Difference between revisions of "Collagenous colitis"

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#redirect [[Colon#Collagenous_colitis]]
'''Collagenous_colitis''' is a type of [[colitis]] has a characteristic clinical presentation and no apparent endoscopic changes. It is a type of [[microscopic colitis]].
 
==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>
 
*Collagenous colitis may be related to [[lymphocytic 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.
 
===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 |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:
*Intraepithelial lymphocytes - '''important'''.
*Collagenous material in the lamina propria (pink on H&E) -- '''key feature'''.
**Can be demonstrated with a trichrome stain -- collagen = green on trichrome.
**Subepithelial collagen needs to be >= 10 micrometres thick for diagnosis.<ref name=pmid19109861/>
***8 micrometres is the diameter of a [[RBC]].
***The normal thickness of the subepithelial collagen is 3 micrometres.<ref name=pmid19109861/>
***Transverse colon usually thickest - in one series ~ 47 micrometres on average.<ref name=pmid10208468>{{Cite journal  | last1 = Offner | first1 = FA. | last2 = Jao | first2 = RV. | last3 = Lewin | first3 = KJ. | last4 = Havelec | first4 = L. | last5 = Weinstein | first5 = WM. | title = Collagenous colitis: a study of the distribution of morphological abnormalities and their histological detection. | journal = Hum Pathol | volume = 30 | issue = 4 | pages = 451-7 | month = Apr | year = 1999 | doi =  | PMID = 10208468 }}</ref>
**Thickening is usually patchy.<ref name=pmid1740280/>
**Thickening "follows the crypts from the surface" - useful for differentiating from tangential sections of the basement membrane.<ref name=bell>Bell, D. 4 Mar 2009.</ref>
**Collagen may envelope capillaries - useful to discern from basement membrane.<ref name=bell>Bell, D. 4 Mar 2009.</ref>
 
Notes:
*CC is typically more prominent in the proximal colon - may reflect concentration gradient of offending causitive agents.<ref name=pmid19109861/>
*Significant negative findings:<ref name=hopkins_cc_lc/>
**No [[PMN]]s.
**No crypt distortion.
*Thickened collagen band uncommon in rectum.<ref name=pmid1740280>{{Cite journal  | last1 = Tanaka | first1 = M. | last2 = Mazzoleni | first2 = G. | last3 = Riddell | first3 = RH. | title = Distribution of collagenous colitis: utility of flexible sigmoidoscopy. | journal = Gut | volume = 33 | issue = 1 | pages = 65-70 | month = Jan | year = 1992 | doi =  | PMID = 1740280 }}</ref>
 
===Images===
<gallery>
Image:Collagenous_colitis_-_intermed_mag.jpg | CC - intermed mag. (WC/Nephron)
Image:Collagenous_colitis_-_high_mag.jpg | CC - high mag. (WC/Nephron)
</gallery>
 
===Sign out===
<pre>
TRANSVERSE COLON, BIOPSY:
- COLLAGENOUS COLITIS.
</pre>
 
===Micro===
The sections show colonic mucosa with abundant intraepithelial lymphocytes (>20 lymphocytes/100 surface epithelial cells). A prominent collagen band is apparent below the epithelium (>10 micrometres thick). The glandular architecture is within normal limits.
 
There are no granulomas. No neutrophilic cryptitis is apparent. The epithelium matures
appropriately to the surface.
 
==See also==
*[[Colon]].
*[[Lymphocytic colitis]].
 
==References==
{{Reflist|2}}


[[Category:Diagnosis]]
[[Category:Diagnosis]]
[[Category:Colon]]
[[Category:Gastrointestinal pathology]]

Revision as of 08:38, 31 July 2013

Collagenous_colitis is a type of colitis has a characteristic clinical presentation and no apparent endoscopic changes. It is a type of microscopic colitis.

General

Presentation:

  • Chronic diarrhea, non-bloody.[1]
  • Collagenous colitis may be related to lymphocytic colitis.
    • It is hypothesized that these conditions may be the same pathology at different time points.[1]

Notes:

Epidemiology

  • Age: a disease of adults - usually 50s.
  • Sex:
    • LC males ~= females,[1]
    • CC females:males = 20:1.[1]
  • 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.[2]
  • No increased risk of colorectal carcinoma.[2]

Treatment

  • Sometimes just follow-up.
  • Steroids - budesonide -- short-term treatment.[2]

Gross

Microscopic

Features:

  • Intraepithelial lymphocytes - important.
  • Collagenous material in the lamina propria (pink on H&E) -- key feature.
    • Can be demonstrated with a trichrome stain -- collagen = green on trichrome.
    • Subepithelial collagen needs to be >= 10 micrometres thick for diagnosis.[2]
      • 8 micrometres is the diameter of a RBC.
      • The normal thickness of the subepithelial collagen is 3 micrometres.[2]
      • Transverse colon usually thickest - in one series ~ 47 micrometres on average.[3]
    • Thickening is usually patchy.[4]
    • Thickening "follows the crypts from the surface" - useful for differentiating from tangential sections of the basement membrane.[5]
    • Collagen may envelope capillaries - useful to discern from basement membrane.[5]

Notes:

  • CC is typically more prominent in the proximal colon - may reflect concentration gradient of offending causitive agents.[2]
  • Significant negative findings:[6]
    • No PMNs.
    • No crypt distortion.
  • Thickened collagen band uncommon in rectum.[4]

Images

  • CC - intermed mag. (WC/Nephron)

  • CC - high mag. (WC/Nephron)

Sign out

TRANSVERSE COLON, BIOPSY:
- COLLAGENOUS COLITIS.

Micro

The sections show colonic mucosa with abundant intraepithelial lymphocytes (>20 lymphocytes/100 surface epithelial cells). A prominent collagen band is apparent below the epithelium (>10 micrometres thick). The glandular architecture is within normal limits.

There are no granulomas. No neutrophilic cryptitis is apparent. The epithelium matures appropriately to the surface.

See also

References

  1. ↑ 1.0 1.1 1.2 1.3 URL: http://emedicine.medscape.com/article/180664-overview. Accessed on: 31 May 2010.
  2. ↑ 2.0 2.1 2.2 2.3 2.4 2.5 Tysk C, Bohr J, Nyhlin N, Wickbom A, Eriksson S (December 2008). "Diagnosis and management of microscopic colitis". World J. Gastroenterol. 14 (48): 7280-8. PMID 19109861. http://www.wjgnet.com/1007-9327/14/7280.asp.
  3. ↑ Offner, FA.; Jao, RV.; Lewin, KJ.; Havelec, L.; Weinstein, WM. (Apr 1999). "Collagenous colitis: a study of the distribution of morphological abnormalities and their histological detection.". Hum Pathol 30 (4): 451-7. PMID 10208468.
  4. ↑ 4.0 4.1 Tanaka, M.; Mazzoleni, G.; Riddell, RH. (Jan 1992). "Distribution of collagenous colitis: utility of flexible sigmoidoscopy.". Gut 33 (1): 65-70. PMID 1740280.
  5. ↑ 5.0 5.1 Bell, D. 4 Mar 2009.
  6. ↑ Cite error: Invalid <ref> tag; no text was provided for refs named hopkins_cc_lc
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