Surgical Pathology Criteria

Crohn Disease

Differential Diagnosis

Ulcerative Colitis Crohn Disease
Inflammation limited to mucosa and superficial submucosa Transmural inflammation
Contiguous disease, no skip lesions Discontinuous, patchy disease with skip lesions
Limited to colon May involve entire GI tract
No granulomas Granulomas may be present
Predominantly neutrophilic infiltrate with crypt abscesses Predominantly lympho-histiocytic infiltrate
Perinuclear anti-neutrophilic cytoplasmic antibody (pANCA) favors ulcerative colitis Anti-Saccharomyces cerevisiae antibody (ASCA) favors Crohn disease

 

Mucosal Prolapse / Cloacogenic Polyp (Solitary Rectal Ulcer) Crohn Disease
Shallow ulceration Deep ulcers and fissures
Restricted to rectum (rarely in sigmoid) May involve any part of GI tract
Not concentric, usually localized to anterior rectal wall Usually concentric
Frequently forms a polyp that appears hamartomatous with muscularis mucosae extension into lamina propria No polyp formation or muscularis mucosae extension into lamina propria

 

Crohn Disease Common Variable Immunodeficiency – GI Involvement
Skip lesions predominate Usually diffuse
Transmural inflammation Mild lamina propria infiltrate with nodular lymphoid hyperplasia
Numerous plasma cells Plasma cells frequently markedly decreased
Deep fissures frequent No fissures or deep ulcers

 

Incidental Chronic Colitis Crohn Disease
Isolated disease Usually multifocal
Virtually restricted to cecum/right colon May involve entire GI tract
No granulomas Granulomas may be present
Incidental, asymptomatic Nearly always symptomatic

Stanford Medicine Resources:

Footer Links: