Surgical Pathology Criteria

Collagenous Colitis

Differential Diagnosis

Artifacts
Tangential Sectioning Collagenous Colitis
Present only where adjacent crypts cut as cross-sections Present even when adjacent crypts are cut longitudinally
Indistinct edges but no entrapped elements Jagged edges with entrapped capillaries and inflammatory cells
Lacks chronic inflammatory infiltrate Prominent chronic inflammatory infiltrate in lamina propria
Systemic Sclerosis Collagenous Colitis
Fibrosis surrounds crypts Collagen restricted to apical zone
Fibrosis may extend into muscularis mucosae through to the serosa Collagen restricted to sub-basement membrane region

Amyloid Collagenous Colitis
Perivascular distribution usually present Restricted to sub-basement membrane zone
Congo red positive Congo red negative
Trichrome variable Trichrome stains blue

Ischemic Colitis and Radiation Damage Collagenous Colitis
Fibrosis surrounds crypts Collagen restricted to apical zone
Crypt distortion frequent Crypt distortion generally not presenet

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