Present address:Pathology Center, Shanghai General Hospital, Shanghai Jiaotong University School of Medicine, 200080, China; Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, 55902 USA.
Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, 55902 USA.
Hum Pathol. 2020 Feb;96:87-95. doi: 10.1016/j.humpath.2019.09.014. Epub 2019 Nov 5.
Patients with inflammatory bowel disease (IBD) may occasionally present with lymphocytic colitis/collagenous colitis (LC/CC) either before or after the onset of IBD. Although a few reports have described a small number of such cases, the relationship between these 2 disorders is still unclear. We evaluated 27 patients with diagnosis of either ulcerative colitis (UC) or Crohn disease (CD) and LC/CC. Clinical, endoscopic, and pathological features were reviewed. Ten patients with initial diagnoses of LC (n = 2)/CC (n = 8) evolved into UC (n = 7) or CD (n = 3) after a median interval of 14 months (range, 2-44 months). Among these, 4 patients with LC/CC evolving into IBD also had recurrent CC in a quiescent phase of IBD. Seventeen patients with initial diagnosis of UC (n = 11) or CD (n = 6) developed LC (n = 6)/CC (n = 11) after a median interval of 108 months (range, 15-548 months). IBD patients with initial presentation of LC/CC were significantly older than those who developed LC/CC after onset of IBD (66.5 versus 34.0 years old, P = .001). The interval time between LC/CC to IBD was significantly shorter than that of IBD to LC/CC (14 versus 108 months, P = .007). Quiescent UC with superimposed CC was the most common pattern (n = 8). Patients with CD had shorter interval time to develop LC/CC than UC patients, although it was not statistically significant (60.5 versus 139 months, P = .14). Endoscopically, most patients that started with LC/CC had unremarkable findings, but 11 of 17 patients who developed LC/CC after IBD showed quiescent chronic colitis. Histologically, LC/CC patients with diagnosis of IBD, either before or after, more frequently show active inflammation. Chronicity was more commonly seen in biopsy of LC/CC patients with a history of IBD. Our study found that IBD patients with initial presentation of LC/CC tend to occur in older age, with shorter interval time and frequent active inflammation in initial LC/CC. These findings suggest that LC/CC may be a spectrum of IBD as the initial presentation in a subset of older IBD patients. On the other hand, IBD patients can develop LC/CC associated with chronic mucosal injury many years after the onset of IBD (typically with >10 years interval time while patients are in remission phase), for which these 2 processes seem unrelated to each other.
炎症性肠病（IBD）患者在 IBD 发病前或后偶尔会出现淋巴细胞性结肠炎/胶原性结肠炎（LC/CC）。尽管有少数报道描述了少数此类病例，但这两种疾病之间的关系仍不清楚。我们评估了 27 例溃疡性结肠炎（UC）或克罗恩病（CD）和 LC/CC 的诊断患者。回顾了临床、内镜和病理特征。10 例最初诊断为 LC（n=2）/CC（n=8）的患者在中位间隔 14 个月（范围 2-44 个月）后发展为 UC（n=7）或 CD（n=3）。其中，4 例 LC/CC 发展为 IBD 的患者在 IBD 缓解期也出现复发性 CC。17 例最初诊断为 UC（n=11）或 CD（n=6）的患者在中位间隔 108 个月（范围 15-548 个月）后发展为 LC（n=6）/CC（n=11）。最初表现为 LC/CC 的 IBD 患者明显比那些在 IBD 发病后出现 LC/CC 的患者年龄更大（66.5 岁比 34.0 岁，P=0.001）。LC/CC 到 IBD 的间隔时间明显短于 IBD 到 LC/CC 的间隔时间（14 个月比 108 个月，P=0.007）。合并 CC 的缓解性 UC 是最常见的模式（n=8）。CD 患者发展为 LC/CC 的间隔时间短于 UC 患者，但无统计学意义（60.5 个月比 139 个月，P=0.14）。内镜下，大多数最初表现为 LC/CC 的患者无明显发现，但 17 例中 11 例在 IBD 后发展为 LC/CC 的患者表现为缓解性慢性结肠炎。组织学上，无论是在 IBD 发病前还是发病后，LC/CC 患者的诊断均显示更频繁的活跃炎症。在有 IBD 病史的 LC/CC 患者的活检中，更常见慢性。我们的研究发现，最初表现为 LC/CC 的 IBD 患者年龄较大，LC/CC 的间隔时间较短，初始 LC/CC 时炎症活跃更常见。这些发现表明 LC/CC 可能是 IBD 的一种表现，是一组老年 IBD 患者的首发表现。另一方面，IBD 患者在 IBD 发病多年后（通常间隔时间>10 年，且患者处于缓解期）可出现与慢性黏膜损伤相关的 LC/CC，这两种过程似乎彼此无关。
