Pitfalls in the diagnosis of collagenous colitis

Experience with 75 cases from a registry of collagenous colitis at the Johns Hopkins hospital

Audrey J Lazenby, John H. Yardley, Francis M. Giardiello, Theodore M. Bayless

Research output: Contribution to journalArticle

118 Citations (Scopus)

Abstract

Collagenous colitis is a relatively rare disorder presenting mainly in middle-aged women as watery diarrhea. Endoscopic and radiographic studies of the colon are usually normal, and diagnosis must be made by biopsy. The characteristic biopsy findings are a combination of increased mucosal inflammation (collagenous colitis) as well as subepithelial collagenous thickening. The mucosal inflammatory changes include increased lamina propria plasma cells, prominent intraepithelial lymphocytes, and in some cases, numerous eosinophils. The collagenous thickening has qualitative as well as quantitative differences from normal, and may be highlighted by Masson trichrome stains. Simply quantitating the thickness of a subepithelial collagen layer is neither adequate nor necessary for the diagnosis of collagenous colitis. Major problems in diagnosing collagenous colitis arise from focusing solely on the subepithelial region without attention to inflammatory changes. For example, tangential sectioning of normal colon results in an artifactually thickened basement membrane, and such cases have been wrongly interpreted as collagenous colitis. If biopsies lack the characteristic inflammatory pattern, a tangentially cut thick basement membrane should be ignored. The key to correct diagnosis of collagenous colitis is analyzing the summation of various inflammatory changes plus subepithelial collagenization, rather than focusing on any single feature in isolation.

Original languageEnglish (US)
Pages (from-to)905-910
Number of pages6
JournalHuman Pathology
Volume21
Issue number9
DOIs
StatePublished - Jan 1 1990

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Collagenous Colitis
Registries
Biopsy
Basement Membrane
Colon
Plasma Cells
Eosinophils
Diarrhea
Mucous Membrane
Collagen
Lymphocytes
Inflammation

ASJC Scopus subject areas

  • Pathology and Forensic Medicine

Cite this

Pitfalls in the diagnosis of collagenous colitis : Experience with 75 cases from a registry of collagenous colitis at the Johns Hopkins hospital. / Lazenby, Audrey J; Yardley, John H.; Giardiello, Francis M.; Bayless, Theodore M.

In: Human Pathology, Vol. 21, No. 9, 01.01.1990, p. 905-910.

Research output: Contribution to journalArticle

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