Granulomas in the diagnosis of intestinal Crohn's disease: amyth exploded?

@article{Shepherd2002GranulomasIT,
  title={Granulomas in the diagnosis of intestinal Crohn's disease: amyth exploded?},
  author={Neil A. Shepherd},
  journal={Histopathology},
  year={2002},
  volume={41}
}
  • N. Shepherd
  • Published 1 August 2002
  • Medicine
  • Histopathology
Mention granuloma , certainly to the average gastroenterologist and probably to many pathologists, in the context of intestinal pathology, and the diagnosis of Crohn’s disease is established irrevocably, it seems, often to the detriment of the patient. Now no selfrespecting pathologist is going to deny the importance of granulomas in the differential diagnosis of inflammatory bowel disease, and major reviews and interobserver studies have confirmed their importance in the differential diagnosis… 

Indeterminate colitis: definition, diagnosis, implications and a plea for nosological sanity

The pathology of cases appropriately classified as indeterminate colitis and the implications of that diagnosis are described and recent advances in its pathological features, clinical management and its immunological and genetic associations are highlighted.

The Pathology of Chronic Inflammatory Bowel Disease

The purpose of this chapter is to discuss and illustrate the pathologic manifestations and differentiating features of UC and CD in biopsies and surgical specimens, the conditions that enter into the differential diagnosis as well as features that are atypical or which can result in difficulties in diagnosis.

Presence of Granulomas in Mesenteric Lymph Nodes Is Associated with Postoperative Recurrence in Crohn's Disease

The presence of granulomas in MLN but not in intestine per se was found to be an independent risk factor for recurrence in CD patients undergoing ileocolonic resection.

What is diverticular colitis?

Diverticular colitis may respond well to treatment similar to that used for chronic inflammatory bowel disease, adding to the similarities of this disease, notably localised to the sigmoid colon, and ulcerative colitis.

The Role of the Pathologist in the Management of Patients with Crohn’s Disease

This chapter summarizes the role of the pathologist in the management of patients with CD, starting from a glossary of the terms used in the information exchange between the pathologists radiologist gastroenterologist, and surgeon.

Inflammatory bowel disease unclassified and indeterminate colitis: the role of the pathologist

An algorithm for a diagnosis of colitis with a focus on indeterminate colitis is described, which allows a correct diagnosis of inflammatory bowel diseases in 66–75% of newly diagnosed patients.

Misdiagnosis and Mistherapy of Crohn's Disease as Intestinal Tuberculosis

It is found that distinguishing between ITB and CD is difficultBecause of their varied clinical presentation, nonspecific investigative tools, and profound similarities even in pathological specimens, each case still poses challenges for diagnosis and administrating the appropriate treatment.

Colitis in Infancy and Childhood

The evaluation of specimens in these settings is essential to confirm the presence of an inflammatory disorder, to establish a diagnosis, to distinguish acute, self-limited disease from chronic processes, to determine the extent of disease and to assess the efficacy of therapy.

Colitis in Childhood

The evaluation of specimens in these settings is essential to confirm the presence of an inflammatory disorder, to establish a diagnosis, to distinguish acute, selflimited disease from chronic processes, to determine the extent of disease, and to assess the efficacy of therapy.

References

SHOWING 1-10 OF 36 REFERENCES

Importance of cryptolytic lesions and pericryptal granulomas in inflammatory bowel disease.

The presence of cryptolytic granulomas in a colorectal biopsy specimen otherwise showing only non-specific inflammatory changes should always raise suspicion of Crohn's disease, especially if surgery or ileo-anal pouch formation is contemplated.

Pathological mimics of chronic inflammatory bowel disease.

It behooves all practising histopathologists to recognise these mimics of ulcerative colitis and Crohn's disease to ensure appropriate management for patients with inflammatory pathology of the intestines.

The pathology of diverticular disease.

It is now realised that mucosal biopsies of the luminal mucosa, in the sigmoid colon affected by diverticular disease, can produce perplexing pathological changes, and diverticular colitis can mimic both ulcerative colitis and Crohn's disease.

The granuloma in Crohn's disease.

It was found that a high content of granulomas predicted a good prognosis in the large bowel and anus, but was of no prognostic significance in the small bowel.

Crohn’s-like reaction in diverticular disease

A Crohn’s-like inflammatory response can be a localised reaction to diverticulitis and does not necessarily indicate chronic inflammatory bowel disease.

The chronological sequence in the pathology of Crohn's disease.

Sixty-three consecutive reexcisions of bowel for recurrent Crohn's disease where the former excision had removed all apparent disease were studied to suggest a central role for ulceration in this disease.

Crohn's colitis-like changes in sigmoid diverticulitis specimens is usually an idiosyncratic inflammatory response to the diverticulosis rather than Crohn's colitis.

It is suggested that CD-like changes within the sigmoid resection specimen are an idiosyncratic inflammatory response to the diverticulosis rather than coexistent CD in the overwhelming majority of patients who do not have prior or concurrent CD at the time of sigmoids resection.

Granulomas of the gut in Crohn's disease

This study proved that granulomas in Crohn's disease are found in the seemingly uninvolved intestinal mucosa as well as in the affected mucosa, and emphasized that these small granuloma, namely microgranulomas, in the apparently uninvolved intestine mucosa are of great value in diagnosing Crohn’s disease.