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Lymphocytic and collagenous colitis in children and adolescents: Comprehensive clinicopathologic analysis with long-term follow-up
- Source :
- Human pathology. 106
- Publication Year :
- 2020
-
Abstract
- Summary Microscopic colitis (MC) is characterized by chronic watery diarrhea, endoscopically normal findings, and abnormal histology. While mostly encountered in adults, pediatric cases are rare and may show varying presentations. Our pathology data system was searched from 1984 to 2019 for patients ≤18 years of age with a lymphocytic colitis (LC) or collagenous colitis (CC) pattern of injury. Twenty-seven cases (23 LC and 4 CC) were retrieved. LC was more prevalent than CC (85% vs 15%, respectively) and affected slightly younger individuals (mean, 9.8 years versus 12.25 years). Immune dysregulation was documented in 11 (41%) patients. Most patients presented with watery diarrhea (n = 26, 96%) and either abdominal pain (n = 18, 67%), nausea/vomiting (n = 5, 19%), flatulence (n = 6, 22%), and/or weight loss (n = 1, 4%). A subset of patients (n = 10, 37%) demonstrated endoscopic abnormalities. Histologically, some patients with LC and CC displayed focal cryptitis or crypt abscess formation (n = 7, 26%) and focally increased crypt apoptosis (n = 9, 33%) in the absence of chronic injury. Clinical follow-up data were available for 23 (85%) patients with variable clinical responses recorded. Only 8 patients experienced complete symptom resolution. Twelve patients (11 LC and 1 CC) had subsequent biopsy material; of which, one developed histologic features of inflammatory bowel disease and another was found to have a CTLA-4 deficiency. Our study shows that pediatric patients with MC may have atypical clinical, histologic, and endoscopic findings and variable clinical responses. Underlying inflammatory and/or genetic conditions may be eventually unmasked, and genetic testing may be helpful in a small subset of patients.
- Subjects :
- 0301 basic medicine
Colitis, Lymphocytic
Male
medicine.medical_specialty
Abdominal pain
Lymphocytic colitis
Cryptitis
Time Factors
Adolescent
Databases, Factual
Nausea
Colon
Biopsy
Colitis, Collagenous
DNA Mutational Analysis
Inflammatory bowel disease
Gastroenterology
Risk Assessment
Pathology and Forensic Medicine
03 medical and health sciences
0302 clinical medicine
Microscopic colitis
Risk Factors
Internal medicine
medicine
Humans
CTLA-4 Antigen
Genetic Predisposition to Disease
Child
Collagenous colitis
business.industry
Age Factors
Colonoscopy
medicine.disease
Prognosis
030104 developmental biology
030220 oncology & carcinogenesis
Child, Preschool
Mutation
Vomiting
Female
medicine.symptom
business
Subjects
Details
- ISSN :
- 15328392
- Volume :
- 106
- Database :
- OpenAIRE
- Journal :
- Human pathology
- Accession number :
- edsair.doi.dedup.....3db86db9e19795738d5f7a1aa4660640