tailieunhanh - INFLAMMATORY BOWEL DISEASE - PART 10

Viêm loét đại tràng. (A) công suất thấp xem thể hiện sự biến dạng kiến trúc nhẹ hầm mộ, thâm nhiễm lymphoplasmacytic cơ bản, và thâm nhiễm lan tỏa neutrophilic. (B) (Đối diện trang) cao sức mạnh của cùng một sinh thiết cho thấy một u hạt liền kề với một hầm mộ bị vỡ. | 332 Hart Fig. 4. Ulcerative colitis. A Low-power view demonstrating mild crypt architectural distortion basal lymphoplasmacytic infiltrates and diffuse neutrophilic infiltrates. B Opposite page High-power of the same biopsy revealing a granuloma adjacent to a ruptured crypt. Transmural disease is another characteristic feature of Crohn s disease but of course this feature cannot be assessed in endoscopic biopsy specimens. Inflammation can extend into the submucosa or even deeper in active ulcerative colitis so the presence of inflammatory cells in the superficial portion of submucosa sometimes included in a biopsy specimen cannot automatically be assumed to be diagnostic of Crohn s disease. However in ulcerative colitis the inflammation of the overlying mucosa is always more severe than that of the submucosa. Therefore a biopsy that exhibits marked inflammation of the superficial submucosa with relatively little active inflammation in the overlying mucosa would suggest a diagnosis of Crohn s colitis. There are additional histologic features which while not diagnostic can be helpful in favoring a diagnosis of either ulcerative colitis or Crohn s colitis. For instance the degree of crypt architectural distortion tends to be greater in ulcerative colitis. Thus biopsies from ulcerative colitis patients often reveal significant mucosal atrophy with numerous branched crypts and marked alteration of the normal parallel arrangement of the crypts. Biopsies from patients with Crohn s colitis in contrast may exhibit only mild crypt architectural distortion with relatively Chapter 17 Pathologic Features of IBD 333 Fig. 5. Early Crohn s colitis. A Low-power view showing a lymphoid follicle. B High-power of the same biopsy reveals an early aphthous erosion with focal neutrophilic infiltrate directly over the lymphoid .

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