By Talbot, Ian
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Additional resources for Biopsy Pathology in Colorectal Disease, 2Ed
Apart from this situation, crypt branching is an abnormal sign, implying prior mucosal damage. The crypts may be bifid (Fig. 9) or, after severe damage, even run parallel to the surface (Fig. 10). 2). In a well-orientated biopsy the failure to cut any crypts along their length, with the majority being cross-cut, is also a sign of crypt branching and irregularity (Fig. 11). 6 MUCOSAL CRYPT ARCHITECTURE Inspection of the crypt architecture initially at low power may reveal either circumscribed noninflammatory abnormalities affecting a group of crypts, as in polyps (Fig.
The debris reflects the luminal contents and is worth careful inspection. Sloughed epithelial cells, collections of neutrophil polymorphs and/or eosinophils are common cellular constituents. 1 Luminal debris and cells. (a) Vacuolated macrophages, degenerate epithelial cells and inflammatory cells overlying a non-specific ulcer. (b) and (c) Amoebae, containing partly digested red blood cells, apart from being larger, are better preserved and their cytoplasmic structures better defined than the macrophages in (a).
It is normal for the crypts to appear attenuated in the rectal mucosa close to the anal canal and in the relatively thin mucosa of the caecum (Fig. 14). Failure to recognize these artefacts and variants can lead to a mistaken diagnosis of atrophy and possibly quiescent ulcerative colitis. 3 Crypt degeneration This may involve the whole crypt or the superficial half of the crypt. Damage to the superficial half of the crypt is a useful pointer to ischaemia and pseudomembranous colitis (Fig. 15). The bases frequently survive and the remaining epithelial cells appear hyperchromatic and basophilic.
Biopsy Pathology in Colorectal Disease, 2Ed by Talbot, Ian