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Importance of cryptolytic lesions and pericryptal granulomas in inflammatory bowel disease.

A journal of evidence-based health care recently featured an editorial' emphasising interobserver disagreement between pathologists and ipso facto the unreliability of histopathology as the "gold standard diagnosis". Recent initiatives to clarify evidencebased histopathology and reduce interobserver disagreement are therefore welcomed. A recent case of clinical chronic ulcerative colitis in which sequential biopsies showed frequent pericryptal aggregates of epithelioid histiocytes caused us to consult both the guidelines for the initial biopsy diagnosis of chronic idiopathic inflammatory bowel disease (CIBD)5 and a simultaneous publication by Lee et al3 addressing the topic of the diagnosis and significance of intramucosal granulomas in CIBD. We were immediately struck by the disparity between the text definitions of epithelioid cell granulomas and the photomicrographs in both articles. Both defined these as discrete collections of at least five epithelioid cells with or without accompanying giant cells; however, in practice these are extremely difficult to count as cytoplasmic boundaries are invariably indistinct. Both articles emphasise the importance of distinguishing between epithelioid cell granulomas and pericryptal histiocytic aggregates (microgranulomas' and pericryptal granuloma' ) composed of histiocytes lacking cytoplasmic features of activation. Both epithelioid cell granulomas" and microgranulomata" are illustrated. The numbers of epithelioid cells and giant cells counted by each of us independently in the paired photomicrographs are given in table 1.