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Ulcerative Colitis

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Crypt distortion is one of the prominent features of ulcerative colitis, resulting from repeated cycles of crypt destruction followed by regeneration and healing. Instead of appearing as symmetrical, vertically lined evenly spaced cylinders (like a row of test tubes), the crypts appear misshapen, distorted, or branching. Note the inflammation in the lamina propria.

During remission, the mucosa may grossly appear normal with subtle changes microscopically. The glands may be branching or slightly irregular instead of parallel and evenly spaced as noted above. The gap between the base of the crypts and muscularis mucosae widens. There is Paneth cell metaplasia and neuroendocrine cell hyperplasia. Normally, Paneth cells are absent beyond right colon.

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