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Area of Science:

  • Gastroenterology
  • Pathology
  • Oncology

Background:

  • Ulcerative colitis (UC) is characterized by chronic inflammation of the colon.
  • Histologic examination of UC colectomy specimens reveals architectural distortions in crypts, termed corrupted colonic crypts (CCC).
  • The frequency and classification of CCC in UC require further assessment.

Purpose of the Study:

  • To classify the histologic features of corrupted colonic crypts (CCC) in ulcerative colitis (UC).
  • To determine the frequency of CCC in UC colectomy specimens.
  • To evaluate the association between CCC and high-grade dysplasia (HGD) or adenocarcinoma in UC.

Main Methods:

  • Review of 516 histologic sections from 29 colectomy specimens with UC.
  • Classification of CCC into four distortion types: fission, length, outline, and axial polarity.
  • Assessment of cellular changes within CCC, including inconclusive-suspected cellular changes (ISCC) and HGD.

Main Results:

  • Corrupted colonic crypts (CCC) were identified and classified into four types, with axial polarity distortions being the most frequent.
  • Out of 902 CCC examined, a significant proportion showed inconclusive-suspected cellular changes (38.0%) or high-grade dysplasia (HGD) (20.6%).
  • A high percentage (91.6%) of HGD in UC colectomy specimens was found within CCC, significantly more than in crypts with normal shapes (CNS).

Conclusions:

  • Microscopic examination for HGD in UC colectomy specimens should prioritize areas with CCC.
  • The presence of CCC is a strong indicator for HGD in UC.
  • Architectural distortions in crypts, as indicated by CCC, correlate with p53 overexpression, a biomarker for epithelial carcinogenesis.