PMC7569431_01
Colonoscopic findings of the hepatic flexure, demonstrating circumferential inflammatory and stenotic mass.
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Colonoscopy showed a circumferentially encasing, partially obstructing, stenotic mass, with overlying granular and inflammatory mucosa in the hepatic flexure (Figures 1(a)-1(c)). The colonic biopsy revealed soft consistency of the mass, and there was excess of bleeding from the biopsy site (Figure 1(c)).
Hematoxylin and eosin (H&E) staining of the hepatic flexure mass, revealing focal active chronic colitis with ulceration, polypoid granulation tissue formation, reactive epithelial, and noncaseation granulomatous changes. Basal cell plasmacytosis could not be demonstrated. Hematoxylin and eosin (H&E) staining of the normal-appearing colon revealing the chronic colitis and preserved crypt architecture.
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The histopathology of the hepatic flexure mass was significant for focal active chronic colitis with ulceration, polypoid granulation tissue formation, reactive epithelial changes, and noncaseating granulomata formation that was consistent with granulomatous inflammation (Figure 2(a)). The crypt architecture was preserved (Figure 2(c)), and the histopathological findings were devoid of the basal cell plasmacytosis to conclude to inflammatory bowel disease.
Posttreatment colonoscopy reveals interval improvement of colonic stenosis resolution of the inflammatory mass.
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A colonoscopy performed five months after treatment revealed interval improvement of colonic stenosis resolution of the inflammatory mass, and the scope could be traversed through the stricture (Figure 3(a)). Some mucosal inflammation and granularity could be noted; however, there was significant improvement as compared to the index colonoscopy (Figure 3(b)).
H&E staining of the colonic mucosa (poststeroid treatment) showing focal active chronic colitis without any evidence of dysplasia, metaplasia, or noncaseating granulomas.
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The biopsy specimens from the previously involved areas showed chronic mucosal injury with no evidence of dysplasia, malignancy, or noncaseating granulomas (Figure 4).