Lymphocytic follicles and aggregates are a determinant of mucosal damage and duration of diarrhea

Nilesh Shah, Bhavin Thakkar, Emily Shen, Marie Loh, Pei Yi Chong, Wee Hoe Gan, Tian Ming Tu, Liang Shen, Richie Soong, Manuel Salto-Tellez

Research output: Contribution to journalArticlepeer-review

5 Citations (Scopus)

Abstract

Context

Nonspecific changes (nonspecific chronic inflammation) in patients with chronic diarrhea represent the commonest diagnosis in colorectal biopsy interpretation, but these changes are of little clinical significance.

Objective

To find, within this group, histologic and immunohistologic diagnostic criteria to predict the duration and resolution of diarrhea.

Design

Detailed clinical features and histologic findings were analyzed in a cohort of 47 patients with chronic diarrhea, with near-normal histology and no clear-cut known etiologic agent. Immunohistochemistry to mast cells (CD117) and Treg cells (FOXP3) was also assessed in 39 patients.

Results

Increased number of lymphoid follicles and aggregates, increased number of mast cells, and paucity of Treg were the statistically significant key findings (P  =  .003, P  =  .008, and P  =  .04, respectively). The duration of diarrhea was correlated with the number of large lymphoid follicles and aggregates (P  =  .001, r  =  .48), number of total lymphoid follicles and aggregates (P  =  .003, r  =  .43), density of lymphoid follicles and aggregates (P  =  .009, r  =  .38), and total lymphoid follicles and aggregates per biopsy (P  =  .004, r  =  .42) and the number of mast cells (P  =  .001, r  =  .52). The number of mast cells and Treg cells showed significant difference between resolved and unresolved cases (P  =  .001 and P  =  .01 respectively).

Conclusions

Lymphocytic follicles and aggregates colitis, previously regarded as of negligible diagnostic significance, allows the prediction of the behavior of chronic diarrhea in a subset of patients with nonspecific changes on colonic biopsy. The increased number of mast cells and paucity of Treg cells further helps to identify such unresolved cases.
Original languageEnglish
Pages (from-to)83-89
JournalArchives of pathology & laboratory medicine
Volume137
Issue number1
DOIs
Publication statusPublished - Jan 2013

Keywords

  • Forkhead Transcription Factors
  • Young Adult
  • Diarrhea
  • Proto-Oncogene Proteins c-kit
  • Humans
  • Immunity, Mucosal
  • Aged
  • Biopsy
  • Intestinal Mucosa
  • Inflammation
  • Lymphoid Tissue
  • Adult
  • Cohort Studies
  • Case-Control Studies
  • Middle Aged
  • Chronic Disease
  • Time Factors
  • Immunohistochemistry
  • Male
  • Female

ASJC Scopus subject areas

  • Pathology and Forensic Medicine
  • Medical Laboratory Technology

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