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lymphocytic colitis

Tuesday 8 February 2005

Digital case

- HPC:327 : Lymphocytic colitis

Definition: Lymphocytic colitis is characterized histologically by an infiltrate of numerous T lymphocytes in the colonic epithelium, with excessive numbers defined as 20 or more intraepithelial lymphocytes (IELs) per 100 epithelial cells.

Clinical synopsis

Lymphocytic colitis is uncommon but not rare. The patients typically present with chronic watery diarrhea. The entity has been recognized only fairly recently, and the label was first proposed by Lazenby et al in 1989.

About 15% of these patients have celiac disease, which is also characterized by excessive numbers of intraepithelial lymphocytes in the villous epithelium of the small bowel. Others are likely linked to infectious outbreaks, but the majority of cases are idiopathic.

Microscopy

Lymphocytic colitis is characterized histologically by an infiltrate of numerous T lymphocytes in the colonic epithelium, with excessive numbers defined as 20 or more intraepithelial lymphocytes (IELs) per 100 epithelial cells.

Types

- focal lymphocytic colitis
- diffuse lymphocytic colitis

See also

- microscopic colitis

References

- Parfitt JR, Driman DK. Pathological effects of drugs on the gastrointestinal tract: a review. Hum Pathol. 2007 Apr;38(4):527-36. PMID: 17367604

- Lazenby AJ, Yardley JH, Giardiello FM, Jessurun J, Bayless TM. Lymphocytic ("microscopic") colitis: a comparative histopathologic study with particular reference to collagenous colitis. Hum Pathol. 1989 Jan;20(1):18-28. PMID: 2912870

- Goldblum JR, Wang N. Lymphocytic and collagenous colitis as possible patterns of Crohn’s colitis. Am J Surg Pathol. 2000 May;24(5):755-6; author reply 756-7. PMID: 10800997

- Wang N, Dumot JA, Achkar E, Easley KA, Petras RE, Goldblum JR. Colonic epithelial lymphocytosis without a thickened subepithelial collagen table: a clinicopathologic study of 40 cases supporting a heterogeneous entity. Am J Surg Pathol. 1999 Sep;23(9):1068-74. PMID: 10478666

- Goldstein NS, Gyorfi T. Focal lymphocytic colitis and collagenous colitis: patterns of Crohn’s colitis? Am J Surg Pathol. 1999 Sep;23(9):1075-81. PMID: 10478667