mucosa.jpg\|A non-necrotizing '''granuloma'''. It is seen as an aggregate of histiocytes in the center of the image, having ample eosinophilic cytoplasm.
	</gallery>		</gallery>