Pseudomembranous colitis

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Pseudomembranous colitis an inflammation of the colon (colitis) with a characteristic endoscopic/gross appearance. It is closely associated with C. difficle infectious; however, may be seen in a number of different situations.

Pseudomembranous colitis
Diagnosis in short

Colonic pseudomembrane. H&E stain.

LM heaped necrotic surface epithelium (described as "volanco lesions"), PMNs in lamina propria, +/-capillary fibrin thrombi
LM DDx cap polyposis, signet ring cell carcinoma (uncommonly), ischemic colitis in general
Site colon

Symptoms +/-diarrhea
Prevalence uncommon
Endoscopy pseudomembranes (pale yellow (or white) irregular, raised mucosal lesions), interlesional mucosa often near normal grossly
Prognosis dependent on comorbidities
Treatment dependent on underlying cause, antibiotics in C. difficle - occasionally surgical resection

General

  • Pseudomembranous colitis is a histomorphologic description which has a DDx. In other words, it can be caused by a number of things.

DDx of pseudomembranous colitis:[1]

Etiology:

  • Anything that causes a severe mucosal injury.

Gross

Features:[2]

  • Pseudomembranes:
    • Pale yellow (or white) irregular, raised mucosal lesions.
    • Early lesions: typical <10 mm.
  • Interlesional mucosa often near normal grossly.

Images

Microscopic

Features:[1]

  • Heaped necrotic surface epithelium.
    • Described as "volanco lesions" - this is what is seen endoscopically.
  • PMNs in lamina propria.
  • +/-Capillary fibrin thrombi.

Notes:

DDx:

Images

www:

See also

References

  1. 1.0 1.1 Cotran, Ramzi S.; Kumar, Vinay; Fausto, Nelson; Nelso Fausto; Robbins, Stanley L.; Abbas, Abul K. (2005). Robbins and Cotran pathologic basis of disease (7th ed.). St. Louis, Mo: Elsevier Saunders. pp. 837-8. ISBN 0-7216-0187-1.
  2. URL: http://radiology.uchc.edu/eAtlas/GI/1749.htm. Accessed on: 22 May 2012.
  3. Abdulkader, I.; Cameselle-Teijeiro, J.; Forteza, J. (Apr 2003). "Signet-ring cells associated with pseudomembranous colitis.". Virchows Arch 442 (4): 412-4. doi:10.1007/s00428-003-0779-1. PMID 12684766.