Ischemic colitis with atypical reactive changes that mimic dysplasia (pseudodysplasia)

To describe reactive or reparative but atypical epithelial changes that occur in ischemic colitis.

Surgical pathology files were searched for the diagnosis "ischemia, bowel." All cases were studied for reactive or reparative atypical changes. These were characterized and correlated with clinical information.

Reactive atypical (pseudodysplastic) changes were found in 8 of 28 cases of ischemic bowel. The clinical history did not indicate ischemic colitis in 6 of 8 cases. In 3 cases, neutrophils in the lamina propria or acute cryptitis and crypt abscesses that suggested inflammatory bowel disease were noted.

Ischemic changes in the bowel may produce reactive epithelial changes with sufficient atypia to simulate dysplasia. These may be associated with histologic changes that simulate inflammatory bowel disease, specifically ulcerative colitis. Since in most cases even the clinician is not sure whether the patient has ischemia or inflammatory bowel disease and because histologic changes of the latter may occur in ischemic bowel, there is a danger that the atypical reactive ischemic changes could be interpreted as true dysplasia that occurs in inflammatory bowel disease.