Loughrey Maurice B, Shepherd Neil A
Department of Histopathology, Royal Victoria Hospital, Grosvenor Road, Belfast, Northern Ireland, BT12 6BA, UK.
Gloucestershire Cellular Pathology Laboratory, Cheltenham General Hospital, Sandford Road, Cheltenham, Gloucestershire, GL53 7AN, UK.
Virchows Arch. 2018 Jan;472(1):81-97. doi: 10.1007/s00428-017-2235-7. Epub 2017 Nov 4.
Histopathological assessment of biopsy and resection specimens of chronic inflammatory bowel disease (CIBD), or possible CIBD, forms a significant component of the routine workload in most tissue pathology laboratories. In this review, we have chosen selected areas of particular diagnostic difficulty in CIBD pathology, providing key advice for pathology reporting. Those mimics of CIBD which have the greatest potential for misdiagnosis are discussed, particularly the wide range of infectious colitides which represent possible diagnostic pitfalls. The most important distinguishing features between the two main forms of CIBD, ulcerative colitis and Crohn's disease, are addressed, first in relation to resection specimens, and then with emphasis on features which may also be diagnostically useful in endoscopic biopsy material. The importance of assessment of the index endoscopic specimen is stressed, before treatment has been instigated, along with careful correlation with clinical and endoscopic features. Problems in the assessment of post-surgical CIBD specimens are described and then the role of upper gastrointestinal pathology specimens in diagnosing both Crohn's disease and ulcerative colitis, with increased recognition of upper gastrointestinal tract involvement in the latter condition. Finally, with recent developments in endoscopic surveillance techniques and local excision options, modern approaches to reporting and managing neoplasia complicating CIBD are reviewed.
对慢性炎症性肠病（CIBD）或疑似CIBD的活检及切除标本进行组织病理学评估，是大多数组织病理学实验室日常工作量的重要组成部分。在本综述中，我们选取了CIBD病理学中具有特殊诊断难度的特定领域，为病理报告提供关键建议。讨论了那些最有可能被误诊为CIBD的疾病，尤其是种类繁多的感染性结肠炎，它们可能是诊断陷阱。阐述了CIBD两种主要形式，即溃疡性结肠炎和克罗恩病之间最重要的鉴别特征，首先是关于切除标本的特征，然后重点介绍在内镜活检材料中也可能具有诊断价值的特征。强调了在开始治疗前对初次内镜标本进行评估的重要性，以及与临床和内镜特征进行仔细对照。描述了术后CIBD标本评估中的问题，接着介绍了上消化道病理标本在诊断克罗恩病和溃疡性结肠炎中的作用，目前后者中上消化道受累的情况已得到更多认识。最后，随着内镜监测技术和局部切除方法的最新进展，综述了报告和处理CIBD并发肿瘤的现代方法。
