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Mikroskopische Kolitis

Histopathologische Übersicht mit klinisch-pathologischer Korrelation

Microscopic colitis

Histopathological review with a clinicopathological correlation

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Zusammenfassung

Die mikroskopische Kolitis ist eine klinisch-pathologische Entität, die neben der typischen Klinik mit wässrigen Diarrhöen eine charakteristische Histologie aufweist. Da die Koloskopie einen endoskopischen Normalbefund zeigt, ist die mikroskopische Kolitis eine Domäne der Histopathologie. Morphologisch werden lymphozytäre und kollagene Kolitis unterschieden. Die lymphozytäre Kolitis zeigt eine Vermehrung der intraepithelialen Lymphozyten auf >20 Lymphozyten pro 100 Deckepithelien, die kollagene Kolitis eine Verbreiterung des subepithelialen Kollagenbands auf mehr als 10 µm. Zur genauen Quantifizierung sind entsprechende Zusatzfärbungen hilfreich. Bei entsprechender Klinik ist die Entnahme von Stufenbiopsien – möglichst mit Lokalisationszuordnung – zu empfehlen, da die mikroskopische Kolitis Darmabschnitte aussparen kann und physiologisch die Lymphozytenanzahl in den verschiedenen Darmabschnitten variiert. Während die Verbreiterung des Kollagenbands als relativ spezifisch für die Diagnose einer kollagenen Kolitis gilt, findet sich eine Lymphozytose der Kolonschleimhaut auch im Rahmen anderer Erkrankungen. Für die korrekte Diagnosestellung ist hier die Korrelation des histomorphologischen Befunds mit der klinischen Symptomatik und dem Leitsymptom der wässrigen Diarrhö entscheidend.

Abstract

Microscopic colitis is a clinicopathological entity which, in addition to typical symptoms such as watery diarrhea, is characterized by its specific histopathology. Since colonoscopy yields normal findings, microscopic colitis belongs in a histological domain. The term encompasses two forms: lymphocytic and collagenous colitis. Histologically, lymphocytic colitis shows an increase in intraepithelial lymphocytes of more than 20 lymphocytes per 100 surface colonocytes, while collagenous colitis is characterized by a thickened subepithelial collagen layer of more than 10 µm. Specific stains help in the quantification of both. Since microscopic colitis does not always affect the entire colon and the number of intraepithelial lymphocytes varies physiologically, obtaining stepwise biopsies of the colon (with information on location where possible) is recommended. A thickened collagen layer is relatively specific for collagenous colitis, whereas intraepithelial lymphocytosis is also found in other diseases. Therefore, to make a correct diagnosis, it is important to correlate histological findings with clinical symptoms, including the main symptom of watery diarrhea.

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  1. Institut für Pathologie, Klinikum Aschaffenburg, Am Hasenkopf, 63739, Aschaffenburg, Deutschland

    C. Platz-Baudin, T. Katzenberger & M. Eck

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  1. C. Platz-Baudin
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  2. T. Katzenberger
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  3. M. Eck
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Correspondence to C. Platz-Baudin.

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Platz-Baudin, C., Katzenberger, T. & Eck, M. Mikroskopische Kolitis. Pathologe 32, 275–281 (2011). https://doi.org/10.1007/s00292-011-1432-4

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