Difference between revisions of "Lymphocytic colitis"

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{{ Infobox diagnosis
| Name      = {{PAGENAME}}
| Image      = Lymphocytic colitis - hps - high mag.jpg
| Width      =
| Caption    = Lymphocytic colitis. [[HPS stain]].
| Micro      = intraepithelial lymphocytes (>20/100 enterocytes), none or rare [[PMN]]s, no architectural distortion, normal subepithelial collagen band (< 10 micrometres thick)
| Subtypes  =
| LMDDx      = [[collagenous colitis]], [[infectious colitis]], [[Crohn's disease]] (rare)
| Stains    =
| IHC        =
| EM        =
| Molecular  =
| IF        =
| Gross      =
| Grossing  =
| Site      = [[colon]], [[rectum]]
| Assdx      = autoimmune diseases ([[celiac disease]], [[diabetes mellitus]], [[thyroid]] disorders, [[arthritis]])
| Syndromes  =
| Clinicalhx =
| Signs      =
| Symptoms  = diarrhea, non-bloody
| Prevalence =
| Bloodwork  =
| Rads      =
| Endoscopy  = normal
| Prognosis  =
| Other      =
| ClinDDx    = [[irritable bowel syndrome]]
}}
{{ Infobox external links
{{ Infobox external links
| Name          = Lymphocytic colitis
| Name          = {{PAGENAME}}
| EHVSC          = 10184
| EHVSC          = 10184
| pathprotocols  =  
| pathprotocols  =  
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}}
}}
'''Lymphocytic colitis''', abbreviated '''LC''', is a type of [[microscopic colitis]]. It has a characteristic clinical presentation and no apparent endoscopic changes.
'''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==
==General==
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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===
Line 26: Line 59:
**NSAIDs - posulated association/weak association,
**NSAIDs - 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 | PMC = 2778111 |doi= |url=http://www.wjgnet.com/1007-9327/14/7280.asp}}</ref>
*No increased risk of colorectal carcinoma.<ref name=pmid19109861/>
*No increased risk of colorectal carcinoma.<ref name=pmid19109861/>


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==Microscopic==
==Microscopic==
Features:
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
*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.
*Lymphocytes in the lamina propria.


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*[[Infectious colitis]] - neutrophils present... not lymphocytes.
*[[Infectious colitis]] - neutrophils present... not lymphocytes.
*[[Collagenous colitis]] - has a band of collagen below the epithelium.
*[[Collagenous colitis]] - has a band of collagen below the epithelium.
*[[Crohn's disease]] - uncommon, 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>


Image:
===Images===
<gallery>
Image: Lymphocytic colitis - low mag.jpg | LC - low mag. (WC)
Image: Lymphocytic colitis - intermed mag.jpg | LC - intermed. mag. (WC)
Image: Lymphocytic colitis - high mag.jpg | LC - high mag. (WC)
</gallery>
<gallery>
Image: Lymphocytic colitis - hps - low mag.jpg | LC - HPS - low mag. (WC)
Image: Lymphocytic colitis - hps - intermed mag.jpg | LC - HPS - intermed. mag. (WC)
Image: Lymphocytic colitis - hps - high mag.jpg | LC - HPS - high mag. (WC)
Image: Lymphocytic colitis - hps - very high mag.jpg | LC - HPS - very high mag. (WC)
</gallery>
<gallery>
Image: Lymphocytic proctitis -- low mag.jpg | LP - low mag.
Image: Lymphocytic proctitis -- intermed mag.jpg | LP - intermed. mag.
Image: Lymphocytic proctitis -- high mag.jpg | LP - high mag.
Image: Lymphocytic proctitis -- very high mag.jpg | LP - very high mag.
</gallery>
www:
*[http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2778111/figure/F2/ LC (nih.gov)].<ref name=pmid19109861/>
*[http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2778111/figure/F2/ LC (nih.gov)].<ref name=pmid19109861/>


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


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There are no granulomas. No neutrophilic cryptitis is apparent. The epithelium matures
There are no granulomas. No neutrophilic cryptitis is apparent. The epithelium matures
appropriately to the surface.
appropriately to the surface.
====Alternate====
<pre>
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.
</pre>


==See also==
==See also==
*[[Colon]].
*[[Colon]].
*[[Collagenous colitis]].
*[[Collagenous colitis]].
*[[Lymphocytic gastritis]].


==References==
==References==

Latest revision as of 14:29, 25 May 2016

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

  • LC - low mag. (WC)

  • LC - intermed. mag. (WC)

  • LC - high mag. (WC)

  • LC - HPS - low mag. (WC)

  • LC - HPS - intermed. mag. (WC)

  • LC - HPS - high mag. (WC)

  • LC - HPS - very high mag. (WC)

  • LP - low mag.

  • LP - intermed. mag.

  • LP - high mag.

  • LP - very high mag.

www:

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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.
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