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Paucicellular lymphocytic colitis: is it a minor form of lymphocytic colitis? A clinical pathological and
Fernando Fernández-Bañares1, Jaume Casalots, Antonio Salas
1Department of Gastroenterology, Hospital Mutua Terrassa, Universitat de Barcelona, Terrassa, Barcelona, Spain. ffbanares@mutuaterrassa.es
Objectives:
It has been suggested that paucicellular lymphocytic colitis (PLC) should be considered to be part of the morphological spectrum of microscopic colitis. The aim of the study was to evaluate whether PLC may be considered to be a true microscopic colitis, and in this case, whether it is a minor form of lymphocytic colitis (LC) or a different entity.
Methods:
All incident cases of PLC, LC, and collagenous colitis (CC) during the period 2004-2006 were included. The incidence rate and the clinical, histopathological, and immunological features of PLC were assessed and compared with those of both LC and CC. Immunoreactivities to CD25, c-Kit, and FOXP3 in lamina propria were assessed.
Results:
In all, 19 patients with CC, 19 with LC, and 26 with PLC were identified. CD25+FOXP3+ expression was seen only in classical forms of microscopic colitis: 12 of 19 LC, 14 of 20 CC, and none of 20 PLC cases (P < 0.0001). Diarrhea ceased in 21 of the 26 patients, with a decrease in the daily stool number from 5.08 +/- 0.44 to 1.7 +/- 0.2 (P < 0.005). The five patients with no response to therapy fulfilled the Rome II criteria of irritable bowel syndrome (IBS).
Conclusions:
The incidence rate of PLC, identified using objective histological criteria, was higher than those of CC and LC. The lack of expression of CD25+FOXP3+ cells in PLC, in contrast to those seen in both LC and CC, would suggest the existence of different pathophysiological mechanisms and does not support that PLC is a minor form of LC.
Insights
Paucicellular lymphocytic colitis (PLC) is not a minor form of lymphocytic colitis (LC) but a distinct entity. Unlike LC and collagenous colitis (CC), PLC lacks specific immune cell markers, suggesting different disease mechanisms.
Area of Science:
- Gastroenterology
- Histopathology
- Immunology
Background:
- Paucicellular lymphocytic colitis (PLC) is debated as a variant of microscopic colitis.
- Distinguishing PLC from lymphocytic colitis (LC) and collagenous colitis (CC) is crucial for understanding its pathophysiology.
Purpose of the Study:
- To determine if PLC is a true microscopic colitis.
- To ascertain if PLC is a variant of LC or a separate condition.
Main Methods:
- Comparative analysis of incident cases of PLC, LC, and CC (2004-2006).
- Assessment of clinical, histopathological, and immunological features, including CD25, c-Kit, and FOXP3 expression.
- Evaluation of treatment response and correlation with Rome II criteria for irritable bowel syndrome (IBS).
Main Results:
- PLC incidence exceeded that of CC and LC.
- CD25+FOXP3+ immune cell expression was absent in PLC but present in LC and CC (P < 0.0001).
- Most PLC patients (21/26) responded to therapy, with significant reduction in stool frequency; non-responders met IBS criteria.
Conclusions:
- PLC exhibits distinct histological and immunological characteristics compared to LC and CC.
- The absence of specific immune markers in PLC suggests different underlying pathophysiological mechanisms.
- Findings do not support classifying PLC as a minor form of LC, indicating it is a separate entity.
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