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Difference between revisions of "Lymphocytic colitis"
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'''Lymphocytic colitis''', abbreviated '''LC''', 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> | |||
*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. | |||
===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: | |||
*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. | |||
Image: | |||
*[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> | |||
===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. | |||
==See also== | |||
*[[Colon]]. | |||
*[[Collagenous colitis]]. | |||
==References== | |||
{{Reflist|2}} | |||
[[Category:Diagnosis]] | [[Category:Diagnosis]] | ||
[[Category:Colon]] | |||
[[Category:Gastrointestinal pathology]] | |||