Pathological analysis of lesions within intestines resected due to ulcerative colitis.

INTRODUCTION: Ulcerative colitis (UC) and Lesniowski-Crohn's disease together constitute a type of intestinal pathology known as Inflammatory Bowel Disease. The etiology of UC still remains unknown, however some epidemiological data suggest the role of bacteria and viruses and also some habitual as well as environmental factors like smoking, diet, drugs, geographical and social status, as well as stress. The genetic predisposition is also suggested. UC affects young people in 2nd - 4th decades of life. Exacerbations of the disease may result in the necessity of surgical treatment, typically in the form of total proctocolectomy accompanied by the subsequent formation of ileo-pouch-anal anastomosis. The aim of our study was to analyze morphological pictures of resected specimens.

MATERIAL AND METHODS: We analyzed 67 cases (40 women and 27 men) of UC with the special interest being focused at macro- as well as microscopic features of the intestines resected. We reviewed macroscopic characteristics of intestines (i.e. the length of resected fragments, localization, shape and diameter of the ulcers, polyps, number of resected lymph nodes), as well as microscopic descriptions concerning, among others the character and localization of inflammatory infiltrate, the architecture of glands, the presence of crypt abscesses and Paneth's metaplasia. Special attention was paid to the morphology of intestinal wall vasculature.

RESULTS: In 42% of the cases macroscopically the inflammation covered the whole length of the resected colon. In 58% macroscopically detected inflammatory changes were segmental in distribution. In four cases the disease had clinically the fulminant course and the inflammation was transmural. There were 3 cases, in which histological assessment revealed the presence of malignancy (2 cases of mucus producing adenocarcinoma and one case of carcinoma in situ situated in the anal canal). Generally, microscopic findings were typical for the active phase of UC. We found intensive vascularization and hyperemia of the intestinal wall to be the common features accompanying the inflammation.

CONCLUSIONS: Young people in the 3rd and 4th decades of life constitute the group being relatively commonly affected by the UC, and undergo the surgical proctocolectomy. Some of the cases present with the fulminant course of the disease. A rich vascular network is a common finding in the inflamed intestinal wall. We hypothesize, that intensive vascularization may play a significant role in the pathogenesis of UC.