Surgical Pathology Criteria

Ulcerative Colitis

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

Ulcerative Colitis Acute Self-limited Colitis
Basal lymphoid aggregates frequent Basal lymphoid aggregates absent
Neutrophil infiltrate in crypts with frequent crypt abscesses Neutrophil infiltrate predominantly in lamina propria
Inflammation involves all levels of mucosa Inflammation largely restricted to upper and mid zones of mucosa
Architectural changes of chronic colitis are present Architecture is preserved
Duration at least 6 months Short duration
Common organisms include Salmonella, Shigella, Campylobacter, Yersinia and viruses

Eosinophilic (Allergic) Proctocolitis Ulcerative Colitis
May occur <12 months of age Very rare <12 months
Marked tissue eosinophilia >60/10 HPF May have moderate numbers of eosinophils

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

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