A surgical pathology report from an ileocolonic resection specimen in a suspected Crohn disease case describes transmural lymphoid aggregates, deep fissuring ulcers, and skip areas of uninvolved mucosa. Non-caseating granulomas are absent. Which conclusion is correct?
- A Granulomas are found in only a minority of Crohn resections and their absence does not exclude the diagnosis ✓
- B The presence of caseation must be confirmed before excluding intestinal tuberculosis
- C The absence of granulomas excludes Crohn disease
- D Transmural lymphoid aggregates indicate ulcerative colitis with backwash ileitis
Correct answer: A. Granulomas are found in only a minority of Crohn resections and their absence does not exclude the diagnosis
Explanation
Non-caseating granulomas are seen in only about 40 to 50 percent of Crohn disease resection specimens and far fewer mucosal biopsies, so they support but are not required for the diagnosis. Transmural inflammation with fissuring ulcers and skip lesions is itself characteristic of Crohn disease, since ulcerative colitis inflammation is limited to the mucosa. In India, however, any granulomatous ileocolitis still warrants active exclusion of tuberculosis with AFB staining and PCR before labelling it Crohn disease.
Reference: Robbins and Cotran Pathologic Basis of Disease, 10th ed.
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