I did this small presentation for the radiology residents of HMC.

1. Inflammatory bowel
disease
RADIOLOGY-PATHOLOGY CORRELATION
NOV 21, 2018

2. CASE 1:
 Previous biopsies showed proctitis
 proctectomy

5. Normal Histology

7. Mucosal
ulceration

9. Pseudopolyps

11.  Acute on chronic inflammation with ulceration.
 No granulomas, fistulas or transmural inflammation (No diagnostic feature
of crohns)
 Considering the clinical features, consistent with ulcerative colitis.

12. CASE 2
 IBD with perianal disease.
 Total proctocolectomy with removal of perianal tissue.

14. Crypt
abscess

16. Serosal
inflammation
and fibrosis

17. Normal and abnormal
mucosa

21.  Acute on chronic transmural inflammation with granulomatous
inflammation in the perianal tissue, consistent with Crohns disease.

22. Inflammatory
bowel disease
Ulcerative colitis
Crohns disease
Indeterminate colitis

23. Ulcerative colitis
Bloody diarrhea,
remissions and
exacerbations.
01
left-sided disease,
which usually begins
in the rectosigmoid
area
02
Microscopically,
ulcerative colitis is
primarily a mucosal
and submucosal
disease.
03
Quiescent or resolving
stage of the disease,
the mucosa may
appear grossly
normal, with nearly
total restoration of the
mucin content.
04

24. Complications
BACKWASH ILEITIS IN 1/3 TO 1/5 OF
THE CASES.
PERFORATION WITH PERITONITIS
AND ABSCESS, TOXIC MEGACOLON
CMV INFECTION

26. Colitis-associated dysplasia
 Develops in areas affected by chronic inflammation
 Can be flat(endoscopically invisible)or raised
 dysplasia-associated lesion/mass [DALM]
 1- 2% increased carcinoma risk each year after 10 years

28. Risk of malignancy
 Carcinoma of the large bowel develops in 5-10% of the cases.
 The risk of carcinoma is higher when the entire colon is involved; when the
disease is continuous, unremitting, and of long-standing (over 10 years)

29. Crohns disease
Soft loose non
bloody diarhea.
01
Small bowel
disease, can
extend to the
colon, RT side
mostly
02
Microscopically
Transmural
disease with
granulomas
03
Doesn’t respond
to steroid or
surgery (small
bowel disease)
04

30. Crohns disease
 Originally described in small bowel, involves large bowel in upto
40 % of the cases.
 Genetic predisposition (slightly more than UC)
 Can involve any part of the GI tract from mouth to anal canal.

31. Classical
features
Aphthous ulcers
Cobblestone
Fissures and
fistulas
Granulomatous
inflammation
Transmural
inflammation

33. Indeterminate colitis
 none of the criteria are pathognomonic for either condition
 Approximately 15% of the cases features of both conditions are present,
so that the differential diagnosis becomes impossible.

34. Ulcerative colitis Crohns disease
Location Rectosigmoid, left sided Small bowel, right colon
Distribution Continuous Skip lesions
Clinical features Liquid, Bloody diarrhea Loose non bloody stools
Bowel layers Mucosa, submucosa Transmural
Distinctive features Pseudopolyps, strictures Cobblestoning, Granulomas, linear
ulcers, fissures and fistulas
Complications Toxic megacolon Recurrence
Risk of cancer
4% in general population
5-10% Very rare (increased with colon
involvement)
Surgery Proctocolectomy Not helpful in small bowel