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Endoskopie heute 2013; 26(1): 62-65
DOI: 10.1055/s-0032-1330619
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© Georg Thieme Verlag KG Stuttgart · New York

Mikroskopische Kolitis – Anforderungen an die histopathologische Diagnostik

Microscopic Colitis – Demands on Histopathological Diagnostics
D. E. Aust
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Publication Date:
06 March 2013 (online)

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Zusammenfassung

Die mikroskopische Kolitis (MC) ist eine häufige Ursache chronischer, nicht blutiger Durchfälle. Sie zeigt eine in den letzten 10 Jahren deutlich steigende Inzidenz. Die Diagnose der MC stützt sich – neben den klassischen klinischen Symptomen – auf charakteristische histologische Veränderungen, mithilfe derer zwei Subtypen, die lymphozytäre (LC) und die kollagene Kolitis (CC), unterschieden werden können. Das Hauptcharakteristikum der LC ist die erhöhte Anzahl intraepithelialer Lymphozyten (IEL). In der Literatur werden > 20 IEL/100 Epithelien für die Diagnose einer LC gefordert. Bei den intraepithelialen Lymphozyten handelt es sich vornehmlich um zytotoxische Lymphozyten (CD8 +). Das Hauptkriterium der CC ist ein kontinuierliches subepitheliales Kollagenfaserband unterhalb des Oberflächenepithels (Breite > 10 µm); dieses Kollagenfaserband schließt klassischerweise Kapillaren, Erythrozyten und Entzündungszellen ein. Das Oberflächenepithel zeigt häufig regressive Veränderungen und hebt sich von der Basalmembran ab. Beide Formen der mikroskopischen Kolitis (LC und CC) zeigen einen vermehrten lymphoplasmazellulären Zellbesatz in der Lamina propria mucosae, auch eosinophile und neutrophile Granulozyten kommen vor. Diese histologischen Veränderungen sind jedoch uncharakteristisch und nicht allein ausreichend für die Diagnose einer mikroskopischen Kolitis, auch wenn das Infiltrat der Lamina propria möglicherweise für die klinischen Symptome verantwortlich ist. Der Begriff MCi (MC incomplete) wurde für eine Patientengruppe mit chronischer Diarrhö und einem vermehrten lymphoplasmazellulären Zellbesatz in der Lamina propria vorgeschlagen, die die Kriterien für eine LC (> 20 IEL/100 Epithelien) bzw. eine CC (> 10 µm Kollagenfaserband) nicht ganz erfüllt. Diese Kriterien sind jedoch insgesamt noch uneinheitlich und müssen in klinischen Studien überprüft werden.

Abstract

Microscopic colitis (MC) is recognized to be a common cause of chronic, non-bloody diarrhea with rising incidence in the last decade. The diagnosis can only be made by histology and the specific histological findings define the subtypes of MC, lymphocytic (LC) or collagenous colitis (CC). The key histological feature of LC is an increased number of surface intraepithelial lymphocytes (IEL). Usually > 20 IELs/100 epithelial cells are requested to warrant the diagnosis of LC. IELs are mostly cytotoxic CD8 + T-lymphocytes. The key histological criterion for CC is a continuous subepithelial fibrous band underneath the surface epithelium (> 10 µm). Other hallmarks of CC are chronic mucosal inflammation, the collagen band contains entrapped capillaries, red blood cells and inflammatory cells. Damaged epithelial cells appear flattened, mucin depleted and irregularly oriented. Focally, small strips of surface epithelium may lift off from their basement membrane. In both subtypes of MC, the lamina propria shows increased numbers of plasma cells and lymphocytes with loss of the normal gradient, even eosinophilic and neutrophilic granulocytes may be present. But these histological features alone do not warrant the diagnosis of MC even though they may be responsible for the clinical symptoms. The term MCi (MC incomplete) was suggested for a subgroup of patients with diarrhea and an increase in cellular infiltrate in the colonic lamina propria and either an abnormal collagenous layer and/or intraepithelial lymphocytes coming short of fulfilling the criteria for CC and LC.

Schlüsselwörter

mikroskopische Kolitis - lymphozytäre Kolitis - kollagene Kolitis - chronisch-entzündliche Darmerkrankungen

Key words

microscopic colitis - lymphocytic colitis - collagenous colitis - inflammatory bowel disease
 

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