Department of Pathology, Henry Lee Moffitt Cancer Center and Research Institute.
Department of Pathology, University of Szeged and Albert Szent-Györgyi Health Center, Szeged, Hungary.
Adv Anat Pathol. 2022 Jan 1;29(1):48-61. doi: 10.1097/PAP.0000000000000325.
Inflammatory bowel disease, including ulcerative colitis and Crohn disease, is an idiopathic chronic inflammatory condition of the gastrointestinal tract. Since neither the clinical manifestations nor the morphologic features of inflammatory bowel disease are pathognomonic alone, the differential diagnosis to consider is relatively broad, and it relies on the synthesis of clinical, endoscopic, and microscopic features. Long-held histologic diagnostic principles include recognizing structural and inflammatory features of chronicity, that is, architectural distortion, basal plasmacytosis, and expansion of the lamina propria lymphoplasmacytic infiltrate. In addition, evaluation of the neutrophilic inflammation and related crypt and epithelial destruction is essential to gauge the activity of the disease. Nevertheless, these features can be difficult to confirm in special settings, including at the inception of the disease or in partially treated cases. This review will explore the classic morphologic features of ulcerative colitis and Crohn disease, followed by a detailed discussion of atypical and diagnostically challenging presentations and a brief review of the clinical aspects necessary for the daily practice of pathologists.
炎症性肠病，包括溃疡性结肠炎和克罗恩病，是一种特发性胃肠道慢性炎症性疾病。由于炎症性肠病的临床表现和形态特征都不是特异性的，因此需要考虑的鉴别诊断范围相对较广，这依赖于临床、内镜和显微镜特征的综合分析。长期以来的组织学诊断原则包括识别慢性的结构和炎症特征，即结构扭曲、基底层浆细胞增多和固有层淋巴浆细胞浸润的扩张。此外，评估中性粒细胞炎症和相关隐窝及上皮破坏对于评估疾病的活动度至关重要。然而，在特殊情况下，包括疾病初期或部分治疗的情况下，这些特征可能难以确认。本文将探讨溃疡性结肠炎和克罗恩病的经典形态特征，随后详细讨论非典型和具有诊断挑战性的表现，并简要回顾病理学家日常实践所需的临床方面。
