pathology report - thoughts?
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I can see why you'd want to postpone your doc appointment till the pathology update... and I think it's great this assistant in the pathology dep't is trying to help you get what you need. So - YES - confusing, but maybe glimmers of optimism... hope the pace picks up on your path to health and remission.
--S
--S
So here is the addendum from the pathologist. Not so helpful and no numbers:
"On immunochistochemistry analysis of block "B" the lamina propia lymphocytic infiltrate is predominantly composed of CD3 positive T-cells with very few CD20 positive B cells and scattered CD117 positive mast cells. No significant increase in intraepithial lymphocytes is identified. Attempt at CD8 staining is unsatisfactory due to absence of tissue on the slide. In summary, the above results fail to offer any diagnostic evidence of lymphocytic or mast cell colitis. All positive controls, including internal controls, showed appropriate immunoreactivity."
I don't think I am going to get any more from him since he failed to answer my emailed questions.
Lisa
"On immunochistochemistry analysis of block "B" the lamina propia lymphocytic infiltrate is predominantly composed of CD3 positive T-cells with very few CD20 positive B cells and scattered CD117 positive mast cells. No significant increase in intraepithial lymphocytes is identified. Attempt at CD8 staining is unsatisfactory due to absence of tissue on the slide. In summary, the above results fail to offer any diagnostic evidence of lymphocytic or mast cell colitis. All positive controls, including internal controls, showed appropriate immunoreactivity."
I don't think I am going to get any more from him since he failed to answer my emailed questions.
Lisa
Lisa,
Those "CD" designations are simply codes that refer to the use of various stains used to make lymphocytes more easily visible under the microscope. In immunology, the CD3 T-Cell Co-Receptor, (CD stands for cluster of differentiation), is a protein complex, composed of four distinct chains, the details of which are irrelevant to this discussion. The relevant point is that CD3 is required for T cell activation.
In normal subjects, 80–90% of colonic and ileal intraepithelial lymphocytes are T cells. Research shows that colonic intraepithelial lymphocytes in lymphocytic and collagenous colitis are CD3+, (IOW, CD3 positive), and CD8+ T cells. That implies that this notation in the report from your pathologist, is a bit disappointing:
Incidentally, an increase of intraepithelial CD8+ T cells has been described in coeliac disease, also.
His notation:
As I mentioned in my initial response to your original post in this thread, you probably have a lymphocyte between the normal level, and the level indicated for a diagnosis of LC, so unless the pathologist is aware of paucicellular LC, you are not going to get a diagnosis of anything from him.
Tex
Those "CD" designations are simply codes that refer to the use of various stains used to make lymphocytes more easily visible under the microscope. In immunology, the CD3 T-Cell Co-Receptor, (CD stands for cluster of differentiation), is a protein complex, composed of four distinct chains, the details of which are irrelevant to this discussion. The relevant point is that CD3 is required for T cell activation.
In normal subjects, 80–90% of colonic and ileal intraepithelial lymphocytes are T cells. Research shows that colonic intraepithelial lymphocytes in lymphocytic and collagenous colitis are CD3+, (IOW, CD3 positive), and CD8+ T cells. That implies that this notation in the report from your pathologist, is a bit disappointing:
That implies that CD8+ T cells could be present, but he was unable to assess that possibility, because the slide was apparently initially improperly prepared. Hmmmmmm. That suggests that the first pathologist didn't go about it correctly.Attempt at CD8 staining is unsatisfactory due to absence of tissue on the slide.
Incidentally, an increase of intraepithelial CD8+ T cells has been described in coeliac disease, also.
His notation:
suggests the possibility of slightly increased mast cell activity, but not enough to confirm mastocytic enterocolitis, obviously. That doesn't mean that you cannot have mast cell problems associated with MC, however.scattered CD117 positive mast cells
As I mentioned in my initial response to your original post in this thread, you probably have a lymphocyte between the normal level, and the level indicated for a diagnosis of LC, so unless the pathologist is aware of paucicellular LC, you are not going to get a diagnosis of anything from him.
Tex
It is suspected that some of the hardest material known to science can be found in the skulls of GI specialists who insist that diet has nothing to do with the treatment of microscopic colitis.
I'm not aware of any official way to do it. It's the pathologist's job to make the diagnosis, and if a pathologist is not familiar with a disease, they can't diagnose it. 
You can't force a doctor to give a diagnosis that he or she doesn't agree with. If you want to pursue it, you may have to go to a gastroenterologist at a leading teaching hospital, where they're more likely to stay up with latest research results.
I wish I knew of a better way to go about this, but when you're dealing with an uncommon version of a disease that very few doctors are comfortable about dealing with in the first place, misdiagnoses and errors of judgment are probably going to be common, and finding someone who truly understands the disease can be like searching for a needle in a haystack. Most people consider pathologists to be 100% reliable, but the sad truth is, mistakes are very common, due to inadequate, or out-of-date training, especially in the case of diseases that are poorly understood, such as MC.
Tex
You can't force a doctor to give a diagnosis that he or she doesn't agree with. If you want to pursue it, you may have to go to a gastroenterologist at a leading teaching hospital, where they're more likely to stay up with latest research results.
I wish I knew of a better way to go about this, but when you're dealing with an uncommon version of a disease that very few doctors are comfortable about dealing with in the first place, misdiagnoses and errors of judgment are probably going to be common, and finding someone who truly understands the disease can be like searching for a needle in a haystack. Most people consider pathologists to be 100% reliable, but the sad truth is, mistakes are very common, due to inadequate, or out-of-date training, especially in the case of diseases that are poorly understood, such as MC.
Tex
It is suspected that some of the hardest material known to science can be found in the skulls of GI specialists who insist that diet has nothing to do with the treatment of microscopic colitis.