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Colitis pp 199-213 | Cite as

Microscopic Colitis

  • Vincenzo Villanacci
  • Anne Jouret Mourin
  • Tiziana Salviato
Chapter

Abstract

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.

Keywords

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

References

  1. 1.
    Magro F, Langner C, Driessen A, Ensari A, Geboes K, Mantzaris GJ, Villanacci V, Becheanu G, Borralho Nunes P, Cathomas G, Fries W, Jouret-Mourin A, Mescoli C, de Petris G, Rubio CA, Shepherd NA, Vieth M, Eliakim R, European Society of Pathology, European Crohn’s and Colitis Organisation. European consensus on the histopathology of inflammatory bowel disease. J Crohns Colitis. 2013;7:827–51.CrossRefPubMedPubMedCentralGoogle Scholar
  2. 2.
    Lindstrom CG. ‘Collagenous colitis’ with watery diarrhoea--a new entity? Pathol Eur. 1976;11:87–9.PubMedGoogle Scholar
  3. 3.
    Yantiss RK, Odze RD. Optimal approach to obtaining mucosal biopsies for assessment of inflammatory disorders of the gastrointestinal tract. Am J Gastroenterol. 2009;104:774–83.CrossRefPubMedGoogle Scholar
  4. 4.
    Guagnozzi D, Landolfi S, Vicario M. Towards a new paradigm of microscopic colitis: incomplete and variant forms. World J Gastroenterol. 2016;22:8459–71.CrossRefPubMedPubMedCentralGoogle Scholar
  5. 5.
    Read NW, Krejs GJ, Read MG, Santa Ana CA, Morawski SG, Fordtran JS. Chronic diarrhea of unknown origin. Gastroenterology. 1980;78:264–71.PubMedGoogle Scholar
  6. 6.
    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;20:18–28.CrossRefPubMedGoogle Scholar
  7. 7.
    Jessurun J, Yardley JH, Lee EL, Vendrell DD, Schiller LR, Fordtran JS. Microscopic and collagenous colitis: different names for the same condition? Gastroenterology. 1986;91:1583–4.CrossRefPubMedGoogle Scholar
  8. 8.
    Gunther U, Bateman AC, Beattie RM, Bauer M, MacDonald TT, Kaskas BA. Connective tissue growth factor expression is increased in collagenous colitis and coeliac disease. Histopathology. 2010;57:427–35.CrossRefPubMedGoogle Scholar
  9. 9.
    Pisani LF, Tontini GE, Vecchi M, Pastorelli L. Microscopic colitis: what do we know about pathogenesis? Inflamm Bowel Dis. 2016;22:450–8.CrossRefPubMedGoogle Scholar
  10. 10.
    Tysk C, Wickbom A, Nyhlin N, Eriksson S, Bohr J. Recent advances in diagnosis and treatment of microscopic colitis. Ann Gastroenterol. 2011;24:253–62.PubMedPubMedCentralGoogle Scholar
  11. 11.
    Vigren L, Sjoberg K, Benoni C, Tysk C, Bohr J, Kilander A, Larsson L, Strom M, Hjortswang H. Is smoking a risk factor for collagenous colitis? Scand J Gastroenterol. 2011;46:1334–9.CrossRefPubMedGoogle Scholar
  12. 12.
    Yen EF, Pokhrel B, Du H, Nwe S, Bianchi L, Witt B, Hall C. Current and past cigarette smoking significantly increase risk for microscopic colitis. Inflamm Bowel Dis. 2012;18:1835–41.CrossRefPubMedGoogle Scholar
  13. 13.
    Koskela RM, Karttunen TJ, Niemela SE, Lehtola JK, Bloigu RS, Karttunen RA. Cytokine gene polymorphism in microscopic colitis association with the IL-6-174 GG genotype. Eur J Gastroenterol Hepatol. 2011;23:607–13.CrossRefPubMedGoogle Scholar
  14. 14.
    Villanacci V, Casella G, Bassotti G. The spectrum of drug-related colitides: important entities, though frequently overlooked. Dig Liver Dis. 2011;43:523–8.CrossRefPubMedGoogle Scholar
  15. 15.
    Park HS, Han DS, Ro YO, Eun CS, Yoo KS. Does lymphocytic colitis always present with normal endoscopic findings? Gut Liver. 2015;9:197–201.CrossRefPubMedGoogle Scholar
  16. 16.
    El-Salhy M, Lomholt-Beck B, Gundersen TD. High chromogranin A cell density in the colon of patients with lymphocytic colitis. Mol Med Rep. 2011;4:603–5.PubMedGoogle Scholar
  17. 17.
    El-Salhy M, Gundersen D, Hatlebakk JG, Hausken T. Chromogranin A cell density as a diagnostic marker for lymphocytic colitis. Dig Dis Sci. 2012;57:3154–9.CrossRefPubMedPubMedCentralGoogle Scholar
  18. 18.
    El-Salhy M, Gundersen D, Hatlebakk JG, Hausken T. High densities of serotonin and peptide YY cells in the colon of patients with lymphocytic colitis. World J Gastroenterol. 2012;18:6070–5.CrossRefPubMedPubMedCentralGoogle Scholar
  19. 19.
    Kellum JM, Albuquerque FC, Stoner MC, Harris RP. Stroking human jejunal mucosa induces 5-HT release and Cl- secretion via afferent neurons and 5-HT4 receptors. Am J Phys. 1999;277:G515–20.Google Scholar
  20. 20.
    Mullhaupt B, Guller U, Anabitarte M, Guller R, Fried M. Lymphocytic colitis: clinical presentation and long term course. Gut. 1998;43:629–33.CrossRefPubMedPubMedCentralGoogle Scholar
  21. 21.
    Spiller R, Garsed K. Postinfectious irritable bowel syndrome. Gastroenterology. 2009;136:1979–88.CrossRefPubMedGoogle Scholar
  22. 22.
    El-Salhy M, Gundersen D, Hatlebakk JG, Hausken T. Irritable bowel syndrome. New York: Nova Scientific Publisher; 2012.Google Scholar
  23. 23.
    Dunlop SP, Jenkins D, Neal KR, Spiller RC. Relative importance of enterochromaffin cell hyperplasia, anxiety, and depression in postinfectious IBS. Gastroenterology. 2003;125:1651–9.CrossRefPubMedGoogle Scholar
  24. 24.
    Kim HS, Lim JH, Park H, Lee SI. Increased immunoendocrine cells in intestinal mucosa of postinfectious irritable bowel syndrome patients 3 years after acute Shigella infection--an observation in a small case control study. Yonsei Med J. 2010;51:45–51.CrossRefPubMedGoogle Scholar
  25. 25.
    Park JH, Rhee PL, Kim G, Lee JH, Kim YH, Kim JJ, Rhee JC, Song SY. Enteroendocrine cell counts correlate with visceral hypersensitivity in patients with diarrhoea-predominant irritable bowel syndrome. Neurogastroenterol Motil. 2006;18:539–46.CrossRefPubMedGoogle Scholar
  26. 26.
    Spiller RC, Jenkins D, Thornley JP, Hebden JM, Wright T, Skinner M, Neal KR. Increased rectal mucosal enteroendocrine cells, T lymphocytes, and increased gut permeability following acute Campylobacter enteritis and in post-dysenteric irritable bowel syndrome. Gut. 2000;47:804–11.CrossRefPubMedPubMedCentralGoogle Scholar
  27. 27.
    Dey I, Beck PL, Chadee K. Lymphocytic colitis is associated with increased pro-inflammatory cytokine profile and up regulation of prostaglandin receptor EP4. PLoS One. 2013;8:e61891.CrossRefPubMedPubMedCentralGoogle Scholar
  28. 28.
    Warren BF, Edwards CM, Travis SP. ‘Microscopic colitis’: classification and terminology. Histopathology. 2002;40:374–6.CrossRefPubMedGoogle Scholar
  29. 29.
    Lazenby AJ. Collagenous and lymphocytic colitis. Semin Diagn Pathol. 2005;22:295–300.CrossRefPubMedGoogle Scholar
  30. 30.
    van den Oord JJ, Geboes K, Desmet VJ. Collagenous colitis: an abnormal collagen table? Two new cases and review of the literature. Am J Gastroenterol. 1982;77:377–81.PubMedGoogle Scholar
  31. 31.
    Jessurun J, Yardley JH, Giardiello FM, Hamilton SR, Bayless TM. Chronic colitis with thickening of the subepithelial collagen layer (collagenous colitis): histopathologic findings in 15 patients. Hum Pathol. 1987;18:839–48.CrossRefPubMedGoogle Scholar
  32. 32.
    Offner FA, Jao RV, Lewin KJ, Havelec L, Weinstein WM. Collagenous colitis: a study of the distribution of morphological abnormalities and their histological detection. Hum Pathol. 1999;30:451–7.CrossRefPubMedGoogle Scholar
  33. 33.
    Freeman HJ, Weinstein WM, Shniita TK, Wensel RH, Sartor VE. Watery diarrhea syndrome associated with a lesion of the colonic basement membrane (BM)-lamina propria (LP) interface. Ann R Coll Phys Surg Can. 1976;9:45.Google Scholar
  34. 34.
    Aigner T, Neureiter D, Muller S, Kuspert G, Belke J, Kirchner T. Extracellular matrix composition and gene expression in collagenous colitis. Gastroenterology. 1997;113:136–43.CrossRefPubMedGoogle Scholar
  35. 35.
    Anagnostopoulos I, Schuppan D, Riecken EO, Gross UM, Stein H. Tenascin labelling in colorectal biopsies: a useful marker in the diagnosis of collagenous colitis. Histopathology. 1999;34:425–31.CrossRefPubMedGoogle Scholar
  36. 36.
    Wagner M, Lampinen M, Sangfelt P, Agnarsdottir M, Carlson M. Budesonide treatment of patients with collagenous colitis restores normal eosinophil and T-cell activity in the colon. Inflamm Bowel Dis. 2010;16:1118–26.CrossRefPubMedGoogle Scholar
  37. 37.
    Baker D. Defusing the baby boomer time bomb: projections of after-tax income in the twenty-first century. Int J Health Serv. 2001;31:239–78.CrossRefPubMedGoogle Scholar
  38. 38.
    Salas A, Fernandez-Banares F, Casalots J, Gonzalez C, Tarroch X, Forcada P, Gonzalez G. Subepithelial myofibroblasts and tenascin expression in microscopic colitis. Histopathology. 2003;43:48–54.CrossRefPubMedGoogle Scholar
  39. 39.
    Mosnier JF, Larvol L, Barge J, Dubois S, De La Bigne G, Henin D, Cerf M. Lymphocytic and collagenous colitis: an immunohistochemical study. Am J Gastroenterol. 1996;91:709–13.PubMedGoogle Scholar
  40. 40.
    Bowling TE, Price AB, al-Adnani M, Fairclough PD, Menzies-Gow N, Silk DB. Interchange between collagenous and lymphocytic colitis in severe disease with autoimmune associations requiring colectomy: a case report. Gut. 1996;38:788–91.CrossRefPubMedPubMedCentralGoogle Scholar
  41. 41.
    Baert F, Wouters K, D'Haens G, Hoang P, Naegels S, D'Heygere F, Holvoet J, Louis E, Devos M, Geboes K. Lymphocytic colitis: a distinct clinical entity? A clinicopathological confrontation of lymphocytic and collagenous colitis. Gut. 1999;45:375–81.CrossRefPubMedPubMedCentralGoogle Scholar
  42. 42.
    Chang F, Deere H, Vu C. Atypical forms of microscopic colitis: morphological features and review of the literature. Adv Anat Pathol. 2005;12:203–11.CrossRefPubMedGoogle Scholar
  43. 43.
    Bjornbak C, Engel PJ, Nielsen PL, Munck LK. Microscopic colitis: clinical findings, topography and persistence of histopathological subgroups. Aliment Pharmacol Ther. 2011;34:1225–34.CrossRefPubMedGoogle Scholar
  44. 44.
    Fernandez-Banares F, Casanova MJ, Arguedas Y, Beltran B, Busquets D, Fernandez JM, Fernandez-Salazar L, Garcia-Planella E, Guagnozzi D, Lucendo AJ, Mancenido N, Marin-Jimenez I, Montoro M, Piqueras M, Robles V, Ruiz-Cerulla A, Gisbert JP, Spanish Microscopic Colitis G. Current concepts on microscopic colitis: evidence-based statements and recommendations of the Spanish Microscopic Colitis Group. Aliment Pharmacol Ther. 2016;43:400–26.CrossRefPubMedGoogle Scholar
  45. 45.
    Langner C, Aust D, Ensari A, Villanacci V, Becheanu G, Miehlke S, Geboes K, Munch A, Working Group of Digestive Diseases of the European Society of Pathology (ESP) and the European Microscopic Colitis Group (EMCG). Histology of microscopic colitis-review with a practical approach for pathologists. Histopathology. 2015;66:613–26.CrossRefPubMedGoogle Scholar
  46. 46.
    Rubio CA, Lindholm J. Cryptal lymphocytic coloproctitis: a new phenotype of lymphocytic colitis? J Clin Pathol. 2002;55:138–40.CrossRefPubMedPubMedCentralGoogle Scholar
  47. 47.
    Buchman AL, Rao S. Pseudomembranous collagenous colitis. Dig Dis Sci. 2004;49:1763–7.CrossRefPubMedGoogle Scholar
  48. 48.
    Deniz K, Coban G, Ozbakir O, Deniz E. Pseudomembranous collagenous colitis. Turk J Gastroenterol. 2012;23:93–5.CrossRefPubMedGoogle Scholar
  49. 49.
    Harpaz N, Fiel MI, Zhang D. Pseudomembranous variant of collagenous colitis. Dig Endosc. 2015;27:793–4.CrossRefPubMedGoogle Scholar
  50. 50.
    Khan-Kheil AM, Disney B, Ruban E, Wood G. Pseudomembranous collagenous colitis: an unusual cause of chronic diarrhoea. BMJ Case Rep. 2014;2014:bcr2013203148.  https://doi.org/10.1136/bcr-2013-203148.CrossRefPubMedPubMedCentralGoogle Scholar
  51. 51.
    Yuan S, Reyes V, Bronner MP. Pseudomembranous collagenous colitis. Am J Surg Pathol. 2003;27:1375–9.CrossRefPubMedGoogle Scholar
  52. 52.
    Villanacci V, Cristina S, Muscara M, Saettone S, Broglia L, Antonelli E, Salemme M, Occhipinti P, Bassotti G. Pseudomembranous collagenous colitis with superimposed drug damage. Pathol Res Pract. 2013;209:735–9.CrossRefPubMedGoogle Scholar
  53. 53.
    Greenson JK, Stern RA, Carpenter SL, Barnett JL. The clinical significance of focal active colitis. Hum Pathol. 1997;28:729–33.CrossRefPubMedGoogle Scholar
  54. 54.
    Driman DK, Preiksaitis HG. Colorectal inflammation and increased cell proliferation associated with oral sodium phosphate bowel preparation solution. Hum Pathol. 1998;29:972–8.CrossRefPubMedGoogle Scholar
  55. 55.
    Lee FD. Drug-related pathological lesions of the intestinal tract. Histopathology. 1994;25:303–8.CrossRefPubMedGoogle Scholar
  56. 56.
    Wong NA, Penman ID, Campbell S, Lessells AM. Microscopic focal cryptitis associated with sodium phosphate bowel preparation. Histopathology. 2000;36:476–8.PubMedGoogle Scholar
  57. 57.
    Zwas FR, Cirillo NW, el-Serag HB, Eisen RN. Colonic mucosal abnormalities associated with oral sodium phosphate solution. Gastrointest Endosc. 1996;43:463–6.CrossRefPubMedGoogle Scholar
  58. 58.
    Shetty S, Anjarwalla SM, Gupta J, Foy CJ, Shaw IS, Valori RM, Shepherd NA. Focal active colitis: a prospective study of clinicopathological correlations in 90 patients. Histopathology. 2011;59:850–6.CrossRefPubMedGoogle Scholar
  59. 59.
    Brown IS, Lambie DL. Microscopic colitis with giant cells: a clinico-pathological review of 11 cases and comparison with microscopic colitis without giant cells. Pathology. 2008;40:671–5.CrossRefPubMedGoogle Scholar
  60. 60.
    Libbrecht L, Croes R, Ectors N, Staels F, Geboes K. Microscopic colitis with giant cells. Histopathology. 2002;40:335–8.CrossRefPubMedGoogle Scholar
  61. 61.
    Sandmeier D, Bouzourene H. Microscopic colitis with giant cells: a rare new histopathologic subtype? Int J Surg Pathol. 2004;12:45–8.CrossRefPubMedPubMedCentralGoogle Scholar
  62. 62.
    Grassia R, Capone P, Villanacci V, Tanzi GP, Buffoli F. Endoscopic features of microscopic colitis: the "grid-like" pattern detected with HD+ colonoscopy plus i-scan. Dig Liver Dis. 2017;49:318–9.CrossRefPubMedGoogle Scholar
  63. 63.
    Iacucci M, Urbanski S. Recognition of microscopic colitis at colonoscopy. Can J Gastroenterol. 2012;26(4):183.CrossRefPubMedPubMedCentralGoogle Scholar
  64. 64.
    Koulaouzidis A, Saeed AA. Distinct colonoscopy findings of microscopic colitis: not so microscopic after all? World J Gastroenterol. 2011;17:4157–65.CrossRefPubMedPubMedCentralGoogle Scholar

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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