Diagnostic problems in chronic inflammatory bowel disease related specimens

A diagnosis of inflammatory bowel disease (IBD) carries serious long term implications for patient management and for cost of care. Pathologists must be aware of common mimics of IBD to prevent misdiagnosis. The distinction between ulcerative colitis and Crohn's disease is usually straightforward in resections but cannot be made easily on mucosal biopsies alone. Correlation with clinical and endoscopic findings is needed in the latter instance. The diagnosis of “indeterminate colitis” must be made only in resection specimens using strict diagnostic criteria. This review deals with common problems associated with the diagnosis of IBD and IBD-associated neoplasia.