{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,12,7]],"date-time":"2025-12-07T02:01:39Z","timestamp":1765072899188,"version":"3.46.0"},"reference-count":24,"publisher":"BMJ","issue":"10","content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["J Clin Pathol"],"accepted":{"date-parts":[[2024,6,30]]},"published-print":{"date-parts":[[2025,10]]},"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Diagnosing paediatric Crohn\u2019s disease (CD) based on histology can present challenges. We evaluate the histological spectrum of treatment-na\u00efve biopsies from children with CD and assess these findings\u2019 diagnostic and predictive value.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>Three cohorts were identified: (1) 137 patients with CD, (2) 116 patients with ulcerative colitis (UC) and (3) 50 patients without inflammatory bowel disease. Biopsies from the gastrointestinal (GI) tract were re-examined for signs of active and chronic inflammation, including lymphocyte-pattern oesophagitis, focal enhancing gastritis and indicators of chronicity. Additionally, granulomas and microgranulomas (defined as clusters of 4\u20139 epithelioid histiocytes) were evaluated.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Lymphocyte-pattern oesophagitis was observed in 15% of patients (n=20). Moderate-to-severe diffuse gastritis was noted in 50.4% of patients (n=68), while focal enhancing gastritis was identified in 11.1% (n=15). In terminal ileal biopsies, 46.1% exhibited activity and 5.3% showed features of chronicity. Active colitis was present in 73% of patients (n=100), with chronic colitis seen in 11.7% (n=16). Granulomas and microgranulomas were observed in 31.4% (43\/137) and 48.9% (67\/137) of patients, respectively. Notably, 30.7% (42\/137) of patients with microgranulomas were without granulomas. Previously undetected microgranulomas were found in 20 of 27 cases. 2.5% of patients with UC and none of the control cohort showed microgranulomas. Lymphocyte-pattern oesophagitis was associated with an increased need for anti-tumor necrosis factor (TNF) therapy (p=0.007).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>GI microgranulomas, often overlooked, are specific to CD in the proper clinical context. Oesophageal lymphocytosis may predict a need for more aggressive treatment. The study brings to light under-recognised aspects of CD\u2019s histological diagnosis, including the oversight of microgranulomas, the high prevalence of diffuse gastritis and low prevalence of focal enhancing gastritis, the frequent absence of terminal ileitis and the infrequent occurrence of chronic colitis.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1136\/jcp-2024-209535","type":"journal-article","created":{"date-parts":[[2024,7,18]],"date-time":"2024-07-18T13:20:32Z","timestamp":1721308832000},"page":"659-666","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":2,"title":["Paediatric Crohn\u2019s disease: histologic findings at initial presentation"],"prefix":"10.1136","volume":"78","author":[{"given":"Smiljana","family":"Spasic","sequence":"first","affiliation":[{"name":"Department of Pathology, Harvard Medical School, Boston, Massachusetts, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Amaya","family":"Pankaj","sequence":"additional","affiliation":[{"name":"Massachusetts General Hospital, Boston, Massachusetts, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jess L","family":"Kaplan","sequence":"additional","affiliation":[{"name":"Pediatric Gastroenterology, MassGeneral for Children, Boston, Massachusetts, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Deepa","family":"Patil","sequence":"additional","affiliation":[{"name":"Department of Pathology, Harvard Medical School, Boston, Massachusetts, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Christopher J","family":"Moran","sequence":"additional","affiliation":[{"name":"Pediatric Gastroenterology, MassGeneral for Children, Boston, Massachusetts, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4230-9308","authenticated-orcid":false,"given":"Vikram","family":"Deshpande","sequence":"additional","affiliation":[{"name":"Department of Pathology, Harvard Medical School, Boston, Massachusetts, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"239","published-online":{"date-parts":[[2024,7,18]]},"reference":[{"key":"2025120618001099000_78.10.659.1","doi-asserted-by":"publisher","DOI":"10.1136\/gut.2004.041715"},{"key":"2025120618001099000_78.10.659.2","doi-asserted-by":"publisher","DOI":"10.1007\/DCR.0b013e3181b7bfb0"},{"key":"2025120618001099000_78.10.659.3","doi-asserted-by":"crossref","first-page":"716","DOI":"10.1080\/00365521.2017.1304571","article-title":"Prognostic significance of granulomas in children with Crohn\u2019s disease","volume":"52","author":"Rothschild","year":"2017","journal-title":"Scand J Gastroenterol"},{"key":"2025120618001099000_78.10.659.4","doi-asserted-by":"publisher","DOI":"10.1136\/jcp.2006.045336"},{"key":"2025120618001099000_78.10.659.5","doi-asserted-by":"publisher","DOI":"10.1097\/MPG.0b013e31812e95e1"},{"key":"2025120618001099000_78.10.659.6","doi-asserted-by":"publisher","DOI":"10.3748\/wjg.v11.i20.3118"},{"key":"2025120618001099000_78.10.659.7","doi-asserted-by":"crossref","first-page":"617","DOI":"10.1097\/MPG.0000000000003417","article-title":"Microgranulomas at diagnosis are associated with need for anti-TNF escalation in pediatric Crohn\u2019s disease","volume":"74","author":"Moran","year":"2022","journal-title":"J Pediatr Gastroenterol Nutr"},{"key":"2025120618001099000_78.10.659.8","doi-asserted-by":"publisher","DOI":"10.1002\/ibd.21493"},{"key":"2025120618001099000_78.10.659.9","doi-asserted-by":"publisher","DOI":"10.1097\/01.pas.0000138182.97366.b4"},{"key":"2025120618001099000_78.10.659.10","doi-asserted-by":"publisher","DOI":"10.1097\/00000478-199610000-00001"},{"key":"2025120618001099000_78.10.659.11","doi-asserted-by":"publisher","DOI":"10.1136\/jcp.50.2.93"},{"key":"2025120618001099000_78.10.659.12","doi-asserted-by":"publisher","DOI":"10.1046\/j.1365-2559.2002.01416.x"},{"key":"2025120618001099000_78.10.659.13","doi-asserted-by":"publisher","DOI":"10.1136\/jcp.48.8.749"},{"key":"2025120618001099000_78.10.659.14","doi-asserted-by":"publisher","DOI":"10.1046\/j.1365-2559.2002.01441.x"},{"key":"2025120618001099000_78.10.659.15","doi-asserted-by":"publisher","DOI":"10.1093\/ajcp\/67.6.550"},{"key":"2025120618001099000_78.10.659.16","unstructured":"Burr Mallory F . 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