Overview about Colon Biopsies

1. Colon Biopsy
What is Normal? What is Abnormal?
-Naveen

2. Normal Histology
• Flat mucosal surface.
• Columnar surface epithelial cells are intact ;
• Crypt density -7 to 9 /1mm of muscularis
mucosa
• Goblet cells(1:4) , Paneth cells in right colon
• Parallel crypts – perpendicular to muscularis
mucosa;

3. • Cellular infiltrate - lamina propria of normal
density, distribution and population ;Plasma cells
– Primary lymphoid follicle - eosinophils – occ
neutrophil
• Sub epithelial zone 3 to 6 microns
• No granulomas or giant cells are present
• Muscularis mucosae - no splaying, below the
base of crypts
• Submucosa – lymphoid follicle- meissner plexus-
ganglion cells

5. • Intra epithelial lymphocyte- 1 for every 20 cell
is normal- not to count the one above the
lymphoid aggregate
• Improper fixation- surface epithelial injury
with no associated inflammtion
• Enema effect-edema, rbcs, mucin in LP-
superficial inflammatory cells -flattening or
stripped of surface epithelium

6. Acute vs chronic colitis

7. Acute Colitis
– Preservation of crypt architecture
– Within 4 days – mucosal edema, acute cryptits,
crypt ulcers and abscesses
– 4 to 9 days – mucus depletion – increased mitotic
figures in crypt – cryptitis
– Resolving –hypercellular lamina
propria(inflammatory cells)
– Presence of more than 10 neutrophils in more
than two crypts in any one biopsy is indicative of
active inflammation.

9. IBD A]Ulcerative colitis
• Severe crypt architectural distortion ;
• Widespread decrease in crypt density ;
• Frankly villous surface;
• Dense diffuse transmucosal increase in cellular
infiltrate in the lamina propria ;
• Diffuse basal plasmacytosis;
• Severe mucin depletion ;
• Paneth cell metaplasia distal to the hepatic
flexure.

11. B]Crohn’s Disease
• Epithelioid granuloma ;
• Discontinuous inflammation ;
• Discontinuous crypt distortion ;
• Focal cryptitis.

12. Non IBD colitis
Parasitic Colitis
• Amoeba Giardia Cryptosporidium
• eosinophils in lamina propria

13. Pseudomembranous colitis
• Dilated crypts with
inflammatory debris-
”volcano”

14. Graft vs host disease
• Increased number of apoptotic bodies in the
surface epithelium
• Crypts -moth eaten

15. Collagenous colitis
• Pink subepithelial stripe -intact crypt
architecture-increase mononuclear cells
• Normal thickness subepithelial - 3 microns

16. Lymphocytic colitis/ Microscopic colitis
• >20 IEL/100 cells [Normal<5]- Ranitidine

17. Drug induced colitis

18. Ischemic colitis

19. Radiation colitis
• Chronic-
Hyalinisaton of
lamina propria-
fibrotic
submucosa,
vascular
ectasia,fibrinoid
necrosis of vessel
wall
• Acute – resemble
ischemic colitis

20. Hirshprung disease

21. Other non neoplastic conditions
• Diverticulum – mucosa and muscularis mucosa
penetrate muscularis propria –smooth muscle
hypertrophy
• Endometriosis – endometrial glands, stroma with
hemosiderin laden macrophages, fibroblastic
response
• Amyloidosis , ingested bone( non viable nuclei)

23. Polyps
– Non neoplastic
– Inflammatory
– Hamartomatous
» Juvenile –Peutz jegher- cowden-cronkite canda
– Hyperplastic
– Neoplastic
– Adenoma
» Tubular – villous- tubulo villous-sessile serrated
– Carcinoid – stromal- lymphomas- metastatic

24. Inflammatory polyp
• SRUS –epithelial hyperplasia-mixed inflammation –lamina
propria fibromuscular hyperplasia

25. Hamartomatous polyps
• Juvenile Polyps – spherical lobulated –
hamartomatous – irregularly shaped and
dilated glands.
• Peutz jeghers polyps – zones of disorganised
mucosa partitioned by smooth muscle
• Cronkhite- canada polyp – similar to juvenile
polyp–broad sessile base, expanded
edematous lamina propria, cystic glands

27. Hyperplastic polyp
• Epithelial tufting confined to surface
epithelium

28. Dysplasia vs regenerative hyperplasia

29. Dysplasia
• Nuclear elongation, Hyperchromatism,
Pleomorphism, Stratification, Loss of polarity
and no evidence of maturation towards the
mucosal surface.
• Large nucleoli-
eosinophilic cytoplasm
reduced goblet cells

30. Dysplasia
• Low grade – maintained nuclear polarity,
• High grade- loss of polarity, cribriforming
pattern,

31. Adenoma
• Adenoma – high grade dysplasia
• Adenoma with pseudo invasion – rounded
glands, lamina propria is dragged in ,
hemosiderin

32. • Tubular adenoma Villous adenoma
Tubulo villous adenoma

33. • Serrated Adenoma
– large, high
proliferative index,
serrations extending
into base,
– dilated architecture of
glands from surface to
base ,
– mismatch repair gene
defect

34. Adenoma with pseudo invasion

35. Adenoma with high grade dyspasia

36. Adeno carcinoma
• Submucosal
invasion or
• If submucosa is
not present in the
biopsy- angulated
glands and single
cells, necrosis, in
desmoplastic
stroma.

38. Eosinophilic colitis

39. Dysplasia associated with mass lesion
Ibd associated dysplasia

40. Thank You!