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The gastrointestinal system
Published in C. Simon Herrington, Muir's Textbook of Pathology, 2020
Sharon J. White, Francis A. Carey
In quiescent or treated colitis, the bowel mucosa usually appears macroscopically slightly reddened, granular, and thinned, but is not ulcerated. Histology shows mild chronic inflammation of the lamina propria, but usually no cryptitis or crypt abscesses. Glands may appear shortened or distorted but usually in inactive disease mucous cell numbers are not reduced, in contrast to the appearances in active disease.
Diagnosis of IBD
Published in Peter Sagar, Andrew G. Hill, Charles H. Knowles, Stefan Post, Willem A. Bemelman, Patricia L. Roberts, Susan Galandiuk, John R.T. Monson, Michael R.B. Keighley, Norman S. Williams, Keighley & Williams’ Surgery of the Anus, Rectum and Colon, 2019
Gregor Novak, Geert D’Haens, Najib Haboubi, John B. Schofield
Focal (discontinuous) chronic inflammation represents an increased cellularity of the lamina propria, of variable density throughout the biopsy specimen, not confined to the superficial mucosa and possibly extending into the submucosa (see Figure 55.15). ‘Focally’ refers to localised increase of mononuclear cell density with or without infiltration of neutrophils. As in UC, the presence of neutrophils, including cryptitis and crypt abscesses, indicates active disease. Crypt irregularity implies to abnormality in >10% of the crypts and is characterised by crypt distortion (non-parallel, variable diameter or cystically dilated crypts), crypt branching and crypt shortening.3,67 The chronic inflammatory process induces alterations in mucosal architecture which are discontinuous (focal) and generally less prominent than in UC.
The anus and anal canal
Published in Professor Sir Norman Williams, Professor P. Ronan O’Connell, Professor Andrew W. McCaskie, Bailey & Love's Short Practice of Surgery, 2018
Professor Sir Norman Williams, Professor P. Ronan O’Connell, Professor Andrew W. McCaskie
Anal papillae occur at the dentate line and are remnants of the ectodermal membrane that separated the hindgut from the proctodaeum. As these papillae are present in 60% of patients examined proctologically, they should be regarded as normal structures. Anal papillae can become elongated, as they frequently do in the presence of an anal fissure. Occasionally, an elongated anal papilla may be the cause of pruritus. An elongated anal papilla associated with pain and/or bleeding at defaecation is sometimes encountered in infancy. Haemorrhage into a hypertrophied anal papilla can cause sudden rectal pain. A prolapsed papilla may become nipped by contraction of the sphincter mechanism after defaecation. Occasionally, a red oedematous papilla is encountered, with local pain and a purulent discharge from the associated crypt. This condition of ‘cryptitis' may be cured by laying open the mouth of the infected anal gland and excising the papilla. Troublesome papillae may be simply excised.
Dasatinib-induced colitis: clinical, endoscopic and histological findings
Published in Scandinavian Journal of Gastroenterology, 2022
Kenji Yamauchi, Tomoki Inaba, Hugh Shunsuke Colvin, Ichiro Sakakihara, Kumiko Yamamoto, Koichi Izumikawa, Sakuma Takahashi, Shigetomi Tanaka, Shigenao Ishikawa, Masaki Wato, Midori Ando, Masato Waki
Of the four patients (cases 1, 2, 3 and 4 shown in Table 2) who underwent colonic biopsy, CMV antigenaemia was negative in cases 1 and 2, positive in case 3 and not measured in case 4. The histopathological features are summarised in Table 3. All cases had severe chronic inflammatory cell infiltration, while neutrophilic infiltration, cryptitis and apoptosis were less common. Nuclear inclusion bodies and positive CMV immunostaining were found in all cases, suggesting CMV infection. In case 4, who underwent follow-up colonoscopy once a year while taking dasatinib, repeated biopsies were performed on the inflamed mucosa every year. Nuclear inclusion bodies were not detected in the first biopsy samples obtained from multiple erosions (Figure 3(B)); however, positive results were obtained from multiple small round elevations with erosion on the top in the following year (Figure 3(C)). CMV immunostaining was positive in both biopsy samples. Additional immunostaining using CD3, CD138, CD20, CD4, CD8 and CD56 antibodies was performed in a patient (case 4) with characteristic multiple elevations, showing predominance of CD138-positive cells and small numbers of CD8-and CD56-positive cells. Thus, plasmacytoid infiltration was predominant, and CD8-positive cytotoxic T cells and NK cells were mildly present in this patient (Figure 4).
Bowel perforation from malignant atrophic papulosis treated with eculizumab
Published in Baylor University Medical Center Proceedings, 2021
Ajithraj Sathiyaraj, Priyanga Jayakumar, Matthew R. McGlennon, John F. Eckford, Sandy Itwaru Anne
A 57-year-old white man had cutaneous manifestations (Figure 1) 1 year prior to his initial hospitalization, along with painful penile ulcerations that were in various stages of healing. Initial biopsies of the lesions were suggestive of Behçet’s disease. He was treated for Behçet’s disease without improvement, and a repeat punch biopsy was conducted, where a diagnosis of MAP was confirmed (Figure 2). A screening colonoscopy showed scant patchy erosions, erythema, and ulcers with focal cryptitis. Blood tests during his initial workup showed hypercalcemia with elevated parathyroid hormone, and he was referred to surgery for primary hyperparathyroidism and parathyroidectomy. During the procedure, a right inferior parathyroid adenoma was found but was adherent to the thyroid gland, so right thyroid lobectomy was performed. Pathology showed infarcted hypercellular parathyroid tissue containing prominent fat necrosis without malignancy.
Surface engineered lipid nanoparticle-mediated site-specific drug delivery system for the treatment of inflammatory bowel disease
Published in Artificial Cells, Nanomedicine, and Biotechnology, 2018
Gurpreet Kaur Sinhmar, Neel N. Shah, Shruti U. Rawal, Nimitt V. Chokshi, Hiren N. Khatri, Bhoomika M. Patel, Mayur M. Patel
Figure 9(a) indicates the representative figures of histology of colon tissue in which normal colon is made of well-designed, intact crypts along with the linings of muscularis and sub-mucosa. Crypts are normal tubular structure composed of cells that extend into the walls of the intestine. These crypts contain the cells that give rise to all of the other cells that migrate out of the crypts and then line the inner surface of the intestine. Inflammation of the crypts is known as cryptitis. The inflammation creates tiny sores called ulcers on the lining of the colon. It is a microscopical manifestation of several different diseases, which was seen in the diseased animals in the current study (Figure 9(b)). The histopathological microscopy of the rats treated with drug suspension showed ulceration hence proving lack of complete healing action of budesonide at the inflamed colon (Figure 9(c)). The colon of BDS-NLCs treated rats (Figure 9(d)) when observed under microscope showed lesser ulceration as compared to the diseased rats. The crypts were almost completely formed when compared to the diseased rats. The rats treated with Mn-NLCs (Figure 9(e)) showed re-formation of the crypts with leucocytes present in the lamina propia of the crypts, which symbolizes superficial damage to colon.