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Asymmetric crypt fission in colectomy specimens in patients with ulcerative colitis
  1. Carlos A Rubio1,
  2. Peter T Schmidt2
  1. 1 Department of Pathology, Karolinska Institute, Stockholm, Sweden
  2. 2 Department of Medicine (Solna), Karolinska Institute, Ersta Hospital, Stockholm, Sweden
  1. Correspondence to Professor Carlos A Rubio, Department of Pathology, Karolinska Institute, Stockholm, Sweden; carlos.rubio{at}


Aims We previously found colonic crypts with asymmetric fission bordering regenerating ulcers in ulcerative colitis (UC). The present objective was to assess the frequency of asymmetric crypt-fission in colectomy specimens from patients with long-lasting UC.

Methods H&E-stained sections from seven colectomies from patients with UC without dysplasia or carcinoma were investigated. Symmetric fission was characterised by branched colon crypts showing ≥2 identical crypts, whereas asymmetric fission exhibited branched colon crypt portraying ≥2 dissimilar crypts, differing in diameter, length and/or shape.

Results The number of crypts in fission in the 89 sections was 3586; of those, 2930 (81.7%) were asymmetric and the remaining 656 (18.3%), symmetric. Out of 927 vertically-cut crypts (in well-oriented sections), 912 (98.4%) were asymmetric, and the remaining 14 (1.6%), symmetric, and out 2660, cross-cut (transected) crypts in fission, 2018 (75.9%) were asymmetric and the remaining 642 (24.1%), symmetric.

Conclusion Crypt fission is rarely found in the normal colon in adults. Symmetric crypt fission found in UC is possibly triggered by a compensatory homeostatic mechanism of crypt production in mucosal areas replaced by chronic inflammation. But asymmetric crypt fission is a pathological aberration that affects crypts in patients with a particular predisposition to develop mucosal dysplasia. It is suggested that this previously unattended histological parameter be included in the pathological descriptions of colectomy specimens from patients with UC.

  • colitis
  • diagnosis
  • inflammatory bowel diseases
  • pathology
  • surgical

Data availability statement

All data relevant to the study are included in the article.

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Data availability statement

All data relevant to the study are included in the article.

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  • Handling editor Dhirendra Govender.

  • Contributors CAR collected the initial data, collected and organised the data on the pathological findings, and wrote the original draft. PTS obtained the permission of The Regional Ethical Review Board in Stockholm, revised the original draft and introduced valuable suggestions.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer-reviewed.