Which histologic feature is most characteristic of ulcerative colitis?

• A. Crypt abscesses
• B. Noncaseating granulomas
• C. Transmural inflammation
• D. Goblet cell hyperplasia in deep crypts without neutrophils

Answer: (D)

In ulcerative colitis the inflammation is limited to the mucosa and submucosa of the colon and tends to be continuous from the rectum. The most characteristic histologic feature is neutrophilic infiltration within the glandular crypts, forming crypt abscesses where neutrophils fill and disrupt the crypt epithelium. This reflects active mucosal inflammation and is a classic sign of UC. By contrast, noncaseating granulomas and transmural inflammation are more typical of Crohn disease, which involves deeper wall layers and granulomatous inflammation. Goblet cells can be diminished with chronic inflammation, not hyperplastic, and the hallmark pattern during active disease is the presence of crypt abscesses rather than goblet cell hyperplasia without neutrophils.