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ulcerative colitis

Tuesday 2 March 2004

Definition: Ulcerative colitis (UC) is generally considered an inflammatory disorder that always involves the rectum and may also involve more proximal portions of the colon, but always in a diffuse and continuous (non-segmental) fashion.

Earlier biopsy studies have shown that both rectal sparing and patchy disease may occur during the natural history of UC and may, in fact, be accentuated by oral or enema therapy. (20410806)


- ulcerative colitis : ruptured crypt granuloma : mucous extravasation after cryptic dysruption


- chronic inflammatory infiltrate (Grade 1)
- lamina propria neutrophils and eosinophiles (Grade 2)
- neutrophils in epithelium (Grade 3)
- crypt destruction (Grade 4)
- mucosal ulceration or ulceration (Grade 5)
- colonic inflamatory pseupolyp

Evaluation Scores

Endoscopical Score / Macroscopical Score

  • Endoscopical Mayo Score for Ulcerative Colitis : Disease Activity Index (DAI) for Ulcerative Colitis


- backwash ileitis
- postcolectomy pouchitis
- diffuse duodenitis (11023103)


- colonic adenoma
- dysplasia-associated lesion or mass (DALM)
- ulcerative colitis-associated colorectal adenocarcinoma

Differential diagnosis

- colonic Crohn disease


- steroid-refractory ulcerative colitis

  • association with CMV infection (15104299)


- Tsang P, Rotterdam H. Biopsy diagnosis of colitis: possibilities and pitfalls.Am J Surg Pathol 1999 Apr;23(4):423-30

- Kleer CG, Appelman HD. Ulcerative colitis: patterns of involvement in colorectal biopsies and changes with time.Am J Surg Pathol 1998 Aug;22(8):983-9

- Morphologic findings in upper gastrointestinal biopsies of patients with ulcerative colitis: a controlled study. Lin J, McKenna BJ, Appelman HD. Am J Surg Pathol. 2010 Nov;34(11):1672-7. PMID: 20962621

- Rectal sparing and skip lesions in ulcerative colitis: a comparative study of endoscopic and histologic findings in patients who underwent proctocolectomy. Joo M, Odze RD. Am J Surg Pathol. 2010 May;34(5):689-96. PMID: 20410806

- Pathologic features of ulcerative colitis in patients with primary sclerosing cholangitis: a case-control study. Joo M, Abreu-e-Lima P, Farraye F, Smith T, Swaroop P, Gardner L, Lauwers GY, Odze RD. Am J Surg Pathol. 2009 Jun;33(6):854-62. PMID: 19295408

- In situ evidence of involvement of Schwann cells in ulcerative colitis: autocrine and paracrine signaling by A disintegrin and metalloprotease-17-mediated tumor necrosis factor alpha production. Mosnier JF, Jarry A, Camdessanch√© JP, Antoine JC, Laboisse CL. Hum Pathol. 2009 Apr 17. PMID: 19376560

- Pathologic Features of Ulcerative Colitis in Patients With Primary Sclerosing Cholangitis: A Case-control Study. Joo M, Abreu-E-Lima P, Farraye F, Smith T, Swaroop P, Gardner L, Lauwers GY, Odze RD. Am J Surg Pathol. 2009 Mar 17. PMID: 19295408

- Alterations in the immunohistochemical expression of Das-1 and CG-3 in colonic mucosal biopsy specimens helps distinguish ulcerative colitis from Crohn disease and from other forms of colitis. Yantiss RK, Das KM, Farraye FA, Odze RD. Am J Surg Pathol. 2008 Jun;32(6):844-50. PMID: 18408596

- Hyperplastic/serrated polyposis in inflammatory bowel disease: a case series of a previously undescribed entity. Srivastava A, Redston M, Farraye FA, Yantiss RK, Odze RD. Am J Surg Pathol. 2008 Feb;32(2):296-303. PMID: 18223333

- AMACR immunostaining is useful in detecting dysplastic epithelium in Barrett’s esophagus, ulcerative colitis, and Crohn’s disease. Dorer R, Odze RD. Am J Surg Pathol. 2006 Jul;30(7):871-7. PMID: 16819330

- Sandle GI. Pathogenesis of diarrhea in ulcerative colitis: new views on an old problem. J Clin Gastroenterol. 2005 Apr;39(4 Suppl 2):S49-52. PMID: 15758659

- Pediatric patients with untreated ulcerative colitis may present initially with unusual morphologic findings. Glickman JN, Bousvaros A, Farraye FA, Zholudev A, Friedman S, Wang HH, Leichtner AM, Odze RD. Am J Surg Pathol. 2004 Feb;28(2):190-7. PMID: 15043308

- Patterns of inflammation in mucosal biopsies of ulcerative colitis: perceived differences in pediatric populations are limited to children younger than 10 years. Robert ME, Tang L, Hao LM, Reyes-Mugica M. Am J Surg Pathol. 2004 Feb;28(2):183-9. PMID: 15043307

- Histopathology of ulcerative colitis in initial rectal biopsy in children. Washington K, Greenson JK, Montgomery E, Shyr Y, Crissinger KD, Polk DB, Barnard J, Lauwers GY. Am J Surg Pathol. 2002 Nov;26(11):1441-9. PMID: 12409720

- Inflammatory bowel disease. Podolsky DK. N Engl J Med. 2002 Aug 8;347(6):417-29. PMID: 12167685

- Colectomy for ulcerative colitis. Joshi VV, Ricci A Jr. Am J Surg Pathol. 1998 Aug;22(8):1040-1. PMID: 9706988

- Ulcerative colitis: patterns of involvement in colorectal biopsies and changes with time. Kleer CG, Appelman HD. Am J Surg Pathol. 1998 Aug;22(8):983-9. PMID: 9706978

- Price AB, Morson BC. Inflammatory bowel disease: the surgical pathology of Crohn’s disease and ulcerative colitis. Hum Pathol. 1975 Jan;6(1):7-29. PMID: 1089084