Colon
Other nonneoplastic
Vasculitis


Topic Completed: 9 February 2021

Minor changes: 17 February 2021

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PubMed Search: Vasculitis[TI] colon[TIAB]

Raul S. Gonzalez, M.D.
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Cite this page: Gonzalez RS. Vasculitis. PathologyOutlines.com website. https://www.pathologyoutlines.com/topic/colonvasculitis.html. Accessed April 18th, 2021.
Definition / general
Essential features
  • Essentially any systemic vasculitis can involve the GI tract, with varying histologic features
Epidemiology
  • Depends on particular vasculitis
Sites
  • Colon can be affected as well as remainder of gastrointestinal tract
Clinical features
  • Colonic manifestations may range from clinically silent to causing intestinal ischemia
Diagnosis
  • Small vessel vasculitis may be observed on biopsy, medium vessel vasculitis on resection
Radiology images

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Occlusion of inferior mesenteric artery

Small intestinal edema

Clinical images

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Marked narrowing of sigmoid colon

Circumferential sigmoidal ulceration

Inflammation, submucosal hemorrhage, and small ulceration

Hyperemic, edematous colonic mucosa

Microscopic (histologic) images

Contributed by Raul S. Gonzalez, M.D.
Vasculitis Vasculitis

Vasculitis

Sample pathology report
  • Ascending colon, ulcer, biopsy:
    • Colonic mucosa with focal submucosal eosinophilic inflammation surrounding blood vessels, suggestive of involvement by the patient's known Churg-Strauss syndrome
Differential diagnosis
  • Main consideration is what form of vasculitis is present
    • Requires careful pathologic analysis and clinical correlation
  • Crohn’s disease or ulcerative colitis:
    • Severe cases of inflammatory bowel disease may show focal inflammation of vessels as part of the overall inflammatory component
    • True vasculitis may rarely coexist (Semin Arthritis Rheum 2016;45:475)
Additional references
Board review style question #1
    Which of the following is true about vasculitis involving the gastrointestinal tract?

  1. It always occurs in the setting of inflammatory bowel disease
  2. It is sometimes clinically silent
  3. Medium vessel vasculitides can often be observed on biopsy
  4. The rest of the gastrointestinal tract is never affected
Board review style answer #1
B. It is sometimes clinically silent

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