Section of Colonic mucosa biopsy. The black arrow points to the - PowerPoint PPT Presentation

Section of Colonic mucosa biopsy. The black arrow points to the shallow broad based ulcers. The blue arrow is on the intact muscularis Mucosa. The yellow arrow points to the Lymphoid hyperplasia. The red points to the crypt abscess. R & D Histopath Lab, Chennai Dr. Meera Govindarajan, MD, DNB

Features of the biopsy which may be common to idiopathic colitis, Crohn;s disease and Tuberculosis in Colonic mucosa • Severe colitis R & D Histopath Lab, Chennai Dr. Meera Govindarajan, MD, DNB • Crypt abscess as pointed by the red arrow • Regenerating • Regenerating base of crypts- black arrow • Dense inflammatory cell infiltrate - yellow

Complete block sectioning with 98 serial sections were cut . Another histopathological change was observed in about 7 sections R & D Histopath Lab, Chennai Dr. Meera Govindarajan, MD, DNB

Microscopic features which are in favour of the final diagnosis • Broad based shallow ulcers • Absence of slit like ulcer- a common feature of Crohn’s of Crohn’s • Intact musclaris mucosa- not seen in Crohn’s • Multiple non caseating granulomas – Black arrows R & D Histopath Lab, Chennai Dr. Meera Govindarajan, MD, DNB

Higher power view of the same granulomas

Inview of the absence of slit like or fissure ulcers, absence of transmural involvement and lack of Sarcoid like granuloma with presence of early Langhan’s type of Giant cell , a diagnosis of Tuberculous colitis was suggested. • Cluster of pale spindle epitheliod cells cells • An early Langhan’s like giant cell • Absence of caseation and necrosis.