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Incidental Chronic Colitis

Definition

  • Isolated, asymptomatic changes of chronic colitis

Diagnostic Criteria

  • Incidental finding on endoscopic biopsy
    • Most commonly found during endoscopy for routine cancer screening
      • Also seen during endoscopy to rule out/identify gi bleeding sites
    • Endoscopic appearance may be normal, erythematous, congested or edematous
    • No associated gi disorders
  • Nearly always restricted to cecum/right colon
  • Changes of chronic active colitis are present
    • Crypt distortion and/or dropout
    • Basal plasmacytosis
      • Separates bases of crypts from muscularis mucosae (crypt shortening)
      • Inflammation may extend into muscularis mucosae
    • Acute inflammation present in most cases
    • No granulomas
    • May be histologically indistinguishable from Crohn disease or ulcerative colitis
  • May be caused by non-steroidal anti-inflammatory drugs (NSAIDs)
    • Frequently associated
    • Cases reported of resolution following NSAID withdrawal
    • NSAIDs are associatd with a variety of gi findings
      • Frequently symptomatic and may include extensive ulceration
      • This finding of isolated incidental chronic colitis is described by Deshpande
  • Reported in adults
    • Age range 46-80

    • Robert V Rouse MD
    Department of Pathology
    Stanford University School of Medicine
    Stanford CA 94305-5342

    Original posting / updates: 5/30/10

Differential Diagnosis

Incidental Chronic Colitis Acute Self-limited Colitis
Isolated disease, virtually restricted to cecum/right colon Usually multifocal or extensive
Histologic changes of chronic colitis present Changes of chronic colitis rare
Incidental, asymptomatic Nearly always symptomatic
 

 

Incidental Chronic Colitis Crohn Disease
Isolated disease Usually multifocal
Virtually restricted to cecum/right colon May involve entire GI tract
No granulomas Granulomas may be present
Incidental, asymptomatic Nearly always symptomatic
  • Histologically indistinguishable

 

Incidental Chronic Colitis Ulcerative Colitis
Virtually restricted to cecum/right colon Involves rectum with contiguous disease proximally in most cases
Incidental, asymptomatic Nearly always symptomatic
  • Histologically indistinguishable

 

Incidental Chronic Colitis Ischemic Colitis (Chronic)
Crypt distortion and dropout Predominantly hyalinization and fibrosis
Prominent basal plasmacytosis Inflammation not prominent
Virtually restricted to cecum/right colon Most common in splenic flexure
  • Acute ischemic colitis bears no resemblance to incidental chronic colitis

 

Incidental Chronic Colitis Lymphocytic Colitis
Crypt distortion and dropout No significant crypt distortion
Basal plasmacytosis Increase in lamina propria lymphocytes and plasma cells with intraepithelial lymphocytes
Isolated disease Usually multifocal
Virtually restricted to cecum/right colon May involve entire GI tract
Incidental, asymptomatic Intractable watery diarrhea in most cases

 

  • Incidental chronic colitis as defined here may be histologically indistinguishable from focal colitis associated with diverticular disease
    • Incidental colitis is virtually restricted to the cecum/right colon while diverticular disease is usually left sided

    Bibliography

  • Deshpande V, Hsu M, Kumarasinghe MP, Lauwers GY. The clinical significance of incidental chronic colitis: a study of 17 cases. Am J Surg Pathol. 2010 Apr;34(4):463-9.
  • Makapugay LM, Dean PJ. Diverticular disease-associated chronic colitis. Am J Surg Pathol. 1996 Jan;20(1):94-102.
  • Greenson JK, Stern RA, Carpenter SL, Barnett JL. The clinical significance of focal active colitis. Hum Pathol. 1997 Jun;28(6):729-33.
  • Püspök A, Kiener HP, Oberhuber G. Clinical, endoscopic, and histologic spectrum of nonsteroidal anti-inflammatory drug-induced lesions in the colon. Dis Colon Rectum. 2000 May;43(5):685-91.
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