Microscopic Colitis with Giant Cells: A Rare New Histopathologic Subtype?

Abstract

Collagenous and lymphocytic colitis might be part of the same disease spectrum. In this report, we present a histopathologic subtype of microscopic colitis characterized by the presence of subepithelial multinucleated giant cells. This reaction is very unusual and not explicable by any underlying disease process or previous treatment. Among 490 cases of microscopic colitis (MC) diagnosed between 1992 and 2002, we found 2 cases with macrophages and giant cells (0.4%). One case of lymphocytic colitis (LC) and 1 case of collagenous colitis (CC) presented aggregates of macrophages and giant cells located in the superficial part of the lamina propria. Infectious or non-infectious colonic granulomatous diseases were excluded on histologic, clinical, and biological grounds. The recognition of this feature in an MC is important to avoid the diagnosis of granulomatous infectious or idiopathic colitis such as Crohn's disease. Even if very unusual, this subtype of MC evolves favorably since the 2 patients responded well to corticosteroid treatment.

Diagnosis and management of microscopic colitis: current perspectives

“…They have an abnormal collagen layer − less than 10 μm − or an increased number of IELs: fewer than 20 per 100 epithelial cells. Uncommon variants are MC with giant cells,55,56 pseudomembranous CC,57 cryptal LC (increased IELs limited to cryptal epithelium),58 and MC with granulomatous inflammation 59. The clinical presentations of these conditions resemble classic MC, but histopathologic features are different.…”

Multinucleated stromal giant cells in colonic lamina propria

“…It is currently the belief that all cells in normal colorectal mucosa are mononucleated, although many types of multinucleated giant cells occur in the setting of various colorectal diseases 1–9 . Bizarre multinucleated stromal giant cells occur in the anus, 10–13 lower genital tract 10,14–24 and many other organs 10,25–34 .…”

Diagnosis and management of microscopic colitis

“…In addition to CC and LC, other rare subtypes of MC have been described including MC with giant cells [84,85] , paucicellular LC [86] , cryptal LC [87] , pseudomembranous CC [88] , MC with granulomatous inflammation [89] , and MC not otherwise specified [74] . The clinical features of these conditions are similar to those of classical MC, but histopathological appearance differs.…”