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Lymphocytic colitis

 

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Terry Hamblin

Lymphocytic colitis is not a recognised complication of CLL. If you look it up on MedLine there are 1400 articles about it. It seems to have been renamed Microscopic Colitis recently. Here is a recent review:

"Microscopic colitis syndrome consists of chronic watery diarrhoea, a normal or near-normal gross appearance of the colonic mucosa, and a specific histologic picture described as either lymphocytic colitis or collagenous colitis. The cause of microscopic colitis is unknown, but recent work suggests some immunologic similarities to celiac disease, suggesting that luminal antigens may be important in its pathogenesis. Diarrhoea in microscopic colitis seems to be directly related to the extent of inflammation, suggesting that inflammatory mediators are responsible for reduced water absorption by the colon. Microscopic colitis is a frequent diagnosis in patients with chronic diarrhoea seen at referral centers. It is often associated with other immune-mediated conditions and frequently is complicated by faecal incontinence. The differential diagnosis is broad, comprising all causes of watery diarrhoea. Evaluation is straightforward with the key aspect being review of colon biopsy specimens by an experienced pathologist. Treatment is still being defined: symptomatic management with antidiarrheal agents, 5-aminosalicylate drugs, corticosteroids, especially budesonide, bile acid-binding resins, and bismuth subsalicylate all can be effective. The prognosis is good with no evidence of conversion to classic inflammatory bowel disease or of development of neoplasia over time." J Clin Gastroenterol. 2004 May-Jun;38(5 Suppl):S27-30.

However, in the context of CLL the diagniosis of lymphoid polyposis of the colon should be considered. 34 is awfully young to develop CLL, so the possibility of an atypical form should be considered. There is an atypical form of CLL that has the t(11;14) translocation. Doctors are divided on how to describe this. Some say that it is just an atypical CLL while others think it is a rather benign form of mantle cell lymphoma. The point is that this disease is characteristically complicated by lymphoid polyposis of the colon, which can be diagnosed by colonoscopy. It is just a thought - I have seen three patients who had this complication among about a thousand I have seen with CLL

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