Gastrointestinal Pathology- Clinicopathologic Correlation in Mucosal Biopsy

Case #9 (question #13):

    A 30 year-old woman with chronic watery diarrhea. Colonoscopy showed normal appearing colon and terminal ileum. Representative images are illustrated below:

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Question No. 13. The Answer is: (C) Collagenous colitis.

Discussion: Collagenous colitis typically presents with a persistent watery diarrhea, frequently in middle-aged and older women with a normal colonoscopy. Microscopically, there is a thickened subepithelial collagen plate with a spiculated and irregular appearance that incorporates capillaries and inflammatory cells within the collagen.  The distribution may be diffuse or patchy.  Superficial lamina propria may be expanded by increased number of inflammatory cells. In addition, epithelial damage and intraepithelial lymphocytosis may be present.  Most cases respond to anti-inflammatory drugs.

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