Microscopic Colitis as a Diagnosis to Consider by Clinicians and Pathologists Together: A Case Series and Review of Literature

Abstract

Background: Microscopic colitis is a term used to define some clinical-pathological entities characterized by chronic watery diarrhea, normal radiological and endoscopic appearance, and microscopic abnormalities. Aim: In this article we report a personal case series of microscopic colitis in patients with different age and sex and symptomatic seriousness to better represent the heterogeneous clinical presentation of this type of disease, and a review of available literature data. Method: A definitive diagnosis of microscopic colitis is only possible by histological analysis. Specific histopathological findings, such as morphologically mild or moderate inflammation in the lamina propria, combined with either thickening of the sub-epithelial collagenous or lymphocytic attack on the surface epithelium, can be used to further classify these clinical entities as collagenous colitis (CC), lymphocytic colitis (LC), or other conditions. Result: We presented a review of the most recents studies about microscopic colitis and we presented a case serie of four lymphocitic colitis and one collagenous colitis in patients with different age and sex and symptomatic seriousness to better represent the heterogeneous clinical presentation of this type of disease, and we also performed a brief review of available literature data analyzing epidemiology, pathogenesis, clinical presentation and therapy strategies of these group of colitis. Discussion: Clinicians should be able to provide elements of clinical suspicion to pathologists that could justify more specific histological evaluation that includes the assessment of the number of intraepithelial cells (IEL), and the thickness of the band of tissue collagen.