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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 |