Importance of cryptolytic lesions and pericryptal granulomas in inflammatory bowel disease

• Published in: Journal of clinical pathology Vol. 50; no. 2; pp. 148 - 152
• Main Authors: Lee, F D, Maguire, C, Obeidat, W, Russell, R I
• Format: Journal Article
• Language: English
• Published: London BMJ Publishing Group Ltd and Association of Clinical Pathologists 01.02.1997; BMJ; BMJ Publishing Group LTD
• Subjects: Biological and medical sciences; Biopsy; Crohn Disease - complications; Crohn Disease - diagnosis; Crohn Disease - surgery; Follow-Up Studies; Gastroenterology. Liver. Pancreas. Abdomen; Granuloma - complications; Granuloma - pathology; Granuloma - surgery; Humans; Inflammatory Bowel Diseases - complications; Inflammatory Bowel Diseases - pathology; Inflammatory Bowel Diseases - surgery; Medical sciences; Other diseases. Semiology; Stomach. Duodenum. Small intestine. Colon. Rectum. Anus; Human; Pathology; Crohn disease; Granuloma; Lysis; Intestinal crypt; Digestive diseases; Intestinal disease; Glandular epithelium; Diagnosis; Inflammatory disease; Giant cell
• ISSN: 0021-9746; 1472-4146
• DOI: 10.1136/jcp.50.2.148

AIMS: To explore the diagnostic importance of pericryptal granulomas associated with epithelial lysis in colorectal biopsy specimens (cryptolytic colitis). METHODS: A series of patients with suspected inflammatory bowel disease and colorectal biopsy specimens showing either isolated pericryptal granulomas (14 cases) or non-granulomatous pericryptal inflammation (eight cases) were followed. A diagnosis of Crohn's disease was established if subsequent biopsy specimens or intestinal resections showed unequivocal non-crypt related granulomas, or if there was evidence of significant small bowel disease. RESULTS: Of the 14 patients with pericryptal granulomas and biopsy specimens, 10 were subsequently found to have Crohn's disease; of the eight patients with pericryptal inflammation only, one developed Crohn's disease. The former group also had a much higher instance of morbidity and required surgical intervention more often. CONCLUSIONS: The presence of cryptolytic granulomas in a colorectal biopsy specimen otherwise showing only non-specific inflammatory changes should always raise suspicion of Crohn's disease, especially if surgery or ileo-anal pouch formation is contemplated.