Crohns Disease

Fig. 4.9. Pilonidal sinus - CK17 was absent in type A epithelium (original magnification x100)

hyperkeratosis of the infundibulum with plugging and dilatation of the follicle (Fig. 4.8). Superficially the sinus is often lined with stratified squamous epithelium but towards the deeper reaches the wall consists of granulation and scar tissue. The early inflammatory event is perifol-liculitis with neutrophils, lymphocytes and his-tiocytes leading to rupture of follicular epithelium.

In a recent study using immunohistochemis-try with six antikeratin antibodies it has been demonstrated that CK expression in PS is similar to that in HS, suggesting that the epithelium may be fragile, hyperproliferative and undiffer-

Differentiating HS from Crohn's disease merits attention. At times these diseases can be clinically indistinguishable and authors have emphasized that although foreign body granulomas are a common finding in HS, the presence of discrete epithelioid granulomas in the dermis away from the site of active inflammation is unusual and should alert the pathologist to the possibility of systemic granulomatous disease such as Crohn's or sarcoidosis [22]. Several authors have reported the co-morbidity of HS and Crohn's [23] (see Fig. 4.10).

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