Colitis pp 199-213 | Cite as

Microscopic Colitis

  • Vincenzo Villanacci
  • Anne Jouret Mourin
  • Tiziana Salviato


The term “microscopic colitis” refers to a particular clinical-pathological entity, whose pathogenesis is still unknown, and includes two different entities named collagenous colitis (CC) and lymphocytic colitis (LC). The diagnosis is based on a correlation between clinical information and specific histological features. A correct pre-analytical phase, characterized by detailed clinical data, and adequate sampling of the different segments of the colon and the ileum are of paramount importance in the evaluation of these diseases; the latter is particularly important because of the morphological findings that may be patchy and not continuous.

Histologically, the normal mucosal architecture of the crypts is usually well preserved; in CC there is a typical thick (>10 μm) amorphous hyaline eosinophilic band immediately beneath the superficial epithelium of the mucosa, with an irregular, jagged aspect of the lower edge and inflammatory features in the lamina propria.

The histological diagnosis of LC is based upon a diffuse increase of intraepithelial T lymphocytes (IELs) (>20 IELs per 100 epithelial cells) in the superficial epithelium with no associated thickening of the subepithelial collagen band accompanied by an increase of lamina propria inflammatory cells.

Sometimes the histological pattern can show an overlap between CC and LC with features of both being present. Besides, both entities can present some so-called atypical forms, and a particular variant, named microscopic colitis incomplete (MCi), is characterized by the presence of clinical features of microscopic colitis without the morphological criteria necessary for a diagnosis of lymphocytic or collagenous colitis. Most patients with microscopic colitis require some form of antiinflammatory therapy; histologically few patients show a complete restitutio ad integrum of the colonic mucosa, even though there is a complete clinical remission.


Collagenous colitis Lymphocytic colitis Thick collagen band Trichrome stain Lamina propria cellular infiltrate Increased intraepithelial T lymphocytes Immunohistochemistry Atypical forms Microscopic colitis “incomplete” 


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Copyright information

© Springer International Publishing AG, part of Springer Nature 2018

Authors and Affiliations

  • Vincenzo Villanacci
    • 1
  • Anne Jouret Mourin
    • 2
  • Tiziana Salviato
    • 3
  1. 1.Institute of Pathology, Spedali Civili Brescia ItalyBresciaItaly
  2. 2.Department of PathologyCliniques Universitaires St Luc, UCLBrusselsBelgium
  3. 3.Department of PathologyUniversity of Trieste School of MedicineTriesteItaly

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