Collagenous colitis: Difference between revisions

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{{ Infobox diagnosis
{{ Infobox diagnosis
| Name      = {{PAGENAME}}
| Name      = {{PAGENAME}}
| Image      = Collagenous_colitis_-_high_mag.jpg
| Image      = Collagenous_colitis_-_high_mag.jpg  
| Width      =
| Width      =
| Caption    = Collagenous colitis. [[H&E stain]].
| Caption    = Collagenous colitis. [[H&E stain]].
| Micro      = intraepithelial lymphocytes (>20/100 enterocytes), subepithelial collagen band (>= 10 micrometres thick)
| Micro      = intraepithelial lymphocytes (>20/100 enterocytes), subepithelial collagen band (>= 10 micrometres thick)
| Subtypes  =
| Subtypes  =
| LMDDx      = [[lymphocytic colitis]]
| LMDDx      = [[lymphocytic colitis]], [[Crohn's disease]] (very rare)
| Stains    =
| Stains    =
| IHC        =
| IHC        =
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==General==
==General==
*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/>
*May be associated with to [[collagenous gastritis]] in adults.<ref name=pmid19730387>{{Cite journal  | last1 = Brain | first1 = O. | last2 = Rajaguru | first2 = C. | last3 = Warren | first3 = B. | last4 = Booth | first4 = J. | last5 = Travis | first5 = S. | title = Collagenous gastritis: reports and systematic review. | journal = Eur J Gastroenterol Hepatol | volume = 21 | issue = 12 | pages = 1419-24 | month = Dec | year = 2009 | doi = 10.1097/MEG.0b013e32832770fa | PMID = 19730387 }}</ref>
Presentation:
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>
*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:
Notes:
*Clinical DDx includes [[irritable bowel syndrome]] - which has no or subtle histopathologic changes.
*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.<ref name=pmid12018911>{{cite journal |author=Agnarsdottir M, Gunnlaugsson O, Orvar KB, ''et al.'' |title=Collagenous and lymphocytic colitis in Iceland |journal=Dig. Dis. Sci. |volume=47 |issue=5 |pages=1122–8 |year=2002 |month=May |pmid=12018911 |doi= |url=}}</ref>


===Epidemiology===
===Epidemiology===
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**CC females:males = 20:1.<ref name=medscape180664/>
**CC females:males = 20:1.<ref name=medscape180664/>
*Drugs are associated with LC and CC.  
*Drugs are associated with LC and CC.  
**NSAIDs - posulated association/weak association,
**[[NSAID]]s - posulated association/weak association,
**SSRIs (used primarily for depression) - moderate association, dependent on specific drug.
**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>
*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>
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==Microscopic==
==Microscopic==
Features:
Features:
*Intraepithelial lymphocytes - '''important'''.
*[[Intraepithelial lymphocytes]] - '''important'''.
*Collagenous material in the lamina propria (pink on H&E) -- '''key feature'''.
*Collagenous material in the lamina propria (pink on H&E) -- '''key feature'''.
**Can be demonstrated with a trichrome stain -- collagen = green on trichrome.
**Can be demonstrated with a trichrome stain -- collagen = green on trichrome.
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**No crypt distortion.
**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>
*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>
*Described in association of [[pseudomembranous colitis|pseudomembranes]].<ref name=pmid14508399>{{Cite journal  | last1 = Yuan | first1 = S. | last2 = Reyes | first2 = V. | last3 = Bronner | first3 = MP. | title = Pseudomembranous collagenous colitis. | journal = Am J Surg Pathol | volume = 27 | issue = 10 | pages = 1375-9 | month = Oct | year = 2003 | doi =  | PMID = 14508399 }}</ref>


DDx:
DDx:
*[[Lymphocytic colitis]].
*[[Lymphocytic colitis]].
*[[Crohn's disease]] - may be a perfect mimic.<ref name=pmid10478667>{{Cite journal  | last1 = Goldstein | first1 = NS. | last2 = Gyorfi | first2 = T. | title = Focal lymphocytic colitis and collagenous colitis: patterns of Crohn's colitis? | journal = Am J Surg Pathol | volume = 23 | issue = 9 | pages = 1075-81 | month = Sep | year = 1999 | doi =  | PMID = 10478667 }}</ref>
*[[Crohn's disease]] - very rare, may be a perfect mimic.<ref name=pmid10478667>{{Cite journal  | last1 = Goldstein | first1 = NS. | last2 = Gyorfi | first2 = T. | title = Focal lymphocytic colitis and collagenous colitis: patterns of Crohn's colitis? | journal = Am J Surg Pathol | volume = 23 | issue = 9 | pages = 1075-81 | month = Sep | year = 1999 | doi =  | PMID = 10478667 }}</ref>


===Images===
===Images===

Latest revision as of 14:30, 25 May 2016

Collagenous colitis
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)
Symptoms diarrhea, non-bloody
Endoscopy normal
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.

General

Presentation:

  • Chronic diarrhea, non-bloody.[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.[3]

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.[4]
  • No increased risk of colorectal carcinoma.[4]

Treatment

  • Sometimes just follow-up.
  • Steroids - budesonide -- short-term treatment.[4]

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.[4]
      • 8 micrometres is the diameter of a RBC.
      • The normal thickness of the subepithelial collagen is 3 micrometres.[4]
      • Transverse colon usually thickest - in one series ~ 47 micrometres on average.[5]
    • Thickening is usually patchy.[6]
    • Thickening "follows the crypts from the surface" - useful for differentiating from tangential sections of the basement membrane.[7]
    • Collagen may envelope capillaries - useful to discern from basement membrane.[7]

Notes:

  • CC is typically more prominent in the proximal colon - may reflect concentration gradient of offending causitive agents.[4]
  • Significant negative findings:[8]
    • No PMNs.
    • No crypt distortion.
  • Thickened collagen band uncommon in rectum.[6]
  • Described in association of pseudomembranes.[9]

DDx:

Images

  • CC - intermed mag. (WC/Nephron)
    CC - intermed mag. (WC/Nephron)
  • CC - high mag. (WC/Nephron)
    CC - high mag. (WC/Nephron)

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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. ↑ 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.
  3. ↑ 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.
  4. ↑ 4.0 4.1 4.2 4.3 4.4 4.5 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.
  5. ↑ 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.
  6. ↑ 6.0 6.1 Tanaka, M.; Mazzoleni, G.; Riddell, RH. (Jan 1992). "Distribution of collagenous colitis: utility of flexible sigmoidoscopy.". Gut 33 (1): 65-70. PMID 1740280.
  7. ↑ 7.0 7.1 Bell, D. 4 Mar 2009.
  8. ↑ http://hopkins-gi.nts.jhu.edu/pages/latin/templates/index.cfm?pg=disease1&disease=29&organ=6&lang_id=1
  9. ↑ Yuan, S.; Reyes, V.; Bronner, MP. (Oct 2003). "Pseudomembranous collagenous colitis.". Am J Surg Pathol 27 (10): 1375-9. PMID 14508399.
  10. ↑ 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.
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