Distribution of histopathological features along the colon in microscopic colitis
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ORIGINAL ARTICLE
Distribution of histopathological features along the colon in microscopic colitis Anne-Marie Kanstrup Fiehn 1,2 & Stephan Miehlke 3 & Daniela Aust 4 & Michael Vieth 5 & Ole Bonderup 6 & Fernando Fernández-Bañares 7 & Emese Mihaly 8 & Juozas Kupcinskas 9 & Ahmed Madisch 10 & Lars Kristian Munck 2,11 & Tanju Nacak 12 & Ralf Mohrbacher 12 & Ralph Mueller 12 & Roland Greinwald 12 & Andreas Münch 13 Accepted: 8 September 2020 # Springer-Verlag GmbH Germany, part of Springer Nature 2020
Abstract Purpose The diagnosis microscopic colitis (MC) consisting of collagenous colitis (CC) and lymphocytic colitis (LC) relies on histological assessment of mucosal biopsies from the colon. The optimal biopsy strategy for reliable diagnosis of MC is controversial. The aim of this study was to evaluate the distribution of histopathological features of MC throughout the colon. Methods Mucosal biopsies from multiple colonic segments of patients with MC who participated in one of the three prospective European multicenter trials were analyzed. Histological slides were stained with hematoxylin-and-eosin, a connective tissue stain, and CD3 in selected cases. Results In total, 255 patients were included, 199 and 56 patients with CC and LC, respectively. Both groups exhibited a gradient with more pronounced inflammation in the lamina propria in the proximal colon compared with the distal colon. Similarly, the thickness of the subepithelial collagenous band in CC showed a gradient with higher values in the proximal colon. The mean number of intraepithelial lymphocytes was > 20 in all colonic segments in patients within both subgroups. Biopsies from 86 to 94% of individual segments were diagnostic, rectum excluded. Biopsies from non-diagnostic segments often showed features of another subgroup of MC. Conclusion Conclusively, although the severity of the histological changes in MC differed in the colonic mucosa, the minimum criteria required for the diagnosis were present in the random biopsies from the majority of segments. Thus, our findings show MC to be a pancolitis, rectum excluded, questioning previously proclaimed patchiness throughout the colon. Keywords Colonic biopsies . Histopathology . Histology . Diagnosis . Chronic diarrhea . Inflammatory bowel disease . Microscopic colitis
* Anne-Marie Kanstrup Fiehn [email protected] 1
Department of Pathology and Department of Surgery, Zealand University Hospital, Roskilde, Denmark
2
Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
3
Center for Digestive Diseases, Internal Medicine Center Eppendorf & Center for Esophageal Disorders, University Hospital Eppendorf, Hamburg, Germany
4
Institute for Pathology, University Hospital Dresden, Dresden, Germany
5
Institute for Pathology, Klinikum Bayreuth, Bayreuth, Germany
6
Diagnostic Center, Silkeborg Hospital, Silkeborg, Denmark
7
Department of Gastroenterology, Hospital Universitari Mútua Terrassa, Terrassa, Barcelona, and Centro de Investigación Biomédica en Red de enfermedades hepá
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