Lymphocytic colitis: Difference between revisions

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#redirect [[Colon#Lymphocytic_colitis]]
{{ Infobox diagnosis
| Name      = {{PAGENAME}}
| Image      = Lymphocytic colitis - hps - high mag.jpg
| Width      =
| 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)
| Subtypes  =
| LMDDx      = [[collagenous colitis]], [[infectious colitis]], [[Crohn's disease]] (rare)
| Stains    =
| IHC        =
| EM        =
| Molecular  =
| IF        =
| Gross      =
| Grossing  =
| Site      = [[colon]], [[rectum]]
| Assdx      = autoimmune diseases ([[celiac disease]], [[diabetes mellitus]], [[thyroid]] disorders, [[arthritis]])
| Syndromes  =
| Clinicalhx =
| Signs      =
| Symptoms  = diarrhea, non-bloody
| Prevalence =
| Bloodwork  =
| Rads      =
| Endoscopy  = normal
| Prognosis  =
| Other      =
| ClinDDx    = [[irritable bowel syndrome]]
}}
{{ Infobox external links
| Name          = {{PAGENAME}}
| EHVSC          = 10184
| pathprotocols  =
| wikipedia      =
| pathoutlines  =
}}
'''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==
Presentation:
*Chronic diarrhea, non-bloody.<ref name=medscape180664>URL: [http://emedicine.medscape.com/article/180664-overview http://emedicine.medscape.com/article/180664-overview]. Accessed on: 31 May 2010.</ref>
 
*Lymphocytic colitis may be related to [[collagenous colitis]].
**It is hypothesized that these conditions may be the same pathology at different time points.<ref name=medscape180664/>
 
Notes:
*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===
*Age: a disease of adults - usually 50s.
*Sex:
**LC males ~= females,<ref name=medscape180664/>
**CC females:males = 20:1.<ref name=medscape180664/>
*Drugs are associated with LC and CC.
**NSAIDs - posulated association/weak association,
**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 | PMC = 2778111 |doi= |url=http://www.wjgnet.com/1007-9327/14/7280.asp}}</ref>
*No increased risk of colorectal carcinoma.<ref name=pmid19109861/>
 
===Treatment===
*Sometimes just follow-up.
*Steroids - budesonide -- short-term treatment.<ref name=pmid19109861/>
 
==Gross==
*Endoscopic examination is normal.
**This is why it is called a ''[[microscopic colitis]]''.
 
==Microscopic==
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
*Lymphocytes in the lamina propria.
 
Significant negatives:<ref name=hopkins_cc_lc>[http://hopkins-gi.nts.jhu.edu/pages/latin/templates/index.cfm?pg=disease1&disease=29&organ=6&lang_id=1 http://hopkins-gi.nts.jhu.edu/pages/latin/templates/index.cfm?pg=disease1&disease=29&organ=6&lang_id=1]</ref>
*No neutrophils.
*No crypt distortion.
 
DDx:
*[[Infectious colitis]] - neutrophils present... not lymphocytes.
*[[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===
<gallery>
Image: Lymphocytic colitis - low mag.jpg | LC - low mag. (WC)
Image: Lymphocytic colitis - intermed mag.jpg | LC - intermed. mag. (WC)
Image: Lymphocytic colitis - high mag.jpg | LC - high mag. (WC)
</gallery>
<gallery>
Image: Lymphocytic colitis - hps - low mag.jpg | LC - HPS - low mag. (WC)
Image: Lymphocytic colitis - hps - intermed mag.jpg | LC - HPS - intermed. 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)
</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>
www:
*[http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2778111/figure/F2/ LC (nih.gov)].<ref name=pmid19109861/>
 
==Sign out==
<pre>
ASCENDING COLON, BIOPSY:
- LYMPHOCYTIC COLITIS.
</pre>
 
<pre>
RECTUM, BIOPSY:
- LYMPHOCYTIC PROCTITIS.
- NEGATIVE FOR ARCHITECTURAL DISTORTION AND NEGATIVE FOR CRYPTITIS.
- NEGATIVE FOR DYSPLASIA.
</pre>
 
===Micro===
The sections show colonic mucosa with abundant intraepithelial lymphocytes (>20 lymphocytes/100 surface epithelial cells). The glandular architecture is within normal limits. No thickened collagen band is apparent below the epithelium.
 
There are no granulomas. No neutrophilic cryptitis is apparent. The epithelium matures
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==
*[[Colon]].
*[[Collagenous colitis]].
*[[Lymphocytic gastritis]].
 
==References==
{{Reflist|2}}


[[Category:Diagnosis]]
[[Category:Diagnosis]]
[[Category:Colon]]
[[Category:Gastrointestinal pathology]]
Retrieved from "https://librepathology.org/wiki/Lymphocytic_colitis"