|Diagnosis in short|
Collagenous colitis. H&E stain.
|LM||intraepithelial lymphocytes (>20/100 enterocytes), subepithelial collagen band (>= 10 micrometres thick)|
|LM DDx||lymphocytic colitis, Crohn's disease (very rare)|
|Site||colon - typically more prominent proximally|
|Clinical history||predominantly women (women:men=20:1)|
|Clin. DDx||irritable bowel syndrome, lymphocytic colitis|
Collagenous colitis is a type of microscopic colitis. It has a characteristic clinical presentation and no apparent endoscopic changes.
- Collagenous colitis may be related to lymphocytic colitis.
- It is hypothesized that these conditions may be the same pathology at different time points.
- May be associated with to collagenous gastritis in adults.
- Chronic diarrhea, non-bloody.
- 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.
- Age: a disease of adults - usually 50s.
- 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.
- No increased risk of colorectal carcinoma.
- Sometimes just follow-up.
- Steroids - budesonide -- short-term treatment.
- Endoscopic examination is normal.
- This is why it is called a microscopic colitis.
- 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.
- Thickening is usually patchy.
- Thickening "follows the crypts from the surface" - useful for differentiating from tangential sections of the basement membrane.
- Collagen may envelope capillaries - useful to discern from basement membrane.
- CC is typically more prominent in the proximal colon - may reflect concentration gradient of offending causitive agents.
- Significant negative findings:
- No PMNs.
- No crypt distortion.
- Thickened collagen band uncommon in rectum.
- Described in association of pseudomembranes.
TRANSVERSE COLON, BIOPSY: - COLLAGENOUS COLITIS.
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.
- URL: http://emedicine.medscape.com/article/180664-overview. Accessed on: 31 May 2010.
- Brain, O.; Rajaguru, C.; Warren, B.; Booth, J.; Travis, S. (Dec 2009). "Collagenous gastritis: reports and systematic review.". Eur J Gastroenterol Hepatol 21 (12): 1419-24. doi:10.1097/MEG.0b013e32832770fa. PMID 19730387.
- Agnarsdottir M, Gunnlaugsson O, Orvar KB, et al. (May 2002). "Collagenous and lymphocytic colitis in Iceland". Dig. Dis. Sci. 47 (5): 1122–8. PMID 12018911.
- 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.
- 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.
- Tanaka, M.; Mazzoleni, G.; Riddell, RH. (Jan 1992). "Distribution of collagenous colitis: utility of flexible sigmoidoscopy.". Gut 33 (1): 65-70. PMID 1740280.
- Bell, D. 4 Mar 2009.
- Yuan, S.; Reyes, V.; Bronner, MP. (Oct 2003). "Pseudomembranous collagenous colitis.". Am J Surg Pathol 27 (10): 1375-9. PMID 14508399.
- Goldstein, NS.; Gyorfi, T. (Sep 1999). "Focal lymphocytic colitis and collagenous colitis: patterns of Crohn's colitis?". Am J Surg Pathol 23 (9): 1075-81. PMID 10478667.