Can you help me read biopsy results please

A-Ileum, C + E. Normal.

B,D,F,G. In Ulcerative Colitis diagnosis, the crypts are of particular interest and exhibit unique histopathology findings for this disease. What is a crypt in medical jargon? The intestinal surface ripples like waves on a pond, with peaks and valleys, and the valleys are known as crypts. Back to your crypts "increasing crypt distortion in the more distal biopsies" distortion of the crypt structure means chronic architectual changes to your cells on the left-side. There's cryptitis which is inflammation of the crypts. There's crypt abscess which are immune cells scattered shallow within your defensive mucosa barrier where they do not belong. You have ulcers (ulcerative colitis includes the word ulcers in it's name) on the left side.

With an Inflammatory Bowel Disease (IBD), we expect to see chronic architectual changes to your cells. A short, one time infection would not permanently change your cell structure. Hyperplasia is an architectual change to your cells. So those two findings alone (Hyperplasia and crypt-distortion) are suggestive of crohnic changes, and land you solidly within an IBD diagnosis.

The crypt distortion, crypt abscesses, crypt inflammation, ulcers, and distal (left-side) are all storybook Ulcerative Colitis (UC) which is a form of IBD. Many of us here have identical findings to those within our own biopsy reports (myself included).

The only weird (not storybook UC) thing is that the inflammation is areas were skipped and they noted it as patchy. The medical term used is a skip-lesion. A skip lesion is inflammation that is clearly patchy, "skipping" areas that thereby are unharmed. It is a typical form of intestinal damage in Crohn's disease. A bit unusual but hardly enough to discredit all of the other findings which are consistent with an UC.

At your followup doctor's consultation, I would say "This sounds like UC based on the crypt findings, ulceration, and distal-left-side involvement. What concerns you is the patchy inflammation appearance (also known as skip-lesions) which are more crohn's-like? Is that finding enough to call this crohn's-colitis or Indeterminate-colitis? Or are you confident enough to call this UC?"

My thoughts. Unless more telltale Crohn's signs appear later, no worries. Keep it on your back burner for future reference and endoscopy. We all have more endoscopy and it can always produce the same results or change over time.

Yes, it is pancolitis when inflammation goes beyond the left-side. You have right-side involvement therefore it is considered to be a pancolitis.

Rectum only = a proctitis.

Rectum + sigmoid colon = proctosigmoiditis. I've also heard this called distal-colitis or left-side-colitis.

We need endoscopy for diagnosis, and then starting annually for colorectal cancer screenings after 10 years of having UC. Endoscopy is used as-needed as a diagnostic tool when we flare or are considering escalating to higher classes of meds (to measure extent and severity of inflammation and choose meds appropriately).

One thing is certain, you/I will have a lot of endoscopy in our lives. More data points to continually confirm or potentially change our diagnosis.

Yes, in a remission we have zero inflammation. Yes, CRC risks are lowest when there's zero inflammation for long periods of time.

CRC risks do not statistically increase until 10 years, thus the screenings starting then. Still, only 3 to 5% of us ever get a crc.

You have pancoltis but experiencing no symptoms ? Wouldn’t you be having some symptoms if you had pancolits ?

quincy said...
Well, it's definitely IBD...

The prominent peyer patch doesn't state where, but more info is about them in the small intestine/terminal ileum. Happens in both UC and CD.
Just found this info on Peyers patches..... 👍
/www.hindawi.com/journals/iji/2010/823710/

The fact that this is all early in diagnosis.....the normal patch areas throughout including rectum aren't classic with UC, but you were pregnant, so maybe that's a factor if the doc is leaning toward one over the other. No commitment of "consistent with" by pathology regarding one over the other, and further investigation in future might clarify it.

I would suggest another scope in a year tho considering you wont be pregnant probably and you will have been on meds.

Its good you got the report....don't worry about cancer at this point since surveillance is always part with scoping. Besides, stats aren't subjective.

Hugs,
q

I think/hope you’re right. What ever version I have it is hopefully mild because it’s basically early stages. So I just need to focus on the inflammation and getting that gone, rather than worry about specifics for now. As I’m sure at some point I’ll be told what’s more likely , whether it’s after another scope or different symptoms appear....
although something makes me want to lean towards a touch of the Crohns ... I just think UC is UC.. although a complex disease. How it presents itself is usually fairly consistent. And this doesn’t sound consistent at all. Sounds all over the place haha.

One thinks I’m certain of is I definitely won’t be pregnant again. So that’s a nice feeling. I’m happy and blessed with two. Plus preggo hormones seemed to have helped this rear its head so I’m not up for that again.

Trying to stay healthy is now the aim of the game plus I seriously need to get back to work. Too much time off being pregnant and looking after babies ... I love them with my whole heart but after this years revelations Im looking forward to being just me again.

The prominent peyers patch was near the TI... still not quite sure what that means to be honest.
Thanks for always replying. Means a lot xx

Severity of inflammation matters more then extent. Try not to overthink this. Gasteroenterologists treat based on symptoms first, and it sounds like you're doing well. Cheers!

So just thought I’d update a little. Nothing much to report. But still like to fill you guys in as your always so good at replying to me.

Had my follow up with my GI today.
I asked the suggested questions by Ipoop.
She said she will sit confidently with the UC diagnoses. As nothing on the reports/biopsies suggest otherwise.
I asked why it would be patchy. And she said that’s just sometimes how it is, but I for sure have inflammation from the rectum to left side. Then it goes patchy... which is why I now have the pancolitis title.
She said the TI was mentioned. She feels this is likely pancolitis backwash as the biopsies confirmed it was normal in that area.

I really feel she’s looking after me well!

But she is referring me for a small bowel MRI as it’s non invasive and she thinks it will be good to have it on record for future reference should I ever need to change medication.
Also to confirm it’s functioning as it should and no areas are inflamed up there.

For now she’s pleased with my current blood tests, and Bm status, plus latest FCP test. So all being well I’ll see her for a routine check up in 6 months. 🤞🏻🤞🏻

Just wanted to say a thank you to you guys for all the information and knowledge.
You really have helped a girl out.
I do hang around reading other posts so will always weigh in if I think it’s appropriate.
But for now. I hope everyone stays well.
Thanks
Kate

They didn’t overly mention it in the report.
But the guy that performed the scope said he saw “colitis” at the entrance of the TI. But biopsies confirmed it was nothing to worry about.
My GI just re confirmed what the biopsies had told us. 👍🏻