The histopathological approach to inflammatory bowel disease: a practice guide.
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.
Institute of Pathology, Medical University of Graz, Auenbruggerplatz 25, 8036, Graz, Austria, cord.langner@medunigraz.at.
Cord
C
Langner
Fernando
F
Magro
Ann
A
Driessen
Arzu
A
Ensari
Gerassimos J
GJ
Mantzaris
Vincenzo
V
Villanacci
Gabriel
G
Becheanu
Paula
P
Borralho Nunes
Gieri
G
Cathomas
Walter
W
Fries
Anne
A
Jouret-Mourin
Claudia
C
Mescoli
Giovanni
G
de Petris
Carlos A
CA
Rubio
Neil A
NA
Shepherd
Michael
M
Vieth
Rami
R
Eliakim
Karel
K
Geboes
D006801:Humans; D015212:Inflammatory Bowel Diseases / Q000175:diagnosis*