Surgical Pathology Criteria

Incidental Chronic Colitis

Differential Diagnosis

Incidental Chronic Colitis Acute Self-limited Colitis
Isolated disease, virtually restricted to cecum/right colon Usually multifocal or extensive
Histologic changes of chronic colitis present Changes of chronic colitis rare
Incidental, asymptomatic Nearly always symptomatic
 

 

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

 

Incidental Chronic Colitis Ulcerative Colitis
Virtually restricted to cecum/right colon Involves rectum with contiguous disease proximally in most cases
Incidental, asymptomatic Nearly always symptomatic

 

Incidental Chronic Colitis Ischemic Colitis (Chronic)
Crypt distortion and dropout Predominantly hyalinization and fibrosis
Prominent basal plasmacytosis Inflammation not prominent
Virtually restricted to cecum/right colon Most common in splenic flexure

 

Incidental Chronic Colitis Lymphocytic Colitis
Crypt distortion and dropout No significant crypt distortion
Basal plasmacytosis Increase in lamina propria lymphocytes and plasma cells with intraepithelial lymphocytes
Isolated disease Usually multifocal
Virtually restricted to cecum/right colon May involve entire GI tract
Incidental, asymptomatic Intractable watery diarrhea in most cases

 

  • Incidental chronic colitis as defined here may be histologically indistinguishable from focal colitis associated with diverticular disease
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