What histology best differentiates lymphoma from IBD?

• A. Neutrophil predominant infiltration
• B. Granulomatous inflammation
• C. Inflammation with lymphocytes
• D. Neoplastic lymphocytes

Answer: (D)

The deciding feature is the presence of neoplastic lymphocytes. Lymphoma is a malignant, clonal proliferation of lymphoid cells that often forms sheets or disrupted architecture in the tissue, reflecting a neoplastic process. Inflammatory bowel disease, on the other hand, shows a chronic inflammatory infiltrate—lymphocytes and plasma cells—with features like crypt distortion, cryptitis, or crypt abscesses, and sometimes granulomas in Crohn’s disease—but no malignant clonal lymphocyte population. So seeing neoplastic lymphocytes distinguishes lymphoma from IBD, whereas the inflammatory cell picture alone fits IBD rather than lymphoma.