Microscopy:
Chronicity:
- Mucosal architecture(Diffuse-UC; Patchy changes-CD):
- Glands-Normal / distorted glands
- Crypt density-Normal/decreased (>1 crypt separation b/w adjacent crypts)
- Crypt atrophy-Present/absent (distance b/w crypt base and muscularis mucosa increased)
- Surface irregularity-present/absent
- Villous architecture
- Lamina propria cellularity:
- Diffuse(UC)/Patchy(CD/quiescent or longstanding UC); Mild/mod/severe; Transmucosal(UC)/Transmural(CD)
- Basal plasmacytosis(UC+, infectious colitis-,CD-)
- Epithelial abnormality:
- Mucin depletion: Reduction in number of goblet cells/ reduced intracellular mucin.
- Others
- Granulomas(Not associated with crypt destruction and extravasated mucin-UC): Present (CD-classical finding, TB, parasites, cryptolytic granuloma in UC) / absent(UC)
- Paneth cell metaplasia
- Hypertrophy of MM
- Submucosal fibrosis
Activity:
- Epithelial abnormality:
- Erosion, ulceration, flattening, focal cell loss
- Crypt abnormality:
- Cryptitis
- Crypt abscess
- Lamina propria
- Increased neutrophilic infiltrate
Note: In biopsies sent from known cases of IBD in quiescent stage: Increased lamina propria eosinophils, basal plasmacytosis and mildly active disease is suggestive of ensuing relapse.
Dysplasia: Negative for dysplasia (Regenerating epithelium)/ Indefinite for dysplasia/ Positive for Low grade dysplasia or High grade dysplasia
Impression:
Chronic Colitis with/without Activity, likely UC/CD/IBDU
Negative/Positive for high/low grade dysplasia
Or
Known case of UC/CD in remission/quiescent stage(Architectural abnormality+/-, Activity-, Basal plasmacytosis-, Eosinophils+/-)/ quiescent stage with features of ensuing relapse(Architectural abnormality+/-, Mild Activity+, Basal plasmacytosis+, Eosinophils++)
Negative/Positive for high/low grade dysplasia