INFLAMMATORY

BOWEL DISEASE
Presented by:
Edward Ariel M. Tadea
COME- Post-Graduate Intern
July 13, 2016

Objective
To define Inflammatory Bowel
Disease (IBD).
To identify the types of IBD.
To describe the gross and
microscopic pathology of the
different types of IBD.

Objective
To identify other causes of
chronic colitis
To discuss colitis-associated
neoplasia

Inflammatory Bowel Disease

(IBD)

Is a chronic condition
resulting from
inappropriate mucosal
immune activation.

Types of IBD

Crohn Disease
Ulcerative Colitis

Crohn Disease
May occur in any area of the GI
tract, but the most common sites
involved at presentation are the
terminal ileum, ileocecal valve, and
cecum.
Skip lesions are characteristic of
Crohn Disease

Crohn Disease: Gross Pathology

Figure A. Small-intestinal

Crohn Disease: Gross Pathology

Figure B. Linear mucosal ulcers, which impart a

cobblestone appearance to the mucosa, and

Crohn Disease: Gross Pathology

Figure C. Perforation and associated

Crohn Disease: Gross Pathology

Figure D. Creeping fat

Crohn Disease: Microscopic

Pathology

Figure A. Haphazard crypt organization results

from repeated injury and regeneration

Crohn Disease: Microscopic

Pathology

Figure B. Noncaseating granuloma

Crohn Disease: Microscopic

Pathology

Figure C.
Transmural Crohn
disease with
submucosal and
serosal
granulomas

Ulcerative Colitis
Always involves the rectum and
extends
proximally
in
a
continuous fashion to involve part
or all of the colon (Pancolitis).

The small intestine is normal,

although
mild
mucosal
inflammation of the distal ileum,
termed backwash ileitis, may be

Ulcerative Colitis: Gross Pathology

Figure A. Total colectomy with pancolitis showing active

disease, with red, granular mucosa in the cecum (left) and
smooth, atrophic mucosa distally (right)

Ulcerative Colitis: Gross Pathology

Figure B. Sharp demarcation between active

ulcerative colitis (right) and normal mucosa (left)

Ulcerative Colitis: Gross Pathology

Figure C. Inflammatory polyps

Ulcerative Colitis: Gross Pathology

Figure D. Mucosal bridges

Ulcerative Colitis: Microscopic

Pathology

Figure A. Crypt abscess

Ulcerative Colitis: Microscopic

Pathology

Figure B. Pseudopyloric Metaplasia

Ulcerative Colitis: Microscopic

Pathology

Figure C. Disease is limited

to mucosa

Vs. Crohn Disease

Other Causes
of Chronic
Colitis

Other Causes of Chronic Colitis

Diversion Colitis
Microscopic Colitis
Collagenous colitis
Lymphocytic colitis

Diversion Colitis

Figure A. Diversion Colitis. Note large lymphoid

aggregates with germinal centers

Collagenous Colitis

Figure B. Collagenous

Lymphocytic Colitis

Figure C. Lymphocytic

ColitisAssociated
Neoplasia

Colitis-Associated Dysplasia

Figure A. Dysplasia with extensive nuclear

stratification and marked nuclear

Colitis-Associated Dysplasia

Figure B. Cribriform glandular arrangement in

high-grade dysplasia

Colitis-Associated Dysplasia

Figure C. Colectomy specimen with high-grade

dysplasia on the surface and underlying
invasive adenocarcinoma

Thank
you!