The severity of ulcerative colitis correlates with the histologic findings, which can be graded based on the epithelial and inflammatory cells changes.



(1) epithelium: normal

(2) inflammatory cells: small numbers of lymphocytes, plasma cells, macrophages and mast cells in the lamina propria

(3) other findings: minimal interstitial edema


Grade 1:

(1) epithelium: no significant epithelial changes

(2) inflammatory cells: increased numbers of chronic inflammatory cells in the lamina propria, with occasional foci of polymorphonuclear leukocytes

(3) other findings: minimal to mild interstitial edema


Grade 2:

(1) epithelium: mild regenerative change, with Paneth cells in the crypts

(2) inflammatory cells: severe chronic inflammation in the lamina propria, with polymorphonuclear leukocytes present within crypts and ducts

(3) other findings: fibrosis may be present


Grade 3:

(1) epithelium: marked regenerative changes, sometimes with areas of ulceration

(2) inflammatory cells: severe inflammation with crypt abscesses

(3) other findings: occasional multinucleated giant cells in the lamina propria


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