Colitis nucleomigrans: The third type of microscopic colitis (part 1)

Abstract

Microscopic colitis (MC), encompassing collagenous colitis and lymphocytic colitis, is featured by chronic diarrhea, normal-looking endoscopic findings and unique microscopic appearance. After reviewing biopsied nonspecific colitis, we propose the third type of MC: colitis nucleomigrans (CN). Histopathological criteria of CN included: (i) chained nuclear migration to the middle part of the surface-lining columnar epithelium; (ii) apoptotic nuclear debris scattered below the nuclei; and (iii) mild/moderate chronic inflammation in the lamina propria. Thirty-three patients (M:F = 20:13; median age 63 years, range 17-88) fulfilled our criteria. Seven cases demonstrated MC-like clinical/endoscopic features. Mucosal reddening with or without erosion/aphtha was endoscopically observed in the remaining 26 cases with inflammatory bowel disease (IBD)-like features: occult/gross hematochezia seen in 19, abdominal pain in two and mucin secretion in two. Cleaved caspase-3-immunoreactive apoptotic debris appeared more frequently in IBD-like CN than in MC-like CN, while CD8-positive intraepithelial lymphocytes comparably appeared in both. Proton pump inhibitors (PPIs) were administered in five (71%) cases with MC-like features, and in three diarrhea improved after drug cessation. In IBD-like CN cases, eight (31%) received PPIs. Four patients received chemotherapy against malignancies. Four patients associated immune-related disorders. Microscopic appearance of CN also appeared in a remission state of ulcerative colitis (12/20 lesions).

Colitis nucleomigrans: The third type of microscopic colitis (part 2). An ultrastructural study

“…Apoptotic nuclear debris in the diseased mucosa was more easily observed in the IBD-like type than in the MC-like type. 6 The present ultrastructural analysis was performed in order to confirm the light microscpic features of CN. Our purpose of study was achieved by analyzing two cases, we believe.…”

“…The chained nuclear migration to the middle part of the surface-lining columnar cells should be the unique event in CN. 6 It is hypothesized that abnormality of cytoskeletal proteins may impair localization of the nuclei that are normally anchored to the basal part of the columnar cells. Wang et al 13 analyzed the molecular basis for the regulation of apoptosis in the gastrointestinal epithelium and proposed cell biological mechanisms that couple changes in actin dynamics to apoptotic cell death.…”

“…Among 33 cases analyzed in the partner article (part 1), 6 two biopsy lesions from a 54‐year‐old male and a 70‐year‐old male were chosen for electron microscopic study. Both cases suffered from CN with inflammatory bowel disease (IBD)‐like symptoms.…”

“…4 Activation (cleavage) of endogenous endonucleases, particularly caspase-3, induces apoptotic cell death, through a process of DNA degradation to inter-nucleosomal fragments of a 180 base pair unit and multiples thereof. 5 In the preceding article (part 1), 6 we proposed the third type of microscopic colitis (MC), named colitis nucleomigrans (CN). We describe herein ultrastructural features of the CN by using endoscopic biopsy samples fixed in neutral-buffered 10% formalin and embedded in paraffin.…”

“…In the preceding article (part 1), 6 we proposed the third type of microscopic colitis (MC), named colitis nucleomigrans (CN). We describe herein ultrastructural features of the CN by using endoscopic biopsy samples fixed in neutral‐buffered 10% formalin and embedded in paraffin.…”