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Difference between revisions of "Lymphocytic colitis"
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{{ Infobox diagnosis | {{ Infobox diagnosis | ||
| Name = {{PAGENAME}} | | Name = {{PAGENAME}} | ||
| Image = Lymphocytic colitis - hps - | | Image = Lymphocytic colitis - hps - high mag.jpg | ||
| Width = | | Width = | ||
| Caption = Lymphocytic colitis. [[HPS stain]]. | | Caption = Lymphocytic colitis. [[HPS stain]]. | ||
| Micro = intraepithelial lymphocytes (>20/100 enterocytes), none or rare [[PMN]]s, no architectural distortion, normal subepithelial collagen band (< 10 micrometres thick) | | Micro = intraepithelial lymphocytes (>20/100 enterocytes), none or rare [[PMN]]s, no architectural distortion, normal subepithelial collagen band (< 10 micrometres thick) | ||
| Subtypes = | | Subtypes = | ||
| LMDDx = [[collagenous colitis]], [[infectious colitis]] | | LMDDx = [[collagenous colitis]], [[infectious colitis]], [[Crohn's disease]] (rare) | ||
| Stains = | | Stains = | ||
| IHC = | | IHC = | ||
| Line 14: | Line 14: | ||
| Gross = | | Gross = | ||
| Grossing = | | Grossing = | ||
| Site = [[colon]] | | Site = [[colon]], [[rectum]] | ||
| Assdx = autoimmune diseases ([[celiac disease]], [[diabetes mellitus]], [[thyroid]] disorders, [[arthritis]]) | | Assdx = autoimmune diseases ([[celiac disease]], [[diabetes mellitus]], [[thyroid]] disorders, [[arthritis]]) | ||
| Syndromes = | | Syndromes = | ||
| Clinicalhx = | | Clinicalhx = | ||
| Signs = | | Signs = | ||
| Symptoms = diarrhea | | Symptoms = diarrhea, non-bloody | ||
| Prevalence = | | Prevalence = | ||
| Bloodwork = | | Bloodwork = | ||
| Line 36: | Line 36: | ||
}} | }} | ||
'''Lymphocytic colitis''', abbreviated '''LC''', is a type of [[microscopic colitis]]. It has a characteristic clinical presentation and no apparent endoscopic changes. | '''Lymphocytic colitis''', abbreviated '''LC''', is a type of [[microscopic colitis]]. It has a characteristic clinical presentation and no apparent endoscopic changes. | ||
''Lymphocytic proctitis'' redirects here. | |||
==General== | ==General== | ||
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Notes: | Notes: | ||
*Clinical DDx includes [[irritable bowel syndrome]] - which has no or subtle histopathologic changes. | *Clinical DDx includes [[irritable bowel syndrome]] - which has no or subtle histopathologic changes. | ||
*This pathology also afflicits rectum; however, it is less commonly found there. | |||
**The rectum is afflicted in approximately in 65% of cases.<ref name=pmid12018911>{{cite journal |author=Agnarsdottir M, Gunnlaugsson O, Orvar KB, ''et al.'' |title=Collagenous and lymphocytic colitis in Iceland |journal=Dig. Dis. Sci. |volume=47 |issue=5 |pages=1122–8 |year=2002 |month=May |pmid=12018911 |doi= |url=}}</ref> | |||
===Epidemiology=== | ===Epidemiology=== | ||
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**NSAIDs - posulated association/weak association, | **NSAIDs - posulated association/weak association, | ||
**SSRIs (used primarily for depression) - moderate association, dependent on specific drug. | **SSRIs (used primarily for depression) - moderate association, dependent on specific drug. | ||
*Associated with autoimmune disorders - [[celiac disease]], [[diabetes mellitus]], [[thyroid]] disorders and [[arthritis]].<ref name=pmid19109861>{{cite journal |author=Tysk C, Bohr J, Nyhlin N, Wickbom A, Eriksson S |title=Diagnosis and management of microscopic colitis |journal=World J. Gastroenterol. |volume=14 |issue=48 |pages=7280-8 |year=2008 |month=December |pmid=19109861 |doi= |url=http://www.wjgnet.com/1007-9327/14/7280.asp}}</ref> | *Associated with autoimmune disorders - [[celiac disease]], [[diabetes mellitus]], [[thyroid]] disorders and [[arthritis]].<ref name=pmid19109861>{{cite journal |author=Tysk C, Bohr J, Nyhlin N, Wickbom A, Eriksson S |title=Diagnosis and management of microscopic colitis |journal=World J. Gastroenterol. |volume=14 |issue=48 |pages=7280-8 |year=2008 |month=December |pmid=19109861 | PMC = 2778111 |doi= |url=http://www.wjgnet.com/1007-9327/14/7280.asp}}</ref> | ||
*No increased risk of colorectal carcinoma.<ref name=pmid19109861/> | *No increased risk of colorectal carcinoma.<ref name=pmid19109861/> | ||
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==Microscopic== | ==Microscopic== | ||
Features: | Features: | ||
*Lots of intraepithelial lymphocytes (>=20/100 lymphocytes/surface epithelial cells<ref name=pmid19109861>{{cite journal |author=Tysk C, Bohr J, Nyhlin N, Wickbom A, Eriksson S |title=Diagnosis and management of microscopic colitis |journal=World J. Gastroenterol. |volume=14 |issue=48 |pages=7280-8 |year=2008 |month=December |pmid=19109861 | PMC = 2778111 |doi= |url=http://www.wjgnet.com/1007-9327/14/7280.asp}}</ref>) and | *Lots of [[intraepithelial lymphocytes]] (>=20/100 lymphocytes/surface epithelial cells<ref name=pmid19109861>{{cite journal |author=Tysk C, Bohr J, Nyhlin N, Wickbom A, Eriksson S |title=Diagnosis and management of microscopic colitis |journal=World J. Gastroenterol. |volume=14 |issue=48 |pages=7280-8 |year=2008 |month=December |pmid=19109861 | PMC = 2778111 |doi= |url=http://www.wjgnet.com/1007-9327/14/7280.asp}}</ref>) and | ||
*Lymphocytes in the lamina propria. | *Lymphocytes in the lamina propria. | ||
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*[[Infectious colitis]] - neutrophils present... not lymphocytes. | *[[Infectious colitis]] - neutrophils present... not lymphocytes. | ||
*[[Collagenous colitis]] - has a band of collagen below the epithelium. | *[[Collagenous colitis]] - has a band of collagen below the epithelium. | ||
*[[Crohn's disease]] - uncommon, may be a perfect mimic.<ref name=pmid10478667>{{Cite journal | last1 = Goldstein | first1 = NS. | last2 = Gyorfi | first2 = T. | title = Focal lymphocytic colitis and collagenous colitis: patterns of Crohn's colitis? | journal = Am J Surg Pathol | volume = 23 | issue = 9 | pages = 1075-81 | month = Sep | year = 1999 | doi = | PMID = 10478667 }}</ref> | |||
===Images=== | ===Images=== | ||
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Image: Lymphocytic colitis - hps - high mag.jpg | LC - HPS - high mag. (WC) | Image: Lymphocytic colitis - hps - high mag.jpg | LC - HPS - high mag. (WC) | ||
Image: Lymphocytic colitis - hps - very high mag.jpg | LC - HPS - very high mag. (WC) | Image: Lymphocytic colitis - hps - very high mag.jpg | LC - HPS - very high mag. (WC) | ||
</gallery> | |||
<gallery> | |||
Image: Lymphocytic proctitis -- low mag.jpg | LP - low mag. | |||
Image: Lymphocytic proctitis -- intermed mag.jpg | LP - intermed. mag. | |||
Image: Lymphocytic proctitis -- high mag.jpg | LP - high mag. | |||
Image: Lymphocytic proctitis -- very high mag.jpg | LP - very high mag. | |||
</gallery> | </gallery> | ||
www: | www: | ||
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ASCENDING COLON, BIOPSY: | ASCENDING COLON, BIOPSY: | ||
- LYMPHOCYTIC COLITIS. | - LYMPHOCYTIC COLITIS. | ||
</pre> | |||
<pre> | |||
RECTUM, BIOPSY: | |||
- LYMPHOCYTIC PROCTITIS. | |||
- NEGATIVE FOR ARCHITECTURAL DISTORTION AND NEGATIVE FOR CRYPTITIS. | |||
- NEGATIVE FOR DYSPLASIA. | |||
</pre> | </pre> | ||
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There are no granulomas. No neutrophilic cryptitis is apparent. The epithelium matures | There are no granulomas. No neutrophilic cryptitis is apparent. The epithelium matures | ||
appropriately to the surface. | appropriately to the surface. | ||
====Alternate==== | |||
<pre> | |||
The sections show rectal mucosa with increased intraepithelial lymphocytes (25-30/100 | |||
epithelial cells), apoptotic epithelial cells, abundant lamina propria plasma | |||
cells, rare lymphoid aggregates and a mild increase of eosinophils (25/1 HPF (0.24 | |||
mm*mm)). There is surface goblet cell depletion. The collagen table is not apparently thickened. | |||
There is no apparent cryptitis. The architecture is within normal limits. | |||
</pre> | |||
==See also== | ==See also== | ||
*[[Colon]]. | *[[Colon]]. | ||
*[[Collagenous colitis]]. | *[[Collagenous colitis]]. | ||
*[[Lymphocytic gastritis]]. | |||
==References== | ==References== | ||