Rubio Carlos A, Lang-Schwarz Corinna, Vieth Michael
Department of Oncology and Pathology, Karolinska Institute and University Hospital, Stockholm, Sweden.
Institute of Pathology, Friedrich-Alexander-Universität Erlangen-Nürnberg, Klinikum Bayreuth, Bayreuth, Germany.
J Gastroenterol Hepatol. 2024 Dec;39(12):2479-2486. doi: 10.1111/jgh.16811. Epub 2024 Nov 10.
Chronic mucosal inflammation and architectural crypt distortions (ACD) are essential for the histologic diagnosis of ulcerative colitis (UC). ACD in UC has been defined as irregularly arranged, dilated, branched, and shortened crypts with inequality of inter-crypt distance. However, neither the diagnostic sections' crypt phenotype nor the cutting mode have been considered. In this regard, previous studies showed that most diagnostic biopsies in UC are fortuitously crosscut at laboratories. In this communication, we review the crypt phenotypes that are included in the ACD in UC notion: crypts in asymmetric branching, crypt rings in tandem, crypts with lateral buds, face-to-face "kissing crypts," crypts-in-crypts, laterally orientated crypts in anthemia fold domains, and crypts with irregular shape and size in innominate groves domains. The awareness that disparate crypt phenotypes may participate in the ACD notion may open new vistas in the interpretation of crypt distortions in crosscut diagnostic sections in UC. The present findings will permit endoscopists and clinicians to better understand the narrative of ACD in the pathological diagnosis.
慢性黏膜炎症和隐窝结构扭曲（ACD）是溃疡性结肠炎（UC）组织学诊断的关键要素。UC中的ACD被定义为隐窝排列不规则、扩张、分支且缩短，隐窝间距不等。然而，此前既未考虑诊断切片的隐窝表型，也未考虑切片方式。在这方面，既往研究表明，UC中大多数诊断性活检标本在实验室都是偶然横切的。在本交流中，我们回顾了UC中ACD概念所包含的隐窝表型：不对称分支的隐窝、串联的隐窝环、有侧芽的隐窝、面对面的“亲吻隐窝”、隐窝内隐窝、花冠状皱襞区域横向排列的隐窝以及无名沟区域形状和大小不规则的隐窝。认识到不同的隐窝表型可能参与到ACD概念中，可能为解释UC横切诊断切片中的隐窝扭曲开辟新的视角。目前的研究结果将使内镜医师和临床医生能更好地理解病理诊断中ACD的情况。
