Lymphocytic colitis

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Lymphocytic colitis
Diagnosis in short

Lymphocytic colitis. HPS stain.

LM intraepithelial lymphocytes (>20/100 enterocytes), none or rare PMNs, no architectural distortion, normal subepithelial collagen band (< 10 micrometres thick)
LM DDx collagenous colitis, infectious colitis, Crohn's disease (rare)
Site colon, rectum

Associated Dx autoimmune diseases (celiac disease, diabetes mellitus, thyroid disorders, arthritis)
Symptoms diarrhea, non-bloody
Endoscopy normal
Clin. DDx irritable bowel syndrome
Lymphocytic colitis
External resources
EHVSC 10184

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.[1]
  • Lymphocytic colitis may be related to collagenous colitis.
    • It is hypothesized that these conditions may be the same pathology at different time points.[1]

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.[2]

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.[3]
  • No increased risk of colorectal carcinoma.[3]

Treatment

  • Sometimes just follow-up.
  • Steroids - budesonide -- short-term treatment.[3]

Gross

Microscopic

Features:

Significant negatives:[4]

  • No neutrophils.
  • No crypt distortion.

DDx:

Images

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ASCENDING COLON, BIOPSY:
- LYMPHOCYTIC COLITIS.
RECTUM, BIOPSY:
- LYMPHOCYTIC PROCTITIS.
- NEGATIVE FOR ARCHITECTURAL DISTORTION AND NEGATIVE FOR CRYPTITIS.
- NEGATIVE FOR DYSPLASIA.

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

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.

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. 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.
  3. 3.0 3.1 3.2 3.3 3.4 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. PMC 2778111. PMID 19109861. http://www.wjgnet.com/1007-9327/14/7280.asp.
  4. http://hopkins-gi.nts.jhu.edu/pages/latin/templates/index.cfm?pg=disease1&disease=29&organ=6&lang_id=1
  5. 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.