Download - Small Intestine Colon-Nonneoplastic I
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7/27/2019 Small Intestine Colon-Nonneoplastic I
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SMALL INTESTINE (normal)
Simple columnar epithelium
Scattered GOBLET CELLS
Distinguish from large intestine by presence of both crypts and VILLI
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LARGE INTESTINE (normal)
long, cigar-shaped/test tube shaped goblet cells
Only crypts (no villi) this is how to distinguish from small intestine
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This is Crohns disease
1) Histo findings: blunting of the villi/abnormal villous architecture; inflammatory
infiltrate (lymphocytes & plasma) which may be transmural & deep into tissues(compare to ulcerative colitis, in which inflammatory infiltrate is often shallow, w/
mucosal involvement only)
2) skip lesions (patchy areas of inflammation, may appear ulcerated)
3) NOD2 (CARD15) , ATG16L1, IRGM (many more have been discovered, but these were
the ones emphasized in lecture)
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Creeping fat
The serosal surface is normally smooth; in Crohns you see fat globules hanging off
serosal surfaceDevelops because mesenteric fat is beginning to spread over the serosal surface
secondary to the inflammation
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In additoin to the strictures, there is transmural thickening and cobblestoning
Transmural thickening + fibrosis
stricture formation
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Absence of normal villous architecture
Inflammatory infiltrate throughout (versus only at the surface for ulcerative colitis)
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loss of villi
Arrow knife-like ulceration
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Non-caseating granuloma seen in quadrant II (light oval-shaped area near the X of the
gridlines)
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Left is UC
Entire mucosal surface is inflamed (not patchy inflammation as in Crohns)
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1) Ulcerative colitis
2) Continuous (moving front lesions; not skip lesions); broad-based ulcers and
pseudopolyps3) limited to mucosa and submucosa
4) Pseudopolyp = random areas of leftover normalmucosa in a sea of irregular
pathology (denuded epithelium
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1) There is a moving front of ulceration in this specimen, starting in the rectum and
moving proximally A) moving front of ulceration starting in rectum B) Hemorrhage C)
Cecum unaffected2) This is the common pattern in ulcerative colitis (continuous spread starting in
rectum, moving proximally)
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1) Inflammation in the mucosa only. There is also loss of architecture of mucosa
(random orientation, loss of test tubes in a rack appearance of the surface, ie loss
of cigar-shaped/fusiform glands)2) This is suggestive of ulcerative colitis
Normal findings: http://www.youtube.com/watch?v=7zrgHuplA18
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Crypt abscesses with neutrophils in the lumen = sign of active inflammation (active
chronic colitis)