What are the typical histologic findings of ulcerative colitis (UC)?

Updated: Apr 10, 2020
  • Author: William A Rowe, MD; Chief Editor: BS Anand, MD  more...
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Answer

The typical histologic findings of ulcerative colitis include expansion of chronic inflammation in the mucosa and, in active cases, the presence of acute inflammation. In mildly active cases, there is an acute cryptitis that progresses to crypt abscesses in moderately active cases. In severe cases, mucosal ulcers develop as a result of the ongoing acute inflammatory process. Areas of relatively preserved mucosa between ulcerated areas may have a polypoid appearance grossly and are referred to as "pseudopolyps." In cases of many years’ duration, dysplasia of the large bowel mucosa may develop and signifies an increased risk for the development of colorectal adenocarcinoma. (See the images below.)

Inflammatory bowel disease. High-power view of a c Inflammatory bowel disease. High-power view of a crypt abscess in ulcerative colitis shows the crypt to be dilated and filled with neutrophils and debris.
Inflammatory bowel disease. This is an example of Inflammatory bowel disease. This is an example of low-grade glandular dysplasia in a patient with longstanding ulcerative colitis. Note the loss of mucin, nuclear hyperchromasia, and nuclear pseudostratification. See the next image.
Inflammatory bowel disease. High-grade dysplasia i Inflammatory bowel disease. High-grade dysplasia in the same patient as the previous image. There is significant cytologic atypia, with rounding of the nuclei and a greater degree of pseudostratification.
Inflammatory bowel disease. Histologic section fro Inflammatory bowel disease. Histologic section from another location in the same patient as described in the previous image. This field shows glands that are suspicious for invasive carcinoma.

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