Challenges in the diagnosis of diversion colitis

Monika Tripathi, H-ECCO Member

Monika Tripathi wrc 2018
Monika Tripathi

Elective or emergency surgical interventions in the management of Inflammatory Bowel Disease (IBD) are mainly reserved for patients with medical refractory disease and life-threatening complications. Approximately 20%–30% of Ulcerative Colitis (UC) and 70%–80% of Crohn’s Disease (CD) patients will need surgery within the first to second decade following primary disease diagnosis [1].

Posted in Volume 14, Issue 3, ECCO News, Committee News, H-ECCO


Histopathological features of colitis due to immunotherapies

Magali Svrcek, H-ECCO Member

Magali Svrcek
Magali Svrcek

Immune checkpoints (ICK) are downregulators of T cell immunity. Immune checkpoint inhibitors (ICKi), by blocking the co-inhibitory receptors on T cells to activate their cytotoxic immune function, have become a major therapeutic tool in oncology, notably for the treatment of metastatic melanoma, non-small cell lung carcinoma, renal cell carcinoma, urothelial carcinoma and mismatch repair (MMR) deficient/microsatellite-unstable tumours. In particular, therapeutic monoclonal antibodies have emerged against cytotoxic T-lymphocyte-associated antigen 4 (CTLA-4), which primarily inhibits T cell activation, and programmed cell death 1 (PD-1), which limits the effector function of activated T cells in the periphery. Food and Drug Administration-approved ICKi include ipilimumab (CTLA-4 inhibitor), pembrolizumab and nivolumab (anti-PD-1) and atezolizumab (anti-PD-L1).

Posted in ECCO News, Volume 14, Issue 2, Committee News, H-ECCO


Report on the 4th H-ECCO IBD Masterclass at ECCO'19

Roger Feakins, H-ECCO Chair

Roger Feakins
Roger Feakins

The Histopathologists of ECCO constitute a small, relatively new but highly enthusiastic entity in a large organisation. Their committee (H-ECCO) organises a successful annual educational Masterclass that is now a regular item at the ECCO Congress. The 4th H-ECCO Masterclass took place in Copenhagen, Denmark on Thursday 7th and Friday 8th March 2019. There were four sessions of a similar length: Basics; Treatment and its effects; Age and demographics; and Tumours.

Posted in ECCO News, ECCO'19, Volume 14, Issue 1, Congress News, H-ECCO


The Value of Scoring Systems in the Histopathology of IBD

Gert de Hertogh, H-ECCO Member

Gert De HertoghGert de Hertogh

Histopathologists have traditionally fulfilled three functions in Inflammatory Bowel Disease (IBD) care. First, they play a role in the initial diagnosis, together with gastroenterologists, endoscopists and radiologists. Second, they establish a differential diagnosis at clinical flares of the disease, resolving the question of whether there is reactivation of the IBD, a superinfection or an unrelated pathology. Third, they are involved in the screening of patients for premalignant lesions and cancer.

Posted in Committee News, Volume 13, Issue 4, H-ECCO


Pouchitis: Practical Points for Pathologists

Paula Borralho Nunes, H-ECCO Member

Paula Borralho
Paula Borralho Nunes

A significant number of patients with Ulcerative Colitis (UC) will require a colectomy [1], with the most frequent indications including medical refractory disease and the occurrence of dysplasia or cancer in cases of longstanding disease. A total proctocolectomy with ileal pouch–anal anastomosis (IPAA) has become the surgery of choice for the “definitive” management of UC since it avoids a permanent stoma while removing all diseased colonic mucosa [2], but it is also used for familial adenomatous polyposis and sometimes (advertently or inadvertently) for Crohn’s Disease (CD). However, although this surgery has significantly improved the quality of life of patients with UC, complications such as fistulas, abscesses, strictures of the anastomosis and pouchitis can occur after restorative proctocolectomies. Pouchitis refers to a chronic relapsing inflammatory condition with active inflammation of IPAA mucosa and is considered to be a primary “non-specific, idiopathic inflammation of the neorectal ileal mucosa”. 

Posted in ECCO News, Committee News, Volume 13, Issue 3, H-ECCO


Serrated lesions in Inflammatory Bowel Disease

Magali Svrcek, H-ECCO Member

Magali Svrcek
Magali Svrcek

In addition to the “classical” pathway of colorectal carcinogenesis, involving development of cancer from an adenomatous precursor lesion, an alternative pathway, the serrated pathway, is now recognised to exist, and it is estimated that approximately 30% of colorectal cancers (CRC) arise via this alternative pathway [1]. In the last WHO classification, serrated polyps were classified as (i) hyperplastic polyps (HP), (ii) sessile serrated adenoma/polyps (SSA/P), with or without dysplasia, and (iii) traditional serrated adenomas (TSA). The possibility of a serrated pathway has also been suggested in colorectal carcinoma complicating Inflammatory Bowel Disease (IBD) [2–4]. Little is known concerning immunohistochemical and molecular features of serrated lesions in IBD: Data are limited to small series of patients or case reports and findings are controversial due to the rarity of the cases. However, the clinical, pathological and biological characteristics of serrated polyps in patients with IBD do seem to resemble those of their sporadic counterparts.

Posted in ECCO News, Committee News, Volume 13, Issue 2, H-ECCO


Report on the 3rd H-ECCO IBD Masterclass at ECCO'18

Roger Feakins, H-ECCO Chair

Roger Feakins
Roger Feakins © ECCO

The 3rd Histopathologists of ECCO (H-ECCO) Masterclass took place in Vienna on February 15–16, 2018.

Since its formation in 2016, the Histology Working Group of ECCO (H-ECCO) has organised a successful annual educational Masterclass. The 3rd H-ECCO Masterclass at the 2018 ECCO Congress in Vienna ran on Thursday afternoon and Friday morning. It coincided with an important event: The official conversion of the H-ECCO Working Group to a full committee on the Thursday evening.  Attendance at the Masterclass was good (over 70 registrants) and the audience comprised a mixture of histopathologists and gastroenterologists from Europe and further afield.

Posted in ECCO News, ECCO'18, Congress News, Volume 13, Issue 1, H-ECCO


The effects of drug treatment on colorectal mucosal histology

Vincenzo Villanacci, H-ECCO WG Member

Vincenzo VillanacciVincenzo Villanacci 

The Inflammatory Bowel Diseases (IBD) Crohn’s Disease (CD) and Ulcerative Colitis (UC) are characterised by flares and remission, reflecting the pathological status of the inflamed intestinal tract. For decades, the treatment goal for IBD was the achievement of clinical response or remission. More recently, however, the normalisation of laboratory parameters and intestinal mucosa, termed mucosal healing (MH), has been considered a major target to prevent extra-intestinal complications and achieve sustained clinical remission. 

Posted in ECCO News, Committee News, Volume 12, Issue 4, H-ECCO