Lymphocytic colitis

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.

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

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.

Epidemiology

• Age: a disease of adults - usually 50s.
• Sex:
  • LC males ~= females,
  • CC females:males = 20:1.
• 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.
• No increased risk of colorectal carcinoma.

Treatment

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

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) and
• Lymphocytes in the lamina propria.

Significant negatives:

• No neutrophils.
• No crypt distortion.

DDx:

• Infectious colitis - neutrophils present... not lymphocytes.
• Collagenous colitis - has a band of collagen below the epithelium.
• Crohn's disease - uncommon, may be a perfect mimic.

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:

• LC (nih.gov).

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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

• Colon.
• Collagenous colitis.
• Lymphocytic gastritis.