Histopathological assessment of the microscopic activity in inflammatory bowel diseases: What are we looking for?

Advances in diagnostics of inflammatory bowel diseases (IBD) and improved treatment strategies allowed the establishment of new therapeutic endpoints. Currently, it is desirable not only to cease clinical symptoms, but mainly to achieve endoscopic remission, a macroscopic normalization of the bowel mucosa. However, up to one-third of IBD patients in remission exhibit persisting microscopic activity of the disease. The evidence suggests a better predictive value of histology for the development of clinical complications such as clinical relapse, surgical intervention, need for therapy escalation, or development of colorectal cancer. The proper assessment of microscopic inflammatory activity thus became an important part of the overall histopathological evaluation of colonic biopsies and many histopathological scoring indices have been established. Nonetheless, a majority of them have not been validated and no scoring index became a part of the routine bioptic practice. This review summarizes a predictive value of microscopic disease activity assessment for the subsequent clinical course of IBD, describes the most commonly used scoring indices for Crohn's disease and ulcerative colitis, and comments on current limitations and unresolved issues.

Current nomenclature and histopathological criteria for assessment of the noninflammatory degenerative diseases of the aorta.

A histopathological examination of the surgical specimen of the aorta usually follows a surgical reconstruction of the aortic aneurysm or dissection. Among the adults, the frequent cause of the aneurysm development is a severe atherosclerosis, while in children the aneurysm or dissection usually come as a complication of genetic syndromes. The common microscopical denominator of those diseases is a medial degeneration of variable degree. For a long time, a terminology of microscopical structural alterations used to be subjective and unsettled. In 2016, the first international guidelines for the histopathological assessment of the non-inflammatory degenerative diseases of the aorta were established. They introduced unified nomenclature, defined individual microscopic alterations and implemented a three-tier grading system. This work aims at practical aspects of the microscopical assessment and interpretation of the degenerative processes in the aorta with regards to the aforementioned consensus.

Histopathological assessment of the intensity and activity of the inflammation in inflammatory bowel diseases: An important addition to the endoscopy, or a pointless effort?

Expanding amount of knowledge about inflammatory bowel diseases has changed current therapeutic goals. In the past times, the main effort of the gastroenterologists was to alleviate patients symptoms. But nowadays, one of the hot topics is a mucosal healing and achieving the endoscopic, eventually even microscopic remission. Therefore, the objective assessment of the microscopic intensity and activity of the inflammation starts to assume its importance and histopathological scoring systems can represent an useful tool. However, their actual contribution is ill-defined. The aim of this review is to inform about available histopathological scoring systems for ulcerative colitis (UC) and Crohns disease (CD) and discuss their benefits and limitations. A systematic literature search in databases OVID SP MEDLINE, OVID EMBASE a The Cochrane library found 19 scoring indexes for UC and 4 for CD were found. The vast majority of them are not validated and their benefit for prediction of the clinical outcome is controversial. Endoscopy still represents a gold standard in the assessment of the extent of the bowel inflammation.

Immunohistochemical Assessment of CD30+ Lymphocytes in the Intestinal Mucosa Facilitates Diagnosis of Pediatric Ulcerative Colitis.

BACKGROUND: Diagnosis of pediatric inflammatory bowel diseases (IBD) remains challenging. We aimed at the value of immunohistochemical assessment of CD30+ lymphocytes in the intestinal mucosa in differential diagnosis between pediatric Crohn's disease (CD) and ulcerative colitis (UC) and its utility as a predictor of future differentiation in patients with IBD unclassified (IBDU). METHODS: Seventy-four treatment naive pediatric patients with IBD (33 CD, 30 UC and 11 IBDU) were enrolled into the study. Biopsy samples from six different regions (terminal ileum, cecum, ascending colon, transverse colon, descending colon and rectum) were immunohistochemically stained with anti-CD30 antibody, and the number of positive cells per one high power field was quantified. RESULTS: Significant differences between CD and UC were found when compared total counts of CD30+ cells in median numbers, mean values and maximal numbers and also for separate counts in terminal ileum, transverse colon, descending colon and rectum. The most profound difference between CD and UC was shown for total median values of CD30+ cells and for the values in rectal localization. The difference was independent on the intensity of inflammation. A cutoff value of 2.5 CD30+ cells with sensitivity 83% and specificity 90% was found for the rectum. There was no difference between patients with CD and IBDU, but a marked difference between UC and IBDU patients was revealed. CONCLUSION: Histopathological assessment of biopsy with rectal CD30+ count is reliable and simple method that could help in differential diagnosis among IBD subtypes in children with IBD.