BEHCETS COLITIS HAS DISTINCTIVE PATHOLOGICAL FEATURES

Patients with Behcet's syndrome commonly have gastrointestinal symptom s. Less commonly, these symptoms are so severe as to necessitate surge ry. The features of the colitis seen in Behcet's syndrome are not clea rly defined histologically, and their similarity to Crohn's disease is often emphasized. After reviewing three cases with Behcet's colitis w e feel that there is a specific constellation of gross and histologic features that, when combined with a relevant clinical history, should suggest Behcet's colitis. On gross examination Behcet's colitis is cha racterized by multiple punched-out ulcers of varying sizes with interv ening normal mucosa. This appearance excludes ulcerative colitis, whic h should have adjacent architectural distortion with active inflammati on, but not Crohn's disease, infectious colitis, or drug-induced colit is. On histologic examination Behcet's colitis has crater-shaped ulcer s that often penetrate the serosa. Fissure ulcers, mural lymphoid aggr egates, and granulomas are not seen in contrast to Crohn's disease. Si milarly, microscopic features of infectious colitis such as cryptitis and crypt withering are not a feature. When the gross and microscopic features are combined with an appropriate clinical picture the patholo gist should be able to suggest Behcet's colitis in a resection specime n rather than merely an atypical variant of Crohn's disease.