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The subtypes of microscopic colitis from a pathologist's perspective: past, present and future
Peter Johan Heiberg Engel1,2, Anne-Marie Kanstrup Fiehn3, Lars Kristian Munck2,4
1Department of Pathology, Zealand University Hospital Roskilde, Roskilde, Denmark.
Annals of Translational Medicine
|April 4, 2018
Summary
Microscopic colitis (MC) diagnosis faces challenges with new subtypes and special stains. This article discusses evolving criteria and proposes solutions like automated analysis and international collaboration for improved accuracy.
Area of Science:
- Gastroenterology
- Histopathology
- Inflammatory Bowel Disease
Background:
- Microscopic colitis (MC) is a chronic inflammatory bowel disease characterized by chronic diarrhea, normal endoscopy, and specific histological findings.
- MC includes lymphocytic colitis (LC) and collagenous colitis (CC) subtypes, historically diagnosed using hematoxylin-eosin (HE) stains.
- Recent advancements include the recognition of incomplete subtypes (MCi) and increased use of special stains in diagnostics.
Purpose of the Study:
- To review the evolution of diagnostic criteria and methods for microscopic colitis.
- To discuss current diagnostic challenges faced by pathologists in distinguishing MC subtypes and related conditions.
- To propose strategies for improving diagnostic accuracy and reducing inter-observer variability.
Main Methods:
- Review of historical and current diagnostic criteria for microscopic colitis.
- Discussion of the role of special stains in differentiating MC subtypes and incomplete forms.
- Exploration of potential solutions including automated image analysis and collaborative efforts.
Main Results:
- Diagnostic criteria for MC have evolved, incorporating incomplete subtypes (MCi) and necessitating advanced staining techniques.
- Pathologists face challenges in differentiating MC, MCi, and minor inflammatory changes, leading to diagnostic uncertainty.
- Inter-observer variability remains a concern in microscopic colitis diagnosis.
Conclusions:
- Accurate diagnosis of microscopic colitis requires adapting to evolving criteria and embracing new staining techniques.
- Automated image analysis and international collaboration (e.g., PRO-MC) are promising avenues to address diagnostic challenges.
- Standardized approaches and collaborative efforts are crucial for improving the reliability and consistency of microscopic colitis diagnosis.