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Unique endoscopic findings in lymphocytic colitis
Arab Journal of Gastroenterology 12 (2011) 203–204
Contents lists available at ScienceDirect
Arab Journal of Gastroenterology journal homepage: www.elsevier.com/locate/ajg
Images in Gastroenterology
Unique endoscopic findings in lymphocytic colitis Anastasios Koulaouzidis ⇑ Centre for Liver and Digestive Disorders, Endoscopy Unit, The Royal Infirmary of Edinburgh, 51 Little France Crescent, Edinburgh, EH16 4SA Scotland, UK
A 50-year-old female presented to her general practitioner with few months’ history of watery, non-bloody diarrhoea and occasional mucus excretion. She had an unremarkable past medical history and eventually underwent a colonoscopy. The colonoscope was inserted without any difficulty to the caecum. In the right colon, dwindling mucosal vascular network with pruning of capillaries and mucosal haziness was noted (Panel A). In the left colon, and in the area of the sigmoid, the mucosa presented a honeycomb-type or peau d’orange texture, albeit of normal colour (Panel B). Biopsies showed normal gland architectural pattern and preserved goblet cells, but with a diffuse increase of intraepi-
thelial (IEL) lymphocytes both in surface epithelium and in the crypts. No thickened collagen table was identified. Lymphocytic colitis (LC) was first described by Lazenby et al. in 1989, and it is currently classified under the ‘umbrella’ term of microscopic colitis [1]. Although the sine quidus non of the histology diagnosis is the presence of IEL P 20 per 100 surface epithelial cells, associated epithelial damage, and/or mild to moderate inflammation in the lamina propria with retention of crypt architecture with a subepithelial collagen layer of <10 lm. Although to date many reports have presented various distinct endoscopic findings in connection with collagenous colitis [1], there is a
Panel A. Dwindling colonic mucosa vascular network with pruning of capillaries and mucosal haziness in the right side of the colon.
Panel B. Honeycomb-type or ‘peau d’ orange0 mucosal texture in the sigmoid colon.
⇑ Tel.: +44 131 2421126; fax: +44 131 242 1618. E-mail address: [email protected] 1687-1979/$ - see front matter Ó 2011 Arab Journal of Gastroenterology. Published by Elsevier B.V. All rights reserved. doi:10.1016/j.ajg.2011.04.004
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A. Koulaouzidis / Arab Journal of Gastroenterology 12 (2011) 203–204
remarkable paucity of similar evidence in relevance to LC [2]. Although not applied in this case, virtual chromoendoscopy or preferably dye spray with indigocarmine, for improved delineation of the identified lesions, has been utilised in 4 prior reports [3]; it seems particularly helpful in the context of subtle mucosal changes and/or disturbed vascular architecture. However, this should be balanced against the associated resource implications and increased procedure time. An alternative might simply be the under water observation of the mucosa.
References [1] Lazenby AJ, Yardley JH, Giardiello FM, et al. Lymphocytic (‘‘microscopic’’) colitis: a comparative histopathologic study with particular reference to collagenous colitis. Hum Pathol 1989;20:18–28. [2] Koulaouzidis A, Saeed AA. Distinct colonoscopy findings of microscopic colitis; not so microscopic after all? World J Gastroenterol, in press. [3] Maroy A. A case of drug-induced lymphocytic colitis with a peculiar colonoscopic mucosal feature. ACEN 2001;31:301–2.
Contents lists available at ScienceDirect
Arab Journal of Gastroenterology journal homepage: www.elsevier.com/locate/ajg
Images in Gastroenterology
Unique endoscopic findings in lymphocytic colitis Anastasios Koulaouzidis ⇑ Centre for Liver and Digestive Disorders, Endoscopy Unit, The Royal Infirmary of Edinburgh, 51 Little France Crescent, Edinburgh, EH16 4SA Scotland, UK
A 50-year-old female presented to her general practitioner with few months’ history of watery, non-bloody diarrhoea and occasional mucus excretion. She had an unremarkable past medical history and eventually underwent a colonoscopy. The colonoscope was inserted without any difficulty to the caecum. In the right colon, dwindling mucosal vascular network with pruning of capillaries and mucosal haziness was noted (Panel A). In the left colon, and in the area of the sigmoid, the mucosa presented a honeycomb-type or peau d’orange texture, albeit of normal colour (Panel B). Biopsies showed normal gland architectural pattern and preserved goblet cells, but with a diffuse increase of intraepi-
thelial (IEL) lymphocytes both in surface epithelium and in the crypts. No thickened collagen table was identified. Lymphocytic colitis (LC) was first described by Lazenby et al. in 1989, and it is currently classified under the ‘umbrella’ term of microscopic colitis [1]. Although the sine quidus non of the histology diagnosis is the presence of IEL P 20 per 100 surface epithelial cells, associated epithelial damage, and/or mild to moderate inflammation in the lamina propria with retention of crypt architecture with a subepithelial collagen layer of <10 lm. Although to date many reports have presented various distinct endoscopic findings in connection with collagenous colitis [1], there is a
Panel A. Dwindling colonic mucosa vascular network with pruning of capillaries and mucosal haziness in the right side of the colon.
Panel B. Honeycomb-type or ‘peau d’ orange0 mucosal texture in the sigmoid colon.
⇑ Tel.: +44 131 2421126; fax: +44 131 242 1618. E-mail address: [email protected] 1687-1979/$ - see front matter Ó 2011 Arab Journal of Gastroenterology. Published by Elsevier B.V. All rights reserved. doi:10.1016/j.ajg.2011.04.004
204
A. Koulaouzidis / Arab Journal of Gastroenterology 12 (2011) 203–204
remarkable paucity of similar evidence in relevance to LC [2]. Although not applied in this case, virtual chromoendoscopy or preferably dye spray with indigocarmine, for improved delineation of the identified lesions, has been utilised in 4 prior reports [3]; it seems particularly helpful in the context of subtle mucosal changes and/or disturbed vascular architecture. However, this should be balanced against the associated resource implications and increased procedure time. An alternative might simply be the under water observation of the mucosa.
References [1] Lazenby AJ, Yardley JH, Giardiello FM, et al. Lymphocytic (‘‘microscopic’’) colitis: a comparative histopathologic study with particular reference to collagenous colitis. Hum Pathol 1989;20:18–28. [2] Koulaouzidis A, Saeed AA. Distinct colonoscopy findings of microscopic colitis; not so microscopic after all? World J Gastroenterol, in press. [3] Maroy A. A case of drug-induced lymphocytic colitis with a peculiar colonoscopic mucosal feature. ACEN 2001;31:301–2.